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Transsphenoidal microsurgery for Cushing's disease
Abstract:
Nineteen patients thought to have Cushing's disease were treated by transsphenoidal microsurgery; the type of operation performed depended upon the findings in the individual patient. Seventeen patients remitted. Failures occurred in a patient with an invasive macroadenoma and in a patient who was subsequently found to have a thymic carcinoid tumour secreting ACTH. One patient who remitted suffered a recurrence during pregnancy, 30 months after operation. The ten patients (Group I) who had a selective removal of a microadenoma or a limited resection of the gland were often GH deficient, but seven regained cortisol reserve and all ten regained normal pituitary-thyroid and pituitary-gonadal responses. By contrast abnormalities of pituitary function were common in nine patients who had a radical or total hypophysectomy. We conclude that transsphenoidal microsurgery is the best treatment for Cushing's disease and that, when feasible, a selective microadenomectomy is the most appropriate operation.
Insights
Transsphenoidal microsurgery effectively treats Cushing's disease, with selective microadenomectomy being the preferred surgical approach. This pituitary surgery offers high remission rates and preserves normal pituitary function.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Cushing's disease is a serious endocrine disorder caused by excess cortisol.
- Transsphenoidal microsurgery is a primary treatment modality for Cushing's disease.
Purpose of the Study:
- To evaluate the efficacy and outcomes of transsphenoidal microsurgery for Cushing's disease.
- To compare the results of selective microadenomectomy versus radical hypophysectomy.
Main Methods:
- Nineteen patients with Cushing's disease underwent transsphenoidal microsurgery.
- Surgical approach was tailored to individual patient findings.
- Patients were monitored for remission, pituitary function, and recurrence.
Main Results:
- Seventeen out of nineteen patients achieved remission.
- Selective microadenomectomy preserved pituitary function in most cases.
- Radical hypophysectomy was associated with more pituitary function abnormalities.
Conclusions:
- Transsphenoidal microsurgery is the optimal treatment for Cushing's disease.
- Selective microadenomectomy is the most appropriate surgical option when feasible.
- Surgical approach impacts long-term pituitary function and disease remission.