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Pituitary function after selective adenomectomy for Cushing's disease
F A Post1, S G Soule, J C De Villiers
1Department of Medicine, University of Cape Town, Observatory, South Africa.
British Journal of Neurosurgery
|January 1, 1995
Summary
Selective adenomectomy for Cushing's disease offers good cure rates with minimal pituitary dysfunction. However, this conservative approach may lead to a higher recurrence rate of the disease.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Cushing's disease, a rare endocrine disorder, results from excess cortisol production, often due to a pituitary adenoma.
- Transsphenoidal selective adenomectomy is a primary treatment, but its efficacy and impact on pituitary function require ongoing evaluation.
Purpose of the Study:
- To assess the cure rates of selective adenomectomy for Cushing's disease.
- To evaluate the incidence of pituitary dysfunction following the procedure.
- To analyze tumor characteristics and long-term outcomes, including recurrence.
Main Methods:
- Retrospective analysis of 34 patients (26 female, 8 male; mean age 33.6 years) who underwent transsphenoidal selective adenomectomy between 1975 and 1992.
- Evaluation of tumor size, histology, and pre- and post-operative pituitary function.
- Follow-up averaged 5.8 years, with cure defined by symptom resolution and normalized urinary cortisol.
Main Results:
- Sixty-three percent of patients achieved initial cure; an additional four were cured by repeat adenomectomy.
- Postoperative pituitary function remained intact in 81% of patients.
- Rates of secondary hypogonadism (8%), hypothyroidism (15%), and permanent diabetes insipidus (4%) were observed. Recurrence occurred in 26% after a mean of 4.6 years.
Conclusions:
- Selective adenomectomy provides acceptable cure rates for Cushing's disease.
- The procedure is associated with a low prevalence of postoperative hypopituitarism.
- Conservative surgical approaches may increase the risk of disease recurrence.