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Persistent and recurrent hypercortisolism after transsphenoidal surgery for Cushing's disease
1Neurochirurgische Abteilung, Universitätskrankenhaus Eppendorf, Hamburg, Federal Republic of Germany.
Acta Neurochirurgica. Supplement
|January 1, 1996
Summary
Transsphenoidal reoperation is recommended for persistent or recurrent Cushing's disease, even without visible MRI evidence. Reoperation offers a high success rate for managing treatment failures after initial pituitary surgery.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Cushing's disease management presents challenges with persistent hypercortisolism or recurrence post-transnasal surgery.
- Identifying ACTH-producing pituitary adenomas is crucial for treatment success.
Purpose of the Study:
- To analyze therapeutic failures in Cushing's disease following primary transsphenoidal microsurgery.
- To evaluate management strategies for persistent and recurrent hypercortisolism.
Main Methods:
- Retrospective analysis of 310 patients undergoing primary transsphenoidal microsurgery for Cushing's disease.
- Evaluation of reoperation outcomes for persistent and recurrent hypercortisolism.
- Assessment of radiation therapy and bilateral adrenalectomy as salvage options.
Main Results:
- A 92.6% adenoma detection rate was observed in the primary surgery cohort.
- Initial remission rates were 92.0% for patients with detected adenomas and 85.2% overall.
- Reoperation for recurrent disease achieved a 70.8% remission rate, while early reoperation for persistent disease yielded 56.3% remission.
Conclusions:
- Transsphenoidal reoperation is a viable option for recurrent Cushing's disease, even with negative MRI findings.
- Early reoperation can be effective for persistent hypercortisolism.
- Radiation therapy and bilateral adrenalectomy serve as secondary treatment options when reoperation fails.