[Cushing's disease: successful surgery through improved preoperative tumor localization]

Area of Science:

• Endocrinology
• Neurosurgery
• Medical Imaging

Background:

• Cushing's disease is caused by a corticotrophin-secreting microadenoma.
• Transsphenoidal surgery is a primary treatment, but outcomes depend on accurate tumor localization.
• Advancements in imaging techniques may improve surgical success rates.

Purpose of the Study:

• To evaluate the impact of enhanced preoperative tumor localization on transsphenoidal surgery outcomes for Cushing's disease.
• To assess the correlation between improved localization accuracy and surgical success, cure rates, and complications.

Main Methods:

• Retrospective study of 61 patients with Cushing's disease due to microadenomas.
• Analysis of preoperative localization methods: computed tomography (CT), Magnetic Resonance Imaging (MRI), and Bilateral Simultaneous Inferior Petrosal Sinus Sampling (BSIPSS).
• Defined surgical success as morning serum cortisol < 500 nmol/l and cure as morning serum cortisol < 140 nmol/l or 24-hr cortisoluria < 250 nmol.

Main Results:

• Preoperative localization rates improved from 36% (1985-1988) to 96% (1992-1995).
• Surgical cure rates increased significantly from 18% to 71% over the study period.
• Postoperative hypopituitarism and disease recurrence rates remained low (<10% and 1-2 respectively).

Conclusions:

• Improved preoperative localization of pituitary microadenomas is associated with higher success and cure rates in transsphenoidal surgery for Cushing's disease.
• Enhanced imaging techniques improve surgical outcomes without increasing the incidence of hypopituitarism or recurrence.