Background: First-line therapy of Cushing disease (CD) is transsphenoidal surgery (TSS) aimed to obtain a complete removal of the pituitary adenoma and remission of disease. Purpose: To analyse the surgical outcome of patients with CD who underwent TSS in our Centre. Methods: Retrospective analysis on patients with CD who underwent TSS between 1990 and 2016. Results: We analysed 102 TSS that included: 84 first TSS and 18 second and third TSS. The overall remission rate after surgery was 76.5%, with a significant higher percentage of remitted patients after the first TSS compared to the subsequent TSS (82% vs 50%, p = 0.014). The remission after the first TSS was significantly higher when performed by a dedicated surgical team (DST) (89.8% vs 71% p = 0.04) and when the immunohistochemical examination confirmed the adrenocorticotropic adenoma (87% vs 55%, p = 0.04). Neuroradiological findings influenced the surgical outcome in a non-significant manner. Post-TSS complications were reported in 32 patients, with no significant variation when TSS was performed by DST. In case of reintervention, remission of disease was obtained in 72.7% of microadenoma, while no remitted patients were observed in case of macroadenomas. The DST did not significantly improve the outcome. Conclusion: Cushing disease is characterized by a broad spectrum of neuroradiological presentation. Despite the availability of a DST make the TSS a safe and effective first-line treatment among all these patients, a precise pre-treatment evaluation is needed in order to define the aim of neurosurgery and to schedule the management of recurrent disease.

Determinants of outcome of transsphenoidal surgery for Cushing disease in a single-centre series / Serban, A. L.; Del Sindaco, G.; Sala, E.; Carosi, G.; Indirli, R.; Rodari, G.; Giavoli, C.; Locatelli, M.; Carrabba, G.; Bertani, G.; Marfia, G.; Mantovani, G.; Arosio, M.; Ferrante, E.. - In: JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION. - ISSN 0391-4097. - (2019). [10.1007/s40618-019-01151-1]

Determinants of outcome of transsphenoidal surgery for Cushing disease in a single-centre series

Serban A. L.
Writing – Original Draft Preparation
;
Carosi G.;
2019

Abstract

Background: First-line therapy of Cushing disease (CD) is transsphenoidal surgery (TSS) aimed to obtain a complete removal of the pituitary adenoma and remission of disease. Purpose: To analyse the surgical outcome of patients with CD who underwent TSS in our Centre. Methods: Retrospective analysis on patients with CD who underwent TSS between 1990 and 2016. Results: We analysed 102 TSS that included: 84 first TSS and 18 second and third TSS. The overall remission rate after surgery was 76.5%, with a significant higher percentage of remitted patients after the first TSS compared to the subsequent TSS (82% vs 50%, p = 0.014). The remission after the first TSS was significantly higher when performed by a dedicated surgical team (DST) (89.8% vs 71% p = 0.04) and when the immunohistochemical examination confirmed the adrenocorticotropic adenoma (87% vs 55%, p = 0.04). Neuroradiological findings influenced the surgical outcome in a non-significant manner. Post-TSS complications were reported in 32 patients, with no significant variation when TSS was performed by DST. In case of reintervention, remission of disease was obtained in 72.7% of microadenoma, while no remitted patients were observed in case of macroadenomas. The DST did not significantly improve the outcome. Conclusion: Cushing disease is characterized by a broad spectrum of neuroradiological presentation. Despite the availability of a DST make the TSS a safe and effective first-line treatment among all these patients, a precise pre-treatment evaluation is needed in order to define the aim of neurosurgery and to schedule the management of recurrent disease.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11573/1350976
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