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Transsphenoidal Surgery for Cushing Disease: Experience With 136 Patients

Ciric, Ivan MD*; Zhao, Jin-Cheng MD, PhD*; Du, Hongyan MS; Findling, James W. MD§; Molitch, Mark E. MD; Weiss, Roy E. MD, PhD; Refetoff, Samuel MD; Kerr, William D. MD*; Meyer, Joel MD*

Neurosurgery:
doi: 10.1227/NEU.0b013e31822dda2c
Research-Human-Clinical Studies
Abstract

BACKGROUND: This is a retrospective study of 136 patients with Cushing disease treated with transsphenoidal microsurgery.

OBJECTIVE: To evaluate factors influencing immediate postoperative results and long-term outcomes.

METHODS: Data regarding clinical presentation, endocrine evaluation, imaging studies, surgical technique, immediate postoperative biochemical remission (IPBR), and long-term results were entered into a database and analyzed statistically. IPBR was based on biochemical evidence of adrenal cortical insufficiency and clinical evidence of such insufficiency.

RESULTS: IPBR for the entire series was 83.4%. In microadenomas, IPBR was 89.8% with a mean immediate postoperative plasma cortisol (IPPC) of 2.1 μg/dL (range, <0.5-5.3). Positive magnetic resonance imaging (MRI) was associated with 18 times greater odds of finding microadenoma at surgery (P < .001) and with 4.1 times greater odds of IPBR (P = .07). In patients with a negative MRI, a positive inferior petrosal sinus sampling (IPSS) test was associated with 93% of IPBR (P = .004). IPBR in macroadenomas was 30.7%. Of patients followed for 12 months or longer, 34.8% required glucocorticoid replacement for the duration of follow-up. The mean follow-up in microadenomas was 68.4 months with a 9.67% incidence of recurrences. The estimated actuarial incidence of recurrences increased with the passage of time and IPPC of greater than 2 μg/dL was associated with higher incidence of recurrences, although without statistical significance (P = .08).

CONCLUSION: In microadenomas, a positive MRI and positive IPSS test were associated with a higher incidence of IPBR. Recurrences increased with the passage of time, and an IPPC of greater than 2 μg/dL may be associated with higher incidence of recurrences.

Author Information

*NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, Evanston, Illinois

Center for Clinical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois

§Medical College of Wisconsin, Milwaukee, Wisconsin

Northwestern University, Feinberg School of Medicine, Chicago, Illinois

University of Chicago, Pritzker School of Medicine, Chicago, Illinois

Correspondence: Ivan Ciric, MD, NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, 2650 Ridge Ave., Evanston, IL 60201. E-mail: iciric@northshore.org

Received October 28, 2010

Accepted May 4, 2011

Copyright © by the Congress of Neurological Surgeons