Long-term mortality after transsphenoidal surgery for Cushing disease.
BACKGROUND
Untreated Cushing disease historically has a high mortality rate, but the long-term survival of patients with Cushing disease after transsphenoidal surgery has not been reported.


OBJECTIVE
To determine long-term mortality rate in patients who are treated for Cushing disease with current management techniques.


METHODS
Retrospective case series.


METHODS
Tertiary care center.


METHODS
161 patients (32 men and 129 women; mean age, 38 years) who were treated for Cushing disease between 1978 and 1996.


METHODS
Transsphenoidal adenomectomy and as-needed adjunctive therapy.


METHODS
Record review with follow-up interview.


RESULTS
The cure rate for patients with microadenomas who had no previous therapy was 90% (123 of 137). No perioperative deaths occurred (0 of 193 procedures [95% CI, 0.0% to 1.9%]). Follow-up data (mean, 8.7 years) were obtained for 99% of patients (159 of 161). Six patients died. The 5- and 10-year survival rates were 99% (CI, 97% to 100%) and 93% (CI, 88% to 99%), respectively. Survival was similar to that seen in an age- and sex-matched sample that was based on U.S. population data (standardized mortality ratio, 0.98 [CI, 0.44 to 2.2]; P > 0.2).


CONCLUSIONS
Survival of patients treated for Cushing disease with current management techniques between 1978 and 1996 was better than the poor survival historically associated with this disorder.
Swearingen
B
B
Neurosurgical Service, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
Biller
B M
BM
Barker
F G
FG
Katznelson
L
L
Grinspoon
S
S
Klibanski
A
A
Zervas
N T
NT
D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D000328:Adult; D000368:Aged; D002648:Child; D003480:Cushing Syndrome / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013223:Statistics as Topic; D015996:Survival Rate; D013997:Time Factors
D006854:Hydrocortisone