[Indications for total hypophysectomy in Cushing's disease].
OBJECTIVE
Transsphenoidal selective adenomectomy is the treatment of choice for Cushing's disease. In some patients, magnetic resonance imaging (MRI) fails to detect small pituitary ACTH-secreting adenomas. Total hypophysectomy can be performed when MRI appears normal. The aim of this paper is to study results and complications after total hypophysectomy for Cushing's disease.


METHODS
Between July 1988 and May 1999, 49 patients underwent transsphenoidal surgery for Cushing's disease at our institution. The criteria for inclusion in this study were clinical and biochemical studies strongly suggestive of Cushing's disease with normal MRI. Total hypophysectomy was performed in 7 patients who fulfilled these criteria. Their results were analyzed retrospectively.


RESULTS
The average age of the patients was 43 years; there were 7 women. Five adrenocorticotrophic hormone-secreting adenomas were proven histologically. Complications occurred in 6 patients (cerebrospinal fluid fistulas in 6 patients, loss of vision in 1 patient, meningitis in 5 patients, anterior pituitary insufficiency in 5 patients, diabetes insipidus in 5 patients). Six patients had sustained remission 36 months after surgery.


CONCLUSIONS
Total hypophysectomy can be perform ed for Cushing's disease with normal MRI. Complications occurs frequently, especially cerebrospinal fluid fistulas. Inferior petrosal sinus sampling can be helpful in localizing the adenoma allowing hemihypophysectomy and thus reduced morbidity.
Jan
M
M
Service de Neurochirurgie, CHU Bretonneau, 37044 Tours Cedex 1, France. micheljan@med.univ-tours.fr
François
P
P
Trouillas
J
J
Hage
P
P
D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000378:metabolism; D000328:Adult; D003480:Cushing Syndrome / Q000209:etiology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007016:Hypophysectomy / Q000379:methods / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging; D008297:Male; D017591:Petrosal Sinus Sampling; D010911:Pituitary Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000324:Adrenocorticotropic Hormone
Place de l'antéhypophysectomie totale dans le traitement de la maladie de Cushing.