[Cushing's disease and corticotrophic adenoma: results of pituitary microsurgery].
Between November 1994 and June 2001, 194 patients with Cushing's disease underwent transsphenoidal surgery: 167 patients had adenomectomy, 14 had ante hypophysectomy, 5 had subtotal hypophysectomy, 4 had hemihypophysectomy 4 had central hypophysectomy. Complications occurred in 18 patients (9.3%), including 4 deaths (three were apparently not related to surgery). Remission of disease was achieved in 162 of 190 (85.3%) patients analyzed. Surgical failures were associated with lack of pituitary adenoma, size of the tumor and invasiveness. Among patients with confirmed adenomas, the rate of remission was significantly higher (p<0.01) in patients with microadenomas (92.6%) than in patients with macroadenomas (66.7%). Reoperation in 6 failures was followed by remission in 4 cases. The overall remission rate was 87.4%. In the 162 patients with immediate success, duration of follow-up was 10.0 +/- 5.9 years (m +/- DS; median=10.0). Recurrence of the disease occurred in 24 (14.8%) of 162 patients at a mean 4.8 years (range: 0.8-12.0 years). Our longest sustained remission is 25.6 years. Actuarial analysis indicates that the probability of a patient remaining well 12 years after surgery is 80.0%. It is 86.2% in microadenomas versus 52.5% in macroadenomas and 94.5% in the patients with postoperative hypocortisolism versus 59.2% in the others.
Stévenaert
A
A
Service de Neurochirurgie, Centre Hospitalier Universitaire, Liege, France. A.Stevenaert@ulg.ac.be
Perrin
G
G
Martin
D
D
Beckers
A
A
D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000601:surgery; D000315:Adrenalectomy; D002426:Cavernous Sinus; D002828:Choristoma / Q000150:complications / Q000175:diagnosis; D003131:Combined Modality Therapy; D003480:Cushing Syndrome / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007016:Hypophysectomy / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008866:Microsurgery / Q000401:mortality; D009364:Neoplasm Recurrence, Local; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology / Q000601:surgery; D010910:Pituitary Irradiation; D010911:Pituitary Neoplasms / Q000150:complications / Q000378:metabolism / Q000532:radiotherapy / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012074:Remission Induction; D012189:Retrospective Studies
Maladie de Cushing et adenome corticotrope: resultats de la microchirurgie hypophysaire.