Surgical treatment and follow-up results of pituitary ACTH microadenoma: 18 years' experience.
OBJECTIVE
To review retrospectively our clinical experience with surgical treatment and follow-up of pituitary adrenocorticotropic hormone (ACTH) microadenomas at Rui Jin Hospital of Shanghai Second Medical University.


METHODS
Eighty-seven patients with ACTH microadenomas underwent surgery via the transsphenoidal approach. Preoperative computed tomography and/or magnetic resonance imaging revealed microadenomas in only 46 patients and was negative in the remaining 41 patients, which were classified as microadenoma grade 0. High-dose dexamethasone (Dx) suppression testing was positive in 86% of patients and low-dose Dx suppression testing was negative in all patients.


RESULTS
Histological confirmation of ACTH microadenoma was made in all 87 cases, with a minimum tumour size of only 1 to 2 mm in diameter. The remission rate was 82% for grade I and 92% for grade 0 microadenomas during 2 to 18 years of follow-up.


CONCLUSIONS
Neuroimaging studies have limited value in diagnosing ACTH grade 0 microadenoma. Clinical manifestation combined with positive Dx suppression testing is decisive in these circumstances. Surgical intervention could achieve a high relief rate for ACTH microadenomas, especially in grade 0 group.
Zhao
Weiguo
W
Department of Neurosurgery, Rui Jin Hospital of Shanghai Second Medical University, Shanghai, People's Republic of China. rjneurosurgery@yahoo.com.cn
Zhan
Shikuen
S
Cai
Yu
Y
Shen
Jiankang
J
Zhang
Tianxi
T
D000236:Adenoma / Q000378:metabolism / Q000601:surgery*; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000601:surgery*; D016896:Treatment Outcome
D000324:Adrenocorticotropic Hormone