title: Surgical treatment and follow-up results of pituitary ACTH microadenoma: 18 years' experience.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Rui Jin Hospital of Shanghai Second Medical University, Shanghai, People's Republic of China. rjneurosurgery@yahoo.com.cn
authors.forename: Weiguo
authors.initials: W
authors.lastname: Zhao
authors.forename: Shikuen
authors.initials: S
authors.lastname: Zhan
authors.forename: Yu
authors.initials: Y
authors.lastname: Cai
authors.forename: Jiankang
authors.initials: J
authors.lastname: Shen
authors.forename: Tianxi
authors.initials: T
authors.lastname: Zhang
mesh_terms: 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
chemical_list: D000324:Adrenocorticotropic Hormone