[Analysis of early prognostic factors for risk of treatment failure in Cushing's disease treated by trans-sphenoidal pituitary surgery].
OBJECTIVE
We performed an analysis of early factors influencing the outcome of Cushing's disease treated by transsphenoidal pituitary surgery.


METHODS
Prospective study of 29 patients who underwent transsphenoidal pituitary surgery for Cushing's disease. The prognostic value of preoperative and operative variables, histological findings and serum cortisol (measured at 8:00 a.m. the day after surgery) were analyzed.


RESULTS
Of the 29 patients included in this study, 26 achieved postoperative remission while in 3 patients treatment failed. Tumor was identified at histology in 92.3% patients in the remission group and in 33.3% in the failure group, this difference being significant (p = 0.03). Median postoperative cortisol levels were 95.8 nmol/l in the remission group and 676 nmol/l in the failure group, this difference being significant (p = 0.024). Serum cortisol of 600 nmol/l correctly classified the remission and failure groups with a sensitivity of 100% and a specificity of 96%.


CONCLUSIONS
In our experience, no identification of an adenoma at histology and an early postoperative cortisol level higher than 600 nmol/l after transsphenoidal pituitary surgery for Cushing's disease was associated with a high risk of failed treatment.
Martino
Juan
J
Departamento de Neurocirugía, Hospital Universitario de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. 37055jmg@comb.es
Acebes
Juan José
JJ
Montanya
Eduard
E
Masuet
Cristina
C
Brell
Marta
M
D000236:Adenoma / Q000097:blood / Q000150:complications / Q000601:surgery*; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000652:urine; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000652:urine; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000209:etiology / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000097:blood / Q000150:complications / Q000601:surgery*; D011184:Postoperative Period; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D014667:Vasopressins / Q000097:blood
D014667:Vasopressins; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone