Late recurrences of Cushing's disease after initial successful transsphenoidal surgery.
BACKGROUND
Few studies have systematically analyzed the long-term recurrence rates of Cushing's disease after initial successful transsphenoidal surgery.


METHODS
This was a retrospective review of patients treated at the University of Virginia Medical Center.


METHODS
A total of 215 subjects with Cushing's disease who underwent initial transsphenoidal surgery for resection of a presumed pituitary microadenoma from 1992-2006 were included.


METHODS
Remission and recurrence rates of Cushing's disease were examined. Recurrence was defined as an elevated 24-h urine free cortisol with clinical symptoms consistent with Cushing's disease.


RESULTS
Of the 215 patients who underwent transsphenoidal surgery for Cushing's disease, surgical remission was achieved in 184 (85.6%). The mean length of follow-up was 45 months. Actuarial recurrence rates of Cushing's disease after initially successful transsphenoidal surgery at 1, 2, 3, and 5 yr were 0.5, 6.7, 10.8, and 25.5%, respectively. Among the 184 patients who achieved remission, 32 (17.4%) patients followed for more than 6 months ultimately had a recurrence of Cushing's disease. The median time to recurrence was 39 months. Immediate postoperative hypocortisolemia (serum cortisol < or = 2 microg/dl within 72-h surgery) was achieved in 97 (45.1%) patients. Patients who had postoperative serum cortisol of more than 2 microg/dl were 2.5 times more likely to have a recurrence than patients who had serum cortisol less than or equal to 2 microg/dl (odds ratio = 2.5; 95% confidence interval 1.12-5.52; P = 0.022).


CONCLUSIONS
A quarter of the patients with Cushing's disease who achieve surgical remission after transsphenoidal surgery, recur with long-term follow-up. This finding emphasizes the need for continued biochemical and clinical follow-up to ensure remission after surgery.
Patil
Chirag G
CG
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California 94305, USA. chiragpatil@gmail.com
Prevedello
Daniel M
DM
Lad
Shivanand P
SP
Vance
Mary Lee
ML
Thorner
Michael O
MO
Katznelson
Laurence
L
Laws
Edward R
ER
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006651:Histocytochemistry; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D053208:Kaplan-Meier Estimate; D008297:Male; D047748:Pituitary ACTH Hypersecretion / Q000601:surgery* / Q000652:urine; D010911:Pituitary Neoplasms / Q000601:surgery* / Q000652:urine; D012008:Recurrence; D012189:Retrospective Studies
D006854:Hydrocortisone