title: Transsphenoidal surgery for Cushing disease: experience with 136 patients.
abstract: BACKGROUND
  This is a retrospective study of 136 patients with Cushing disease treated with transsphenoidal microsurgery.
  
  
  OBJECTIVE
  To evaluate factors influencing immediate postoperative results and long-term outcomes.
  
  
  METHODS
  Data regarding clinical presentation, endocrine evaluation, imaging studies, surgical technique, immediate postoperative biochemical remission (IPBR), and long-term results were entered into a database and analyzed statistically. IPBR was based on biochemical evidence of adrenal cortical insufficiency and clinical evidence of such insufficiency.
  
  
  RESULTS
  IPBR for the entire series was 83.4%. In microadenomas, IPBR was 89.8% with a mean immediate postoperative plasma cortisol (IPPC) of 2.1 μg/dL (range, <0.5-5.3). Positive magnetic resonance imaging (MRI) was associated with 18 times greater odds of finding microadenoma at surgery (P < .001) and with 4.1 times greater odds of IPBR (P = .07). In patients with a negative MRI, a positive inferior petrosal sinus sampling (IPSS) test was associated with 93% of IPBR (P = .004). IPBR in macroadenomas was 30.7%. Of patients followed for 12 months or longer, 34.8% required glucocorticoid replacement for the duration of follow-up. The mean follow-up in microadenomas was 68.4 months with a 9.67% incidence of recurrences. The estimated actuarial incidence of recurrences increased with the passage of time and IPPC of greater than 2 μg/dL was associated with higher incidence of recurrences, although without statistical significance (P = .08).
  
  
  CONCLUSIONS
  In microadenomas, a positive MRI and positive IPSS test were associated with a higher incidence of IPBR. Recurrences increased with the passage of time, and an IPPC of greater than 2 μg/dL may be associated with higher incidence of recurrences.
authors.affiliation: NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, Evanston, Illinois 60201, USA. iciric@northshore.org
authors.forename: Ivan
authors.initials: I
authors.lastname: Ciric
authors.forename: Jin-Cheng
authors.initials: JC
authors.lastname: Zhao
authors.forename: Hongyan
authors.initials: H
authors.lastname: Du
authors.forename: James W
authors.initials: JW
authors.lastname: Findling
authors.forename: Mark E
authors.initials: ME
authors.lastname: Molitch
authors.forename: Roy E
authors.initials: RE
authors.lastname: Weiss
authors.forename: Samuel
authors.initials: S
authors.lastname: Refetoff
authors.forename: William D
authors.initials: WD
authors.lastname: Kerr
authors.forename: Joel
authors.initials: J
authors.lastname: Meyer
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003346:Corticotropin-Releasing Hormone / Q000097:blood; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods*; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000601:surgery*; D010902:Pituitary Gland / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone