title: Results of repeated transsphenoidal surgery in Cushing's disease. Long-term follow-up.
abstract: OBJECTIVE
  Transsphenoidal surgery (TSS) is the treatment of choice for Cushing's disease (CD). However, the best treatment option when hypercortisolism persists or recurs remains unknown. The aim of this study was to analyze the short and long-term outcome of repeat TSS in this situation and to search for response predictors.
  
  
  METHODS
  Data from 26 patients with persistent (n=11) or recurrent (n=15) hypercortisolism who underwent repeat surgery by a single neurosurgeon between 1982 and 2009 were retrospectively analyzed. Remission was defined as normalization of urinary free cortisol (UFC) levels, and recurrence as presence of elevated UFC levels after having achieved remission. The following potential outcome predictors were analyzed: adrenal status (persistence or recurrence) after initial TSS, tumor identification in imaging tests, degree of hypercortisolism before repeat TSS, same/different surgeon in both TSS, and time to repeat surgery.
  
  
  RESULTS
  Immediate postoperative remission was achieved in 12 patients (46.2%). Five of the 10 patients with available follow-up data relapsed after surgery (median time to recurrence, 13 months). New hormone deficiencies were seen in seven patients (37%), and two patients had cerebrospinal fluid leakage. No other major complications occurred. None of the preoperative factors analyzed was predictive of surgical outcome.
  
  
  CONCLUSIONS
  When compared to initial surgery, repeat TSS for CD is associated to a lower remission rate and a higher risk of recurrence and complications. Further studies are needed to define outcome predictors.
authors.affiliation: Endocrinology Department, Hospital Universitario Puerta de Hierro Majadahonda, C/ Joaquín Rodrigo n° 2, 28222 Majadahonda, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Valderrábano
authors.affiliation: Endocrinology Department, Hospital Universitario Puerta de Hierro Majadahonda, C/ Joaquín Rodrigo n° 2, 28222 Majadahonda, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Aller
authors.affiliation: Endocrinology Department, Hospital Universitario Puerta de Hierro Majadahonda, C/ Joaquín Rodrigo n° 2, 28222 Majadahonda, Madrid, Spain.
authors.forename: Leopoldo
authors.initials: L
authors.lastname: García-Valdecasas
authors.affiliation: Neurosurgery Department, Hospital Universitario Puerta de Hierro Majadahonda, C/ Joaquín Rodrigo n° 2, 28222 Majadahonda, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: García-Uría
authors.affiliation: Endocrinology Department, Hospital Universitario Puerta de Hierro Majadahonda, C/ Joaquín Rodrigo n° 2, 28222 Majadahonda, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Martín
authors.affiliation: Endocrinology Department, Hospital Universitario Puerta de Hierro Majadahonda, C/ Joaquín Rodrigo n° 2, 28222 Majadahonda, Madrid, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Palacios
authors.affiliation: Endocrinology Department, Hospital Universitario Puerta de Hierro Majadahonda, C/ Joaquín Rodrigo n° 2, 28222 Majadahonda, Madrid, Spain. Electronic address: jestrada.hpth@salud.madrid.org.
authors.forename: Javier
authors.initials: J
authors.lastname: Estrada
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013101:Sphenoid Sinus; D013514:Surgical Procedures, Operative / Q000379:methods; D013997:Time Factors; D055815:Young Adult
keywords: ACTH-secreting pituitary adenoma; Adenoma hipofisario productor de hormona adrenocorticotropa; Cushing's syndrome; Hipofisectomía; Hypophysectomy; Recidiva; Recurrence; Reintervención; Repeat surgery; Síndrome de Cushing