Outcome of Transsphenoidal Surgery for Cushing Disease: A Single-Center Experience Over 32 Years.
BACKGROUND
Transsphenoidal surgery is the standard approach for treating Cushing disease. Evidence is needed to document effectiveness.


OBJECTIVE
To analyze results of transsphenoidal surgery in 276 consecutive patients, including 19 children.


METHODS
Medical records were reviewed for patients treated initially with surgery for Cushing disease from 1980 to 2012. Radiographic features, pathology, remissions, recurrences, and complications were recorded. Patients were categorized for statistical analysis based on tumor size (microadenomas, macroadenomas, and negative imaging) and remission type (type 1 = morning cortisol ≤3 μg/dL; type 2 = morning cortisol normal).


RESULTS
Females comprised 78% of patients and were older than men. Imaging showed 50% microadenomas, 13% macroadenomas, and 37% negative for tumor. Remission rates for microadenomas, macroadenomas, and negative imaging were 89%, 66%, and 71%, respectively. Patients with microadenomas were more likely to have type 1 remission. Pathology showed adrenocorticotropic hormone-secreting adenomas in 82% of microadenomas, in 100% of macroadenomas, and in 43% of negative imaging. The incidence of hyperplasia was 8%. The finding of hyperplasia or no tumor on pathology predicted treatment failure. The recurrence rate was 17%, with an average time to recurrence of 4.0 years. Patients with type 1 remission had a lower rate of recurrence (13% type 1 vs 50% type 2) and a longer time to recurrence. Children had similar imaging findings, remission rates, and pathology. There were no operative deaths.


CONCLUSIONS
Transsphenoidal surgery provides a safe and effective treatment for Cushing disease. For both adults and children, the best outcomes occurred in patients with microadenomas and/or those with type 1 remission.
*Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; ‡Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan; §Michigan Endocrine Consultants, Berkley, Michigan; ¶Department of Neurosurgery, University of San Diego Health System, San Diego, California; ‖Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta, Atlanta, Georgia.
William F
WF
Chandler
Ariel L
AL
Barkan
Todd
T
Hollon
Alla
A
Sakharova
Jayson
J
Sack
Barunashish
B
Brahma
David E
DE
Schteingart
D049913:ACTH-Secreting Pituitary Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery*; D047748:Pituitary ACTH Hypersecretion / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult