title: Therapeutic outcomes in patients undergoing surgery after diagnosis of Cushing's disease: A single-center study.
abstract: This study aimed to investigate early and late outcomes of patients who underwent neurosurgical procedures for the preoperative diagnosis of Cushing's disease (CD). Clinical, endocrine, imaging, and histologic data from 252 patients undergoing pituitary surgery at Toranomon Hospital through the end of 2012 were entered into a database and statistically analyzed. In 22 of these patients (8.7%; positive venous sampling in 15 and negative venous sampling in 7 patients), tumors were invisible on magnetic resonance imaging (MRI) and 42.9% of them achieved remission. In the remaining 230 patients, 93.5% of those with microadenomas (n=154) and 71.1% of those with macroadenomas (n=76) achieved early postoperative remission, with recurrence rates of 2.7% and 14.8%, respectively, during a 72.5-month median follow-up. In multivariate analyses, cavernous sinus invasion (CSI; odds ratio [OR], 13.0), type of surgery (OR, 4.0), and tumor size (OR, 2.7) were significant preoperative factors affecting early postoperative results, whereas peak cortisol levels ≥9.4 μg/dL in response to corticotropin-releasing hormone (CRH) and CSI were significant factors predicting recurrence. Tumor recurrence was more common in patients with non-densely granulated adenomas than in patients with densely granulated adenomas. We propose that the higher remission and lower recurrence rates in this series are due to our surgical strategies, including extracapsular tumor removal, aggressive resection of tumors with CSI, extended transsphenoidal surgery (TSS), or a combined approach for large/giant adenomas. Appropriate multimodal treatments, including radiotherapy, medication, and repeated surgery in patients with persistent or recurrent CD, could result in better overall outcomes than previously achieved.
authors.affiliation: Department of Hypothalamic & Pituitary Surgery, Toranomon Hospital, Tokyo 105-8470, Japan.
authors.forename: Shozo
authors.initials: S
authors.lastname: Yamada
authors.forename: Naoko
authors.initials: N
authors.lastname: Inoshita
authors.forename: Noriaki
authors.initials: N
authors.lastname: Fukuhara
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Yamaguchi-Okada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishioka
authors.forename: Akira
authors.initials: A
authors.lastname: Takeshita
authors.forename: Hisanori
authors.initials: H
authors.lastname: Suzuki
authors.forename: Junko
authors.initials: J
authors.lastname: Ito
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takeuchi
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D002426:Cavernous Sinus / Q000473:pathology; D003346:Corticotropin-Releasing Hormone / Q000494:pharmacology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010902:Pituitary Gland / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology; D012074:Remission Induction; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone