title: [Diagnosis and surgical management in patients with Cushing disease with negative magnetic resonance imaging].
abstract: OBJECTIVE
  To analyze the outcome in patients who underwent transsphenoidal surgery (TSS) with Cushing's disease (CD) with no visible adenoma on magnetic resonance imaging (MRI).
  
  
  METHODS
  Between 2012 and 2014, 118 patients with CD underwent TSS at PUMCH. We retrospectively analyzed data in 43 patients without visible adenomas on MRI and compared them with 75 patients with MRI-visible microadenomas.
  
  
  RESULTS
  Of 75 patients with MRI-visible microadenomas, postoperative remission was achieved in 64 patients (85.3%), and no recurrence or persistent of CD was observed during 2-year follow-up, and pituitary adenoma confirmed by pathology examination in 71 cases.Of 43 patients with negative MRI, postoperative remission was achieved in 32 patients (74.4%), and pituitary adenoma confirmed by pathology examination in 38 cases. No statistic difference was found between MRI-negative group and MRI-visible group after χ2 test (P value>0.05). BIPSS was performed in 32 cases, and 27 cases were positive. Pituitary adenoma was confirmed in 28 cases.
  
  
  CONCLUSIONS
  There is no difference in remission rate of CD in MRI-visible and MRI-negative group. BIPSS should be performed in normal MRI cases. We recommend transsphenoidal surgery as the first-line treatment for CD. Selective adenomectomy was recommended when an adenoma was found during surgery, and partial or hemihypophysectomy when no adenoma was found.
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Feng
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Xinjie
authors.initials: X
authors.lastname: Bao
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Kan
authors.initials: K
authors.lastname: Deng
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Xiaohai
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Congxin
authors.initials: C
authors.lastname: Dai
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Xing
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Feng
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Huijuan
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; Email: wangrz@126.com.
authors.forename: Renzhi
authors.initials: R
authors.lastname: Wang
mesh_terms: D000236:Adenoma; D006801:Humans; D008279:Magnetic Resonance Imaging; D047748:Pituitary ACTH Hypersecretion; D010911:Pituitary Neoplasms; D011184:Postoperative Period; D012189:Retrospective Studies