title: Safety of transsphenoidal microsurgical approach in patients with an ACTH-secreting pituitary adenoma.
abstract: OBJECTIVE
  Patients affected by Cushing's disease often have important comorbidities directly linked to hypercortisolism that might enhance the operative risk. We report the safety of transsphenoidal surgery in patients affected by Cushing's disease as compared with patients with nonfunctioning pituitary adenoma.
  
  
  METHODS
  We have retrospectively analyzed 142 patients with Cushing's disease and 299 patients with nonfunctioning pituitary adenoma who underwent transsphenoidal surgery performed by a single experienced neurosurgeon between September 2007 and December 2014. For all of them, an intraoperative computerized anesthetic record for the automatic storage of data was available.
  
  
  RESULTS
  The intraoperative vital parameters and the frequency of drugs administered during anesthesia were comparable between Cushing's disease and nonfunctioning pituitary adenoma groups. The duration of surgery was similar between the two groups (41.2 ± 11.8 vs. 42.9 ± 15.6 min), while the duration of anesthesia was slightly shorter in Cushing's disease patients (97.6 ± 18.1 min) than in nonfunctioning pituitary adenoma patients (101.6 ± 20.6 min, p = 0.04). The total perioperative mortality rate was 0.2% (0% in Cushing's disease vs. 0.3% in nonfunctioning pituitary adenoma). Cushing's disease patients had surgical and medical complication rates of 3.5% each, not different from those occurring in nonfunctioning pituitary adenoma. The postoperative incidence of diabetes insipidus (10.6%) and isolated hyponatremia (10.6%) in Cushing's disease patients was significantly higher than in nonfunctioning pituitary adenoma patients (4.4 and 4.1%; p = 0.02 and p = 0.01, respectively).
  
  
  CONCLUSIONS
  In a large series of unselected and consecutive patients with Cushing's disease, transsphenoidal surgery performed by one dedicated experienced neurosurgeon had a reasonably low risk of complications. In particular, despite the higher burden of comorbidities typically associated with hypercortisolism, medical complications are rare and no more frequent than in patients with nonfunctioning pituitary adenoma.
authors.affiliation: Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. donofrio.carmine@hsr.it.
authors.forename: Carmine Antonio
authors.identifier: http://orcid.org/0000-0002-9123-8158
authors.initials: CA
authors.lastname: Donofrio
authors.affiliation: Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Losa
authors.affiliation: Service of Anesthesia and Intensive Care Unit, Head and Neck Department, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Gemma
authors.affiliation: Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Lodoviga
authors.initials: L
authors.lastname: Giudice
authors.affiliation: Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Lina Raffaella
authors.initials: LR
authors.lastname: Barzaghi
authors.affiliation: Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Mortini
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000601:surgery*; D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000601:surgery*; D000067369:Transanal Endoscopic Microsurgery / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult
keywords: Anesthesia; Cushing’s disease; Intraoperative monitoring; Pituitary neoplasm; Pituitary surgery