Determinants of outcome of transsphenoidal surgery for Cushing disease in a single-centre series

A. L. Serban, G. Del Sindaco, E. Sala, G. Carosi, R. Indirli, G. Rodari, C. Giavoli, M. Locatelli, G. Carrabba, G. Bertani, G. Marfia, G. Mantovani, M. Arosio, E. Ferrante

Research output: Contribution to journalArticle

Abstract

Background: First-line therapy of Cushing disease (CD) is transsphenoidal surgery (TSS) aimed to obtain a complete removal of the pituitary adenoma and remission of disease. Purpose: To analyse the surgical outcome of patients with CD who underwent TSS in our Centre. Methods: Retrospective analysis on patients with CD who underwent TSS between 1990 and 2016. Results: We analysed 102 TSS that included: 84 first TSS and 18 second and third TSS. The overall remission rate after surgery was 76.5%, with a significant higher percentage of remitted patients after the first TSS compared to the subsequent TSS (82% vs 50%, p = 0.014). The remission after the first TSS was significantly higher when performed by a dedicated surgical team (DST) (89.8% vs 71% p = 0.04) and when the immunohistochemical examination confirmed the adrenocorticotropic adenoma (87% vs 55%, p = 0.04). Neuroradiological findings influenced the surgical outcome in a non-significant manner. Post-TSS complications were reported in 32 patients, with no significant variation when TSS was performed by DST. In case of reintervention, remission of disease was obtained in 72.7% of microadenoma, while no remitted patients were observed in case of macroadenomas. The DST did not significantly improve the outcome. Conclusion: Cushing disease is characterized by a broad spectrum of neuroradiological presentation. Despite the availability of a DST make the TSS a safe and effective first-line treatment among all these patients, a precise pre-treatment evaluation is needed in order to define the aim of neurosurgery and to schedule the management of recurrent disease.

Original languageEnglish
JournalJournal of Endocrinological Investigation
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Pituitary ACTH Hypersecretion
Neurosurgery
Pituitary Neoplasms
Disease Management
Adenoma
Appointments and Schedules

Keywords

  • Cushing disease
  • Hypercortisolism
  • Remission
  • Transsphenoidal surgery

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

@article{844b8038f9eb4496b3f3dba392a7646e,
title = "Determinants of outcome of transsphenoidal surgery for Cushing disease in a single-centre series",
abstract = "Background: First-line therapy of Cushing disease (CD) is transsphenoidal surgery (TSS) aimed to obtain a complete removal of the pituitary adenoma and remission of disease. Purpose: To analyse the surgical outcome of patients with CD who underwent TSS in our Centre. Methods: Retrospective analysis on patients with CD who underwent TSS between 1990 and 2016. Results: We analysed 102 TSS that included: 84 first TSS and 18 second and third TSS. The overall remission rate after surgery was 76.5{\%}, with a significant higher percentage of remitted patients after the first TSS compared to the subsequent TSS (82{\%} vs 50{\%}, p = 0.014). The remission after the first TSS was significantly higher when performed by a dedicated surgical team (DST) (89.8{\%} vs 71{\%} p = 0.04) and when the immunohistochemical examination confirmed the adrenocorticotropic adenoma (87{\%} vs 55{\%}, p = 0.04). Neuroradiological findings influenced the surgical outcome in a non-significant manner. Post-TSS complications were reported in 32 patients, with no significant variation when TSS was performed by DST. In case of reintervention, remission of disease was obtained in 72.7{\%} of microadenoma, while no remitted patients were observed in case of macroadenomas. The DST did not significantly improve the outcome. Conclusion: Cushing disease is characterized by a broad spectrum of neuroradiological presentation. Despite the availability of a DST make the TSS a safe and effective first-line treatment among all these patients, a precise pre-treatment evaluation is needed in order to define the aim of neurosurgery and to schedule the management of recurrent disease.",
keywords = "Cushing disease, Hypercortisolism, Remission, Transsphenoidal surgery",
author = "Serban, {A. L.} and {Del Sindaco}, G. and E. Sala and G. Carosi and R. Indirli and G. Rodari and C. Giavoli and M. Locatelli and G. Carrabba and G. Bertani and G. Marfia and G. Mantovani and M. Arosio and E. Ferrante",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s40618-019-01151-1",
language = "English",
journal = "Journal of Endocrinological Investigation",
issn = "0391-4097",
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TY - JOUR

T1 - Determinants of outcome of transsphenoidal surgery for Cushing disease in a single-centre series

AU - Serban, A. L.

AU - Del Sindaco, G.

AU - Sala, E.

AU - Carosi, G.

AU - Indirli, R.

AU - Rodari, G.

AU - Giavoli, C.

AU - Locatelli, M.

AU - Carrabba, G.

AU - Bertani, G.

AU - Marfia, G.

AU - Mantovani, G.

AU - Arosio, M.

AU - Ferrante, E.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: First-line therapy of Cushing disease (CD) is transsphenoidal surgery (TSS) aimed to obtain a complete removal of the pituitary adenoma and remission of disease. Purpose: To analyse the surgical outcome of patients with CD who underwent TSS in our Centre. Methods: Retrospective analysis on patients with CD who underwent TSS between 1990 and 2016. Results: We analysed 102 TSS that included: 84 first TSS and 18 second and third TSS. The overall remission rate after surgery was 76.5%, with a significant higher percentage of remitted patients after the first TSS compared to the subsequent TSS (82% vs 50%, p = 0.014). The remission after the first TSS was significantly higher when performed by a dedicated surgical team (DST) (89.8% vs 71% p = 0.04) and when the immunohistochemical examination confirmed the adrenocorticotropic adenoma (87% vs 55%, p = 0.04). Neuroradiological findings influenced the surgical outcome in a non-significant manner. Post-TSS complications were reported in 32 patients, with no significant variation when TSS was performed by DST. In case of reintervention, remission of disease was obtained in 72.7% of microadenoma, while no remitted patients were observed in case of macroadenomas. The DST did not significantly improve the outcome. Conclusion: Cushing disease is characterized by a broad spectrum of neuroradiological presentation. Despite the availability of a DST make the TSS a safe and effective first-line treatment among all these patients, a precise pre-treatment evaluation is needed in order to define the aim of neurosurgery and to schedule the management of recurrent disease.

AB - Background: First-line therapy of Cushing disease (CD) is transsphenoidal surgery (TSS) aimed to obtain a complete removal of the pituitary adenoma and remission of disease. Purpose: To analyse the surgical outcome of patients with CD who underwent TSS in our Centre. Methods: Retrospective analysis on patients with CD who underwent TSS between 1990 and 2016. Results: We analysed 102 TSS that included: 84 first TSS and 18 second and third TSS. The overall remission rate after surgery was 76.5%, with a significant higher percentage of remitted patients after the first TSS compared to the subsequent TSS (82% vs 50%, p = 0.014). The remission after the first TSS was significantly higher when performed by a dedicated surgical team (DST) (89.8% vs 71% p = 0.04) and when the immunohistochemical examination confirmed the adrenocorticotropic adenoma (87% vs 55%, p = 0.04). Neuroradiological findings influenced the surgical outcome in a non-significant manner. Post-TSS complications were reported in 32 patients, with no significant variation when TSS was performed by DST. In case of reintervention, remission of disease was obtained in 72.7% of microadenoma, while no remitted patients were observed in case of macroadenomas. The DST did not significantly improve the outcome. Conclusion: Cushing disease is characterized by a broad spectrum of neuroradiological presentation. Despite the availability of a DST make the TSS a safe and effective first-line treatment among all these patients, a precise pre-treatment evaluation is needed in order to define the aim of neurosurgery and to schedule the management of recurrent disease.

KW - Cushing disease

KW - Hypercortisolism

KW - Remission

KW - Transsphenoidal surgery

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U2 - 10.1007/s40618-019-01151-1

DO - 10.1007/s40618-019-01151-1

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