Factors influencing the immediate and late outcome of Cushing's disease treated by transsphenoidal surgery

A retrospective study by the European Cushing's Disease Survey Group

D. Bochicchio, M. Losa, M. Buchfelder, A. Stevenaert, A. Beckers, C. Hagen, P. Bjerre, A. Kruse, J. Lindholm, R. Fahlbusch, O. A. Muller, K. Von Werder, B. Ambrosi, G. Faglia, M. Giovanelli, A. Angeli, G. Maira, G. F F M Pieters, D. Carvalho

Research output: Contribution to journalArticle

283 Citations (Scopus)

Abstract

Hypercortisolism attributable to hypersecretion of ACTH by a pituitary adenoma is an uncommon and progressively lethal disease. Because of its rarity, it has been difficult to collect a large series of patients in order to identify the prognostic factors influencing the outcome after transsphenoidal surgery. We conducted a multicenter, retrospective analysis of the early and late results of surgical treatment of Cushing's disease. Files of patients with Cushing's disease who underwent transsphenoidal surgery between 1975 and 1990 were collected from 25 institutions throughout Europe. Data from 668 of 716 patients were suitable for statistical analyses. Surgical mortality was 1.9%, and major morbidity occurred in 97 patients (14.5%). Clinical and biochemical remission of Cushing's disease after surgery occurred in 510 cases (76.3%). Identification of the tumor by neuroradiological imaging or at operation with histopathological corroboration was associated with remission of hypercortisolism. Recurrence of the disease occurred in 65 (12.7%) of 510 patients in remission after surgery at a mean time of 39.3 months (range 6-104 months). The distribution of the recurrences did not show any apparent plateau or cluster throughout the follow-up period. Low postoperative steroid levels, absence of cortisol response to CRH, and the need for long-term glucocorticoid substitution therapy were all associated with a high probability of long-term remission. Our study demonstrates that transsphenoidal surgery is a safe and effective treatment for patients with Cushing's disease. However, after successful surgery there is a steady increase in the percentage of recurrences, which continues with time. Patients who after operation had hypoadrenocorticism and needed long-term glucocorticoid substitution therapy had the lowest risk of relapse.

Original languageEnglish
Pages (from-to)3114-3120
Number of pages7
JournalJournal of Clinical Endocrinology and Metabolism
Volume80
Issue number11
Publication statusPublished - 1995

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Pituitary ACTH Hypersecretion
Surgery
Retrospective Studies
Recurrence
Cushing Syndrome
Glucocorticoids
Substitution reactions
Adrenocorticotropic Hormone
Pituitary Neoplasms
Therapeutics
Hydrocortisone
Surveys and Questionnaires
Tumors
Steroids
Imaging techniques
Morbidity
Mortality

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Factors influencing the immediate and late outcome of Cushing's disease treated by transsphenoidal surgery : A retrospective study by the European Cushing's Disease Survey Group. / Bochicchio, D.; Losa, M.; Buchfelder, M.; Stevenaert, A.; Beckers, A.; Hagen, C.; Bjerre, P.; Kruse, A.; Lindholm, J.; Fahlbusch, R.; Muller, O. A.; Von Werder, K.; Ambrosi, B.; Faglia, G.; Giovanelli, M.; Angeli, A.; Maira, G.; Pieters, G. F F M; Carvalho, D.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 80, No. 11, 1995, p. 3114-3120.

Research output: Contribution to journalArticle

Bochicchio, D, Losa, M, Buchfelder, M, Stevenaert, A, Beckers, A, Hagen, C, Bjerre, P, Kruse, A, Lindholm, J, Fahlbusch, R, Muller, OA, Von Werder, K, Ambrosi, B, Faglia, G, Giovanelli, M, Angeli, A, Maira, G, Pieters, GFFM & Carvalho, D 1995, 'Factors influencing the immediate and late outcome of Cushing's disease treated by transsphenoidal surgery: A retrospective study by the European Cushing's Disease Survey Group', Journal of Clinical Endocrinology and Metabolism, vol. 80, no. 11, pp. 3114-3120.
Bochicchio, D. ; Losa, M. ; Buchfelder, M. ; Stevenaert, A. ; Beckers, A. ; Hagen, C. ; Bjerre, P. ; Kruse, A. ; Lindholm, J. ; Fahlbusch, R. ; Muller, O. A. ; Von Werder, K. ; Ambrosi, B. ; Faglia, G. ; Giovanelli, M. ; Angeli, A. ; Maira, G. ; Pieters, G. F F M ; Carvalho, D. / Factors influencing the immediate and late outcome of Cushing's disease treated by transsphenoidal surgery : A retrospective study by the European Cushing's Disease Survey Group. In: Journal of Clinical Endocrinology and Metabolism. 1995 ; Vol. 80, No. 11. pp. 3114-3120.
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abstract = "Hypercortisolism attributable to hypersecretion of ACTH by a pituitary adenoma is an uncommon and progressively lethal disease. Because of its rarity, it has been difficult to collect a large series of patients in order to identify the prognostic factors influencing the outcome after transsphenoidal surgery. We conducted a multicenter, retrospective analysis of the early and late results of surgical treatment of Cushing's disease. Files of patients with Cushing's disease who underwent transsphenoidal surgery between 1975 and 1990 were collected from 25 institutions throughout Europe. Data from 668 of 716 patients were suitable for statistical analyses. Surgical mortality was 1.9{\%}, and major morbidity occurred in 97 patients (14.5{\%}). Clinical and biochemical remission of Cushing's disease after surgery occurred in 510 cases (76.3{\%}). Identification of the tumor by neuroradiological imaging or at operation with histopathological corroboration was associated with remission of hypercortisolism. Recurrence of the disease occurred in 65 (12.7{\%}) of 510 patients in remission after surgery at a mean time of 39.3 months (range 6-104 months). The distribution of the recurrences did not show any apparent plateau or cluster throughout the follow-up period. Low postoperative steroid levels, absence of cortisol response to CRH, and the need for long-term glucocorticoid substitution therapy were all associated with a high probability of long-term remission. Our study demonstrates that transsphenoidal surgery is a safe and effective treatment for patients with Cushing's disease. However, after successful surgery there is a steady increase in the percentage of recurrences, which continues with time. Patients who after operation had hypoadrenocorticism and needed long-term glucocorticoid substitution therapy had the lowest risk of relapse.",
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T1 - Factors influencing the immediate and late outcome of Cushing's disease treated by transsphenoidal surgery

T2 - A retrospective study by the European Cushing's Disease Survey Group

AU - Bochicchio, D.

AU - Losa, M.

AU - Buchfelder, M.

AU - Stevenaert, A.

AU - Beckers, A.

AU - Hagen, C.

AU - Bjerre, P.

AU - Kruse, A.

AU - Lindholm, J.

AU - Fahlbusch, R.

AU - Muller, O. A.

AU - Von Werder, K.

AU - Ambrosi, B.

AU - Faglia, G.

AU - Giovanelli, M.

AU - Angeli, A.

AU - Maira, G.

AU - Pieters, G. F F M

AU - Carvalho, D.

PY - 1995

Y1 - 1995

N2 - Hypercortisolism attributable to hypersecretion of ACTH by a pituitary adenoma is an uncommon and progressively lethal disease. Because of its rarity, it has been difficult to collect a large series of patients in order to identify the prognostic factors influencing the outcome after transsphenoidal surgery. We conducted a multicenter, retrospective analysis of the early and late results of surgical treatment of Cushing's disease. Files of patients with Cushing's disease who underwent transsphenoidal surgery between 1975 and 1990 were collected from 25 institutions throughout Europe. Data from 668 of 716 patients were suitable for statistical analyses. Surgical mortality was 1.9%, and major morbidity occurred in 97 patients (14.5%). Clinical and biochemical remission of Cushing's disease after surgery occurred in 510 cases (76.3%). Identification of the tumor by neuroradiological imaging or at operation with histopathological corroboration was associated with remission of hypercortisolism. Recurrence of the disease occurred in 65 (12.7%) of 510 patients in remission after surgery at a mean time of 39.3 months (range 6-104 months). The distribution of the recurrences did not show any apparent plateau or cluster throughout the follow-up period. Low postoperative steroid levels, absence of cortisol response to CRH, and the need for long-term glucocorticoid substitution therapy were all associated with a high probability of long-term remission. Our study demonstrates that transsphenoidal surgery is a safe and effective treatment for patients with Cushing's disease. However, after successful surgery there is a steady increase in the percentage of recurrences, which continues with time. Patients who after operation had hypoadrenocorticism and needed long-term glucocorticoid substitution therapy had the lowest risk of relapse.

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