Endoscopic transsphenoidal pituitary surgery: a good and safe primary treatment option for Cushing's disease, even in case of macroadenomas or invasive adenomas

ContextAlthough the endoscopic technique of transsphenoidal pituitary surgery (TS) has been widely adopted, reports on its results in Cushing's disease (CD) are still scarce and no studies have investigated long-term recurrence rates. This is the largest endoscopic series published till now.Obj...

Full description

Saved in:
Bibliographic Details
Published in:European journal of endocrinology 2013-09, Vol.169 (3), p.329-337
Main Authors: Wagenmakers, M A E M, Boogaarts, H D, Roerink, S H P P, Timmers, H J L M, Stikkelbroeck, N M M L, Smit, J W A, van Lindert, E J, Netea-Maier, R T, Grotenhuis, J A, Hermus, A R M M
Format: Article
Language:English
Subjects:
ACTH-Secreting Pituitary Adenoma - pathology
ACTH-Secreting Pituitary Adenoma - physiopathology
ACTH-Secreting Pituitary Adenoma - prevention & control
ACTH-Secreting Pituitary Adenoma - surgery
Adenoma - pathology
Adenoma - physiopathology
Adenoma - prevention & control
Adenoma - surgery
Adrenals. Adrenal axis. Renin-angiotensin system (diseases)
Adult
Biological and medical sciences
Cavernous Sinus - pathology
Clinical Study
Cohort Studies
Dexamethasone
Endocrinopathies
Endoscopy - adverse effects
Female
Follow-Up Studies
Fundamental and applied biological sciences. Psychology
Glucocorticoids
Humans
Hydrocortisone - blood
Male
Medical Records
Medical sciences
Middle Aged
Neoplasm Invasiveness - pathology
Neoplasm Recurrence, Local - prevention & control
Netherlands
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Pituitary ACTH Hypersecretion - etiology
Pituitary ACTH Hypersecretion - physiopathology
Pituitary ACTH Hypersecretion - prevention & control
Pituitary ACTH Hypersecretion - surgery
Pituitary Gland - pathology
Pituitary Gland - physiopathology
Pituitary Gland - surgery
Remission Induction
Retrospective Studies
Vertebrates: endocrinology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:ContextAlthough the endoscopic technique of transsphenoidal pituitary surgery (TS) has been widely adopted, reports on its results in Cushing's disease (CD) are still scarce and no studies have investigated long-term recurrence rates. This is the largest endoscopic series published till now.ObjectiveTo gain insight into the role of endoscopic TS as a primary treatment option for CD, especially in patients with magnetic resonance imaging (MRI)-negative CD and (invasive) macroadenomas.DesignRetrospective cohort study.Patients and methodsThe medical records of 86 patients with CD who underwent endoscopic TS were examined. Data on preoperative and postoperative evaluation, perioperative complications, and follow-up were collected. Remission was defined as disappearance of clinical symptoms with a fasting plasma cortisol level ≤50 nmol/l either basal or after 1 mg dexamethasone.ResultsThe remission rate in different adenoma subclasses varied significantly: 60% in MRI-negative CD (n=20), 83% in microadenomas (n=35), 94% in noninvasive macroadenomas (n=16), and 40% in macroadenomas that invaded the cavernous sinus (n=15). The recurrence rate was 16% after 71±39 months of follow-up (mean±s.d., range 10–165 months).ConclusionsEndoscopic TS is a safe and effective treatment for all patients with CD. Recurrence rates after endoscopic TS are comparable with those reported for microscopic TS. Our data suggest that in patients with noninvasive and invasive macroadenomas, the endoscopic technique of TS should be the treatment of choice as remission rates seem to be higher than those reported for microscopic TS, although no comparative study has been performed.
ISSN:0804-4643
1479-683X
DOI:10.1530/EJE-13-0325