Lateral one-third gland resection in Cushing patients with failed adenoma identification leads to low remission rates: long-term observations from a small, single-center cohort.

Abstract

BACKGROUND:

Currently, there are no guidelines for neurosurgeons treating patients with Cushing's disease (CD) when intraoperative adenoma identification is negative. Under these circumstances, a total hypophysectomy or hemi-hypophysectomy on the side indicated by inferior petrosal sinus sampling (IPSS) is the approach being used, although there is a subsequent risk of hypopituitarism. Data on whether one-third lateral pituitary gland resection results in cure of hypercortisolism and low rates of hypopituitarism remain inconclusive.

METHODS:

Retrospective single-center study of CD patients with failed intraoperative adenoma identification and subsequent resection of the lateral one-third of the pituitary gland as predicted by IPSS. We assessed (i) histopathological findings, (ii) early and long-term remission rates, and (iii) rates of additional pituitary hormone insufficiency.

RESULTS:

Ten women and three men met the inclusion criteria. At 3 months, remission was noted in six (46%) patients: three (23%) had histologically confirmed adenomas, two (15%) had ACTH hyperplasia, and one patient (8%) was positive for Crooke's hyaline degeneration. New pituitary hormone deficits were noted in two patients (15%). After a median (±SD) follow-up of 14±4 years, recurrence was noted in two (15%) patients. Long-term control of hypercortisolism was attained by 10 patients (77%), with additional therapies required in nine (69%) of them.

CONCLUSIONS:

In CD patients with failed intraoperative adenoma visualization, lateral one-third gland resection resulted in low morbidity and long-term remission in 31% of patients without the need for additional therapies. Bearing in mind the sample size of this audit, the indication for lateral one-third-gland resection has to be critically appraised and discussed with the patients before surgery.

• Authors: Lukas Andereggen, Luigi Mariani, Jürgen Beck, Robert H Andres, Jan Gralla, Markus M Luedi, Joachim Weis, Emanuel Christ
• Journal: Acta neurochirurgica (Acta Neurochir (Wien)) Vol. 163 Issue 11 Pg. 3161-3169 (11 2021) ISSN: 0942-0940 [Electronic] Austria
• PMID: 33811521 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s).

Chemical References

• Adrenocorticotropic Hormone

Topics

• Adenoma (surgery)
• Adrenocorticotropic Hormone
• Female
• Humans
• Male
• Petrosal Sinus Sampling
• Pituitary Neoplasms
• Retrospective Studies