Surgical Outcomes and Comorbidities in Cushing Disease: 30 Years of Experience in a Referral Center.

Abstract

OBJECTIVE:

Cushing disease (CD) is a rare, poorly understood entity. Our aim was to add our clinical experience of >30 years in a multidisciplinary specialized unit to the global knowledge of CD.

METHODS:

This descriptive retrospective study included all patients admitted to the Endocrinology and Nutrition Department of the Virgen del Rocío University Hospital, Seville, Spain, from January 1980 to May 2016. All patients had a definitive diagnosis of CD.

RESULTS:

Total sample included 119 patients; 100 (84%) were female. Median age at diagnosis was 37.97 years (interquartile range [IQR]: 25.89-45.07 years). Median follow-up was 88 months (IQR: 45.50-157.00 months). Most tumors were microadenomas (62/95) (5.1 mm [IQR: 4.0-7.0 mm]) without sinus invasion. Surgical procedures were conventional transsphenoidal surgery (CTSS) (101/108; cured 70 after first attempt) and expanded endoscopic transsphenoidal surgery (EETSS) (7/108; cured 5 after first attempt); 11 patients did not receive surgical treatment. Fourteen patients received radiotherapy after a first surgery and 5 patients after a second surgical removal attempt. In 13 patients (12.04%), CD relapse was demonstrated after initial CTSS (median disease-free period 65 months [IQR: 45-120 months]). Ten patients developed panhypopituitarism owing to the surgical procedure (CTSS); 8 patients developed panhypopituitarism after adjuvant radiotherapy.

CONCLUSIONS:

We observed slightly inferior cure rate after first surgery compared with moderately better relapse rates and time to relapse. Radiotherapy after surgery failure seemed to be more effective than CTSS; however, EETSS may be a valid alternative. Postoperative panhypopituitarism rate after first surgery was lower than expected; after radiotherapy, our results were comparable to other series.

• Authors: Antonio Jesús Martínez Ortega, Eva Venegas-Moreno, Elena Dios, Pablo Jesús Remón Ruíz, Francisco Javier Márquez Rivas, Eugenio Cárdenas Valdepeñas, Ariel Matías Kaen, David A Cano, Alfonso Soto-Moreno
• Journal: World neurosurgery (World Neurosurg) Vol. 122 Pg. e436-e442 (02 2019) ISSN: 1878-8769 [Electronic] United States
• PMID: 31108069 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Topics

• ACTH-Secreting Pituitary Adenoma (complications, surgery)
• Adenoma (complications, surgery)
• Adult
• Endoscopy (methods)
• Female
• Humans
• Hypopituitarism (etiology)
• Male
• Middle Aged
• Pituitary ACTH Hypersecretion (radiotherapy, surgery)
• Postoperative Complications (etiology)
• Radiotherapy, Adjuvant (adverse effects)
• Retrospective Studies
• Treatment Outcome