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.

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. - In: JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION. - ISSN 0391-4097. - 43:5(2020 May), pp. 631-639.

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

G. Del Sindaco;G. Carosi;R. Indirli;G. Rodari;C. Giavoli;M. Locatelli;G. Marfia;G. Mantovani
;
M. Arosio;E. Ferrante
2020

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.
Cushing disease; Hypercortisolism; Remission; Transsphenoidal surgery
Settore MED/13 - Endocrinologia
mag-2020
Article (author)
File in questo prodotto:
File Dimensione Formato  
Serban_et_al-2020-Journal_of_Endocrinological_Investigation.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 757.95 kB
Formato Adobe PDF
757.95 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/736163
Citazioni
  • ???jsp.display-item.citation.pmc??? 4
  • Scopus 9
  • ???jsp.display-item.citation.isi??? 9
social impact