Determinants of outcome of transsphenoidal surgery for Cushing disease in a single-centre series.
J Endocrinol Invest
; 43(5): 631-639, 2020 May.
Article
em En
| MEDLINE
| ID: mdl-31773581
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Hipofisárias
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Adenoma
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Procedimentos Neurocirúrgicos
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Hipersecreção Hipofisária de ACTH
Tipo de estudo:
Observational_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Endocrinol Invest
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Itália