TY - JOUR
T1 - Outcomes and management of patients with Cushing's disease without pathological confirmation of tumor resection after transsphenoidal surgery
AU - Pouratian, Nader
AU - Prevedello, Daniel M.
AU - Jagannathan, Jay
AU - Lopes, M. Beatriz
AU - Vance, Mary Lee
AU - Laws, Edward R.
PY - 2007/9
Y1 - 2007/9
N2 - Context: Despite the success of transsphenoidal surgery (TSS) for the treatment of Cushing's disease, in a number of cases, an ACTH-staining pituitary adenoma is not identified histologically. The clinical significance of lack of histological confirmation remains unclear. Setting: This was a retrospective review of patients treated at the University of Virginia Medical Center. Patients: Of 490 TSS procedures for Cushing's disease between 1993 and 2004, we identified 111 cases without histological adenoma confirmation. Main Outcome Measure: Remission and recurrence of Cushing's disease were measured. Results: Overall, 50% of these patients achieved remission, a figure lower than for our entire series (79%) and for patients with histological confirmation of an ACTH-staining adenoma (88%) (P < 0.001). Patients with a history of two prior TSS achieved remission less often than patients with a history of fewer TSS (P = 0.026). No other factors influenced remission rates. Although the overall recurrence rate (21%, seven of 33 evaluated) was not different from previously published long-term studies, in three of seven cases of recurrence, early recurrences were noted between 2 and 4 months after remission. In patients who did not achieve remission, the most common and effective treatment options were repeat TSS, γ-knife radiosurgery, and bilateral adrenalectomy. Conclusion: The lower remission rate in patients without histological evidence of an adenoma is most likely a result of a decreased rate of adenoma extirpation. The incidence of early recurrence may be a unique feature of this patient population; patients without histological confirmation of tumor resection therefore require close and consistent monitoring postoperatively.
AB - Context: Despite the success of transsphenoidal surgery (TSS) for the treatment of Cushing's disease, in a number of cases, an ACTH-staining pituitary adenoma is not identified histologically. The clinical significance of lack of histological confirmation remains unclear. Setting: This was a retrospective review of patients treated at the University of Virginia Medical Center. Patients: Of 490 TSS procedures for Cushing's disease between 1993 and 2004, we identified 111 cases without histological adenoma confirmation. Main Outcome Measure: Remission and recurrence of Cushing's disease were measured. Results: Overall, 50% of these patients achieved remission, a figure lower than for our entire series (79%) and for patients with histological confirmation of an ACTH-staining adenoma (88%) (P < 0.001). Patients with a history of two prior TSS achieved remission less often than patients with a history of fewer TSS (P = 0.026). No other factors influenced remission rates. Although the overall recurrence rate (21%, seven of 33 evaluated) was not different from previously published long-term studies, in three of seven cases of recurrence, early recurrences were noted between 2 and 4 months after remission. In patients who did not achieve remission, the most common and effective treatment options were repeat TSS, γ-knife radiosurgery, and bilateral adrenalectomy. Conclusion: The lower remission rate in patients without histological evidence of an adenoma is most likely a result of a decreased rate of adenoma extirpation. The incidence of early recurrence may be a unique feature of this patient population; patients without histological confirmation of tumor resection therefore require close and consistent monitoring postoperatively.
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U2 - 10.1210/jc.2007-0208
DO - 10.1210/jc.2007-0208
M3 - Article
C2 - 17595252
AN - SCOPUS:34548721140
SN - 0021-972X
VL - 92
SP - 3383
EP - 3388
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 9
ER -