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Outcomes and management of patients with Cushing s disease without pathological confirmation of tumor resection after transsphenoidal surgery Pouratian N; Prevedello DM; Jagannathan J; Lopes MB; Vance ML; Laws ER JrJ Clin Endocrinol Metab 2007[Sep]; 92 (9): 3383-8CONTEXT: 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, gamma-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.|ACTH-Secreting Pituitary Adenoma/diagnosis/pathology/*surgery[MESH]|Adenoma/diagnosis/pathology/surgery[MESH]|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Child[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Neoplasm Recurrence, Local/diagnosis/pathology[MESH]|Neoplasm, Residual[MESH]|Pituitary ACTH Hypersecretion/*diagnosis/pathology/*surgery[MESH]|Prognosis[MESH]|Remission Induction[MESH]|Retrospective Studies[MESH]|Treatment Failure[MESH]|Treatment Outcome[MESH] |
