Cushings disease an audit of outcomes following pituitary surgery from a single centre
V Baskar, G Varugheese, V Carlin & RN Clayton
We evaluate the short and long-term outcomes following diagnosis and treatment of pituitary dependent Cushings disease from a single centre. From 1971, there were 47 patients with proven endogenous cortisol excess, of whom, 43 (92%) had pituitary dependent Cushings disease. The median age of this cohort was 38±11years and the majority (77%) were females. 17 patients had primary treatment either with radiotherapy (n=9), bilateral adrenalectomy (n=7) or long term medical therapy (n=1) and this group was excluded from further analysis. Of the remaining 26 individuals who had pituitary dependent Cushings and had pituitary surgery, the pre-operative imaging findings were, 19 (73%) microadenoma, 4 (15%) macroadenoma and 3 (12%) normal pituitary tissue. Pituitary surgery performed were, selective adenomectomy (n=15, 58%), hemi or subtotal hypophysectomy (n=8, 31%), total hypophysectomy (n=1, 4%) and surgery abandoned following tumour bleed (n=2, 7%). At the 6 week post pituitary surgery evaluation, 7 (27%) had normal adrenal function, 13 (50%) had adrenal deficiency requiring steroids and 6 (23%) remained biochemically Cushingoid. All 6 of the early relapsers were subsequently subjected to bilateral adrenalectomy and cured off their Cushings. Over a median follow up of 8 years (range 115 years), a further 7 of the initially cured group (n=20) relapsed later (median time to relapse 18 months post original pituitary surgery). Further management in this group included bilateral adrenalectomy (n=2), further pituitary surgery and subsequent radiotherapy (n=1), further pituitary surgery and subsequent adrenalectomy (n=3) and radiotherapy and subsequent adrenalectomy (n=1). At the time of final evaluation (n=26), 6 (23%) had normal adrenal function, 19 (73%) had adrenal deficiency requiring steroid support and 1 (4%) remained biochemically Cushingoid currently on long term medical treatment. Overall, the cure rate following 1 pituitary surgery in individuals with pituitary dependent Cushings were 77% in the short term and 50% in the longer term.