Endocrine Abstracts (2002) 3 P192

Single centre audit of surgical outcome in Cushing's disease

SE Baldeweg1, JR Pollock2, P Kane2, MJ Levy2, J Akinwunmi2, GS Conway1 & M Powell2

1Department of Diabetes and Endocrinology, The Middlesex Hospital, University College London Hospitals, London, UK; 2Department of Surgical Neurology, National Hospital for Neurology and Neurosurgery, London, UK.

We examined the results of treatment of adult Cushing's disease by transphenoidal surgery by a single neurosurgeon (MP). Patients with Nelson's syndrome and those who previously had received treatment for Cushing's by a different surgeon were excluded. We reviewed the pituitary database and patient records for all patients operated between 1988 and 2000 with clear pre-operative evidence of Cushing's disease. 117 patients had clear evidence of a pituitary source of excess ACTH. Patients with incomplete pre- or postoperative data on cortisol status were excluded from further analysis. Data were therefore analysed from 89 patients.

Cure was assessed according to clinical and biochemical criteria. Depending on the criteria for post-operative 9 am cortisol levels surgical cure was achieved in 76% (cortisol <200nmol/l), 71% (cortisol <100nmol/l) and 63% (cortisol <50nmol\/l) of patients.

Patients were more likely to be cured if a discrete lesion was present on MRI. Among patients with a discrete lesion, patients with a microadenoma (78 %) were more likely to be cured than patients with a macroadenoma (57 %).

Our findings confirm transphenoidal surgery to be an effective primary therapy for Cushing's disease. The criteria of surgical cure applied in previously reported large surgical series have been inconsistent, making comparison between units difficult. We emphasise the need to standardise criteria for cure in surgical practice.

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