Endocrine Abstracts

Introduction: Transsphenoidal surgery (TSS) currently presents treatment of choice for Cushing’s disease (CD). Dependent on tumor size, remission rates after initial TSS range from 66 to 94%. In ACTH-secreting pituitary macroadenomas, remission rates are reported to be lower. Visible adenomas on preoperative MRI or intraoperatively and neurosurgical expertise might contribute to successful TSS.

Design: A retrospective, single center analysis in 51 CD patients.

Results: All patients with ACTH-secreting pituitary micro- or macroadenomas underwent TSS as initial treatment for CD. Overall, 45.9% of the CD patients were in remission after initial TSS. In the subset of microadenomas, a remission rate of 48% was observed, followed by a lower remission rate in the group of macroadenomas (41.7%).

54.1% of the patients (52% with microadenomas, 58.3% with macroadenomas) experienced a relapse after initial TSS. Mean time until relapse was 27.58±26.00 months. 29.7% of the patients with persistent hypercortisolism after initial TSS (28% with microadenomas, 33.3% with macroadenomas) underwent second TSS. In 17.6% of these patients, second TSS was carried out in the same neurosurgical center where initial TSS took place. After second TSS, biochemical remission of the disease was documented in 67.6% of the patients (72% with microadenomas, 58.3% with macroadenomas). A subset of patients (27%, 24% with microadenomas, 33.3% with macroadenomas) experienced a relapse after second TSS. Mean time until second relapse was shorter (13.25±16.76 months).

68.6 and 13.7% of the CD patients, respectively, underwent TSS in a center of neurosurgical expertise. There was no significant correlation between lack of neurosurgical expertise and relapse rate after initial or repeated TSS.

Conclusion: CD patients with macroadenomas presented with lower remission rates after initial or repeated TSS and a higher chance of experiencing a relapse postoperatively. Interestingly, lack of neurosurgical expertise did not correlate with a higher relapse rate after initial or repeated TSS.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This work was supported, however funding details unavailable.