Surgical outcomes in cushing disease: Endoscopic transsphenoidal pituitary surgery

Pablo Remon-Ruiz; Elena Dios-Fuentes; Eva Venegas; Miriam Cozar-Duenas; Ariel Kaen; Eugenio Cardenas; Natividad Gonzalez; Ignacio Martin; Florinda Roldan; Elena Fajardo; David Cano; Alfonso Soto-Moreno

doi:10.1530/endoabs.63.P1087

Introduction: Endoscopic transsphenoidal pituitary surgery has become the first line method for removal pituitary tumours. A new way to see the surgical field and the cooperation of two neurosurgeons has supposed a revolution in the area.

Objetives: Analyse surgical outcomes and complications of a cohort of patients from a single center who underwent ETPS for Cushing disease.

Methods: Descriptive prospective-retrospective study including patients who underwent ETPS for Cushing disease in a single center from January/2013 to June/2018.

Results: 27 patients underwent ETPS as first line treatment for Cushing disease, 22 (81.48%) were women; mean surgical age was 42.74±19.77 years. 22 (81.48%) were microadenomas. Cavernous invasion according to Knosp score 3-4 was found in 3 (11.1%) patients. At december/2018, with a mean follow-up 2.42±1.34 years, 22 (81.48%) were cured, this rate was similar for invasive tumours (100%), non invasive (79.16%), microadenomas (81.89%) and macroadenomas (80%). Before surgery only 1 patient has a campimetric commitment with a partial recovery after the intervention. Hormone dysfunction was found in 2 (7.4%) patients, 1 with hypothyroidism and hypogonadism and 1 with hypothyroidism. After the intervention, new thyroid dysfunction was observed in 2 (7.4%) patients, gonadal in 1 (3.7%) and permanent steroid deficiency in 11 (40.74%). 9 patients underwent ETPS after a microscopic transsphenoidal approach. 6 (66.67%) women; mean surgical age 42.62±13.82 years. 6 (66.67%) macroadenomas, 3 (33.33%) 2 (22.22%) and 1 adenoma with cavernous sinus invasion. After this second surgery and at december/2018, with a mean follow-up 2.32±1.37 years, 6 (66.67%) were cured, all (100%) macroadenomas and invasive tumors were cured, no invasive tumors cure rate was 62.5%, microadenomas cure rate was 50%. 2 patient has a campimetric commitment with a partial recovery after the intervention. After surgery, 3 (37.5%) new diabetes insipidous, 1 (11.1%) new steroid deficiency, 1 thyroid commitment were found.

Conclusions: ETPS is an effective and secure surgical approach as first line treatment in Cushing disease, with better outcomes than traditional approaches. Cure rates in reintervention after MTS put ETPS as an elective second line treatment in patients with relapse of disease after a first surgery. According to this results, the role of ETPS in algorithm treatment may be restated and reintervention could be propose before other second line treatment, at least in patient who underwent MPS as first line surgery.

Endocrine Abstracts

P1087