Endocrine Abstracts

Introduction

Cushing’s disease described in 1973 by Harvey Cushing is the most frequent cause of endogenous hypercorticism in adults in 80-85% of cases of Cushing’s syndromes, it is secondary to a pituitary microadenoma most often, its treatment is first-line neurosurgical.

Aim of the study

To evaluate the results of the short and medium term therapeutic management of Cushing’s disease and to try to determine the predictive factors of remission.

Material and methods

Retrospective study: 85 patients recruited by CPMC. All of our patients underwent clinical, biological and morphological (CT and/or static MRI) pituitary and adrenal evaluation as well as petrous sinus catheterization (n = 9).

Surgical results

All our patients were operated on and 14% resumed Surgically; the transphenoidal route (TSP) has been the rule for all of our patients; the procedure performed is adenomectomy in 88% (selective 84% and enlarged 16%) and hemi-hypophysectomy in 12% of cases. ’The extirpated pituitary adenoma’ is identified in 95% by histology. 8.33% of our patients underwent a positive immunohistochemical examination in all cases. Pituitary surgery in cushing’s disease resulted in 69% remissions in microadenomas immediately after surgery. Reoperation may improve outcomes if initial surgery fails 8/12 (66%). However, the risk of long-term recurrence is high, 25% beyond 10 years.

Conclusion

Despite advances in diagnosis and treatment, CD is still difficult to treat. TSP surgery is the standard treatment. Our results are satisfactory: the experience of the neurosurgeon remains a fundamental asset. In the event of post-op recurrence, additional radiotherapy treatment is offered in combination with synthetic anti-cortisol drugs.