Friday, January 30, 2009

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

From http://www.ingentaconnect.com/content/bsc/cend/2009/00000070/00000002/art00015

Authors: Wagenmakers, M. A. E. M.1; Netea-Maier, R. T.1; van Lindert, E. J.2; Timmers, H. J. L. M.1; Grotenhuis, J. A.2; Hermus, A. R. M. M.1

Source: Clinical Endocrinology, Volume 70, Number 2, February 2009 , pp. 274-280(7)

Publisher: Blackwell Publishing

Abstract:
Summary Background

No data on results of repeated transsphenoidal surgery via the endoscopic technique for patients with persistent or recurrent Cushing's disease are available.

Design and patients

We retrospectively evaluated the remission rates and complications of repeated transsphenoidal surgery via the endoscopic technique in 14 patients with persistent (N = 6) or recurrent (N = 8) Cushing's disease treated in our centre between 1999 and 2007.

Main outcomes

Remission was defined as the disappearance of symptoms of hypercortisolism with basal plasma cortisol level ? 50 nmol/l 24-48 h after glucocorticoid withdrawal and/or suppression of plasma cortisol level ? 50 nmol/l after 1 mg dexamethasone overnight within the first 3 months after transsphenoidal surgery.

Results

With repeated endoscopic transsphenoidal surgery a remission rate of 10/14 (71%) was achieved. No patient had a relapse during a median follow-up of 24 months. Cerebrospinal fluid leakage was the most frequent complication (6 patients) and 11 patients required hormonal substitution after surgery. The success of repeated transsphenoidal surgery could not be predicted by visualization of an adenoma on MRI before first or second surgery, histopathological confirmation of an ACTH secreting adenoma after first or second surgery, treatment with cortisol lowering agents before first or second surgery, the operation technique used during the first surgery, persistent vs. recurrent disease after the first surgery, age, gender and interval between the two surgeries.

Conclusion

Repeated transsphenoidal surgery via the endoscopic technique is a good treatment option for selected patients with recurrent or persistent Cushing's disease following primary pituitary surgery.

Document Type: Research article

DOI: 10.1111/j.1365-2265.2008.03334.x

Affiliations: 1: Department of Endocrinology and 2: Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 8, 6500 HB, Nijmegen, the Netherlands

 

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