Therapeutic outcomes in patients undergoing surgery after diagnosis of Cushing’s disease: A single-center study

Endocrine Journal

Akira Takeshita³  Shozo Yamada²  Noriaki Fukuhara²  Hiroshi Nishioka²  Naoko Inoshita³  Hisanori Suzuki¹  Junko Ito³  Mitsuo Yamaguchi-Okada²  Yasuhiro Takeuchi³ 

[1] Department of Endocrinology & Metabolism, Toranomon Hospital, Tokyo 105-8470, Japan;Department of Hypothalamic & Pituitary Surgery, Toranomon Hospital, Tokyo 105-8470, Japan;Okinaka Memorial Institute for Medical Research, Tokyo 105-8470, Japan

关键词: Cushing’s disease;    Transsphenoidal surgery;    Long-term results;    Temozolomide;    Radiosurgery;   

DOI  :  10.1507/endocrj.15-0463

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

References(41)This study aimed to investigate early and late outcomes of patients who underwent neurosurgical procedures for the preoperative diagnosis of Cushing’s disease (CD).Clinical, endocrine, imaging, and histologic data from 252 patients undergoing pituitary surgery at Toranomon Hospital through the end of 2012 were entered into a database and statistically analyzed.In 22 of these patients (8.7%; positive venous sampling in 15 and negative venous sampling in 7 patients), tumors were invisible on magnetic resonance imaging (MRI) and 42.9% of them achieved remission.In the remaining 230 patients, 93.5% of those with microadenomas (n=154) and 71.1% of those with macroadenomas (n=76) achieved early postoperative remission, with recurrence rates of 2.7% and 14.8%, respectively, during a 72.5-month median follow-up.In multivariate analyses, cavernous sinus invasion (CSI; odds ratio [OR], 13.0), type of surgery (OR, 4.0), and tumor size (OR, 2.7) were significant preoperative factors affecting early postoperative results, whereas peak cortisol levels ≥9.4 μg/dL in response to corticotropin-releasing hormone (CRH) and CSI were significant factors predicting recurrence.Tumor recurrence was more common in patients with non-densely granulated adenomas than in patients with densely granulated adenomas.We propose that the higher remission and lower recurrence rates in this series are due to our surgical strategies, including extracapsular tumor removal, aggressive resection of tumors with CSI, extended transsphenoidal surgery (TSS), or a combined approach for large/giant adenomas.Appropriate multimodal treatments, including radiotherapy, medication, and repeated surgery in patients with persistent or recurrent CD, could result in better overall outcomes than previously achieved.

【 授权许可】

Unknown