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Long-term Remission in Cushing’s Disease After Endoscopic Endonasal Surgery

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In patients with Cushing’s disease (CD), long-term remission was noted in those who underwent selective adenomectomy via endoscopic endonasal approach (EEA) performed by experienced surgeons and supported by a multidisciplinary dedicated team, according to new study results. These patients also had low complication rates.

In this retrospective study, clinical, radiological, and histological data from 151 consecutive patients with CD who were operated on from 1998 to 2017 in an Italian referral Pituitary Center were analyzed.

Of the 151 patients included, 88.7% were treatment naïve, 11.3% had previous surgical treatment, and 11.2% previous medical treatment. Prior to surgery, 35 patients had a macroadenoma and 80 had microadenoma; 36 patients had tumors that was undetectable.

In cases of disease persistence, patients underwent a second surgery and/or received medial or radiation therapy.

Mean follow-up was 92.3 ± 12.0 (range 12-237.4) and median 88.2 months.

Remission rate after first surgery and at last follow-up was 88.1% and 90.7%, respectively. One patient died of pituitary carcinoma. Post-surgical cortisol drop (P = 0.004), tumor detection at MRI (P = 0.03) and size < 1 cm (P = 0.045) increased the chance of disease remission, whereas cavernous sinus invasion was a negative predictor of outcome (P = 0.002)

Diabetes insipidus and hypopituitarism were developed in 27 patients and 18 patients, respectively. Surgery repetition increased the risk of hypopituitarism (P = 0.03).

The authors concluded that, “Selective adenomectomy via EEA performed by experienced surgeons, supported by a multidisciplinary dedicated team, allows long-term remission in the vast majority of CD patients with low complication rate.”

Reference:

F Guaraldi F, Zoli M, Asioli S, et al. Results and predictors of outcome of endoscopic endonasal surgery in Cushing’s disease: 20-year experience of an Italian referral pituitary center. J Endocrinol Invest. 2020 Mar 25[Online ahead of print]. DOI: 10.1007/s40618-020-01225-5.

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