nach oben

Erschienen in:

20.08.2021 | Original Article

Surgical outcome of transsphenoidal surgery in Cushing’s disease: a case series of 1106 patients from a single center over 30 years

verfasst von: Congxin Dai, Ming Feng, Bowen Sun, Xinjie Bao, Yong Yao, Kan Deng, Zuyuan Ren, Binghao Zhao, Lin Lu, Renzhi Wang, Jun Kang

Erschienen in: Endocrine | Ausgabe 1/2022

Einloggen, um Zugang zu erhalten

Abstract

Objective

Transsphenoidal surgery (TSS) is the first-line treatment for patients with Cushing’s disease (CD). However, the reported remission rates of patients who received TSS vary widely between different studies, and the predictors of surgical outcomes remain controversial. The present study analyzed the early outcome of TSS in a large population of patients with CD at a single center, and identified potential predictors of initial remission of TSS in patients with CD.

Methods

The clinical features and surgical outcomes of CD patients who underwent TSS between 1988 and 2018 at Peking Union Medical College Hospital (PUMCH) were collected and analyzed from their medical records.

Results

Of the 1604 CD patients who underwent TSS at PUMCH between February 1988 and October 2018, 1106 patients had complete medical data and pathological results. After surgery, the overall postoperative initial remission rate was 72.5, and 27.5% of patients maintained persistent hypercortisolism. The initial remission rate of patients with preoperative noninvasive adenoma based on MRI (77.1%), intraoperative noninvasiveness (72.5%), microadenoma (74.3%), pathological confirmation (76.4%), and first TSS (73.9%) was significantly higher than that in patients with preoperative invasive adenoma (53.0%), intraoperative invasiveness (60.7%), macroadenomas (65.9%), pathologically negative (49.7%), and repeat TSS (56.0%), respectively (all P < 0.05). The initial remission rate in patients with pseudocapsule-based extracapsular resection (88.1%), MRI-visible adenoma (74.2%) was higher than that in patients without pseudocapsule-based extracapsular resection (77.1%), and with MRI-negative results (64.5%), respectively, but did not reach statistical significance (All P > 0.05). Striking, there was no significant differences in initial remission rates between patients who underwent selective adenomectomy and enlarged adenomectomy (P > 0.05). Whereas, the initial remission rates in patients who underwent partial hypophysectomy only was 51.0%, which was much lower than that in patients underwent selective adenomectomy and enlarged adenomectomy (P < 0.05).

Conclusion

The TSS is a safe and effective procedure for the treatment of CD. Whereas, preoperative invasiveness based on MRI, intraoperative invasiveness, macroadenomas pathologically negative, and repeat TSS are related to lower initial remission rates.

Nur mit Berechtigung zugänglich

T.J. Mampalam, J.B. Tyrrell, C.B. Wilson, Transsphenoidal microsurgery for Cushing disease. A report of 216 cases. Ann. Intern. Med. 109(6), 487–93 (1988). https://doi.org/10.7326/0003-4819-109-6-487CrossRefPubMed

N.A. Tritos, B.M. Biller, B. Swearingen, Management of Cushing disease. Nat. Rev. Endocrinol. 7(5), 279–89 (2011). https://doi.org/10.1038/nrendo.2011.12CrossRefPubMed

G. Ntali, O. Hakami, M. Wattegama, S. Ahmed, N. Karavitaki, Mortality of patients with Cushing’s disease. Exp. Clin. Endocrinol. Diabetes 129(3), 203–207 (2021). https://doi.org/10.1055/a-1197-6380CrossRefPubMed

O.A. Hakami, S. Ahmed, N. Karavitaki, Epidemiology and mortality of Cushing’s syndrome. Best. Pract. Res. Clin. Endocrinol. Metab. 35(1), 101521 (2021). https://doi.org/10.1016/j.beem.2021.101521CrossRefPubMed

R.N. Clayton, D. Raskauskiene, R.C. Reulen, P.W. Jones, Mortality and morbidity in Cushing’s disease over 50 years in Stoke-on-Trent, UK: audit and meta-analysis of literature. J. Clin. Endocrinol. Metab. 96(3), 632–42 (2011). https://doi.org/10.1210/jc.2010-1942CrossRefPubMed

A. Juszczak, M.E. Ertorer, A. Grossman, The therapy of Cushing’s disease in adults and children: an update. Horm. Metab. Res. 45(2), 109–17 (2013). https://doi.org/10.1055/s-0032-1330009CrossRefPubMed

B.M. Biller, A.B. Grossman, P.M. Stewart, S. Melmed, X. Bertagna, J. Bertherat, M. Buchfelder, A. Colao, A.R. Hermus, L.J. Hofland, A. Klibanski, A. Lacroix, J.R. Lindsay, J. Newell-Price, L.K. Nieman, S. Petersenn, N. Sonino, G.K. Stalla, B. Swearingen, M.L. Vance, J.A. Wass, M. Boscaro, Treatment of adrenocorticotropin-dependent Cushing’s syndrome: a consensus statement. J. Clin. Endocrinol. Metab. 93(7), 2454–62 (2008). https://doi.org/10.1210/jc.2007-2734CrossRefPubMedPubMedCentral

W.F. Chandler, A.L. Barkan, T. Hollon, A. Sakharova, J. Sack, B. Brahma, D.E. Schteingart, Outcome of transsphenoidal surgery for cushing disease: a single-center experience over 32 years. Neurosurgery 78(2), 216–23 (2016). https://doi.org/10.1227/NEU.0000000000001011CrossRefPubMed

R.R. Lonser, J.J. Wind, L.K. Nieman, R.J. Weil, H.L. DeVroom, E.H. Oldfield, Outcome of surgical treatment of 200 children with Cushing’s disease. J. Clin. Endocrinol. Metab. 98(3), 892–901 (2013). https://doi.org/10.1210/jc.2012-3604CrossRefPubMedPubMedCentral

10.

M. Feng, Z. Liu, X. Liu, X. Bao, Y. Yao, K. Deng, B. Xing, W. Lian, H. Zhu, L. Lu, R. Wang, Diagnosis and outcomes of 341 patients with Cushing’s disease following transsphenoid surgery: a single-center experience. World Neurosurg. 109, e75–e80 (2018). https://doi.org/10.1016/j.wneu.2017.09.105CrossRefPubMed

11.

G. Aranda, J. Ensenat, M. Mora, M. Puig-Domingo, D.O.M. Martinez, G. Casals, E. Verger, M.T. Ribalta, F.A. Hanzu, I. Halperin, Long-term remission and recurrence rate in a cohort of Cushing’s disease: the need for long-term follow-up. Pituitary 18(1), 142–9 (2015). https://doi.org/10.1007/s11102-014-0567-8CrossRefPubMed

12.

L. Guignat, J. Bertherat, The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline: commentary from a European perspective. Eur. J. Endocrinol. 163(1), 9–13 (2010). https://doi.org/10.1530/EJE-09-0627CrossRefPubMed

13.

L.K. Nieman, B.M. Biller, J.W. Findling, J. Newell-Price, M.O. Savage, P.M. Stewart, V.M. Montori, The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 93(5), 1526–40 (2008). https://doi.org/10.1210/jc.2008-0125CrossRefPubMedPubMedCentral

14.

R. Gilbert, E.M. Lim, The diagnosis of Cushing’s syndrome: an endocrine society clinical practice guideline. Clin. Biochem. Rev. 29(3), 103–6 (2008)PubMedPubMedCentral

15.

C. Dai, S. Liang, X. Liu, Y. Fan, X. Bao, Y. Yao, K. Deng, L. Lu, R. Wang, M. Feng, Outcomes of transsphenoidal surgery in cushing disease patients with negative pituitary magnetic resonance imaging findings: a single-center experience. Endocr. Pract. 26(11), 1320–1330 (2020). https://doi.org/10.4158/EP-2020-0177CrossRefPubMed

16.

M. Feng, Z. Liu, X. Liu, X. Zhang, X. Bao, Y. Yao, K. Deng, B. Xing, W. Lian, H. Zhu, L. Lu, R. Wang, Tumour lateralization in Cushing’s disease by inferior petrosal sinus sampling with desmopressin. Clin. Endocrinol. 88(2), 251–257 (2018). https://doi.org/10.1111/cen.13505CrossRef

17.

E. Valassi, B.M. Biller, B. Swearingen, G.F. Pecori, M. Losa, P. Mortini, D. Hayden, F. Cavagnini, A. Klibanski, Delayed remission after transsphenoidal surgery in patients with Cushing’s disease. J. Clin. Endocrinol. Metab. 95(2), 601–10 (2010). https://doi.org/10.1210/jc.2009-1672CrossRefPubMedPubMedCentral

18.

J.M. Hinojosa-Amaya, D. Cuevas-Ramos, The definition of remission and recurrence of Cushing’s disease. Best Pract. Res. Clin. Endocrinol. Metab. 101485 (2021) https://doi.org/10.1016/j.beem.2021.101485

19.

Y. Liu, X. Liu, X. Hong, P. Liu, X. Bao, Y. Yao, B. Xing, Y. Li, Y. Huang, H. Zhu, L. Lu, R. Wang, M. Feng, Prediction of recurrence after transsphenoidal surgery for Cushing’s disease: the use of machine learning algorithms. Neuroendocrinology 108(3), 201–210 (2019). https://doi.org/10.1159/000496753CrossRefPubMed

20.

L.K. Nieman, B.M. Biller, J.W. Findling, M.H. Murad, J. Newell-Price, M.O. Savage, A. Tabarin, Treatment of Cushing’s Syndrome: an Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 100(8), 2807–31 (2015). https://doi.org/10.1210/jc.2015-1818CrossRefPubMedPubMedCentral

21.

G.D. Hammer, J.B. Tyrrell, K.R. Lamborn, C.B. Applebury, E.T. Hannegan, S. Bell, R. Rahl, A. Lu, C.B. Wilson, Transsphenoidal microsurgery for Cushing’s disease: initial outcome and long-term results. J. Clin. Endocrinol. Metab. 89(12), 6348–6357 (2004). https://doi.org/10.1210/jc.2003-032180CrossRefPubMed

22.

I. Ciric, J.C. Zhao, H. Du, J.W. Findling, M.E. Molitch, R.E. Weiss, S. Refetoff, W.D. Kerr, J. Meyer, Transsphenoidal surgery for Cushing disease: experience with 136 patients. Neurosurgery 70(1), 70–80 (2012). https://doi.org/10.1227/NEU.0b013e31822dda2c. discussion 80-1CrossRefPubMed

23.

F. Esposito, J.R. Dusick, P. Cohan, P. Moftakhar, D. McArthur, C. Wang, R.S. Swerdloff, D.F. Kelly, Clinical review: Early morning cortisol levels as a predictor of remission after transsphenoidal surgery for Cushing’s disease. J. Clin. Endocrinol. Metab. 91(1), 7–13 (2006). https://doi.org/10.1210/jc.2005-1204CrossRefPubMed

24.

C.G. Patil, D.M. Prevedello, S.P. Lad, M.L. Vance, M.O. Thorner, L. Katznelson, E.J. Laws, Late recurrences of Cushing’s disease after initial successful transsphenoidal surgery. J. Clin. Endocrinol. Metab. 93(2), 358–62 (2008). https://doi.org/10.1210/jc.2007-2013CrossRefPubMed

25.

R.F. Dallapiazza, E.H. Oldfield, J.A. Jane, Surgical management of Cushing’s disease. Pituitary 18(2), 211–216 (2015). https://doi.org/10.1007/s11102-015-0646-5CrossRefPubMed

26.

D.A. Abu, O.N. Singh, N.A. Al, W.H. Farah, P. Barrionuevo, M. Sarigianni, A.B. Mohabbat, K. Benkhadra, L.B. Carranza, M.R. Gionfriddo, Z. Wang, K. Mohammed, A.T. Ahmed, T.A. Elraiyah, Q. Haydour, F. Alahdab, L.J. Prokop, M.H. Murad, Predictors of biochemical remission and recurrence after surgical and radiation treatments of Cushing disease: a systematic review and meta-analysis. Endocr. Pract. 22(4), 466–75 (2016). https://doi.org/10.4158/EP15922.RACrossRef

27.

S. Yamada, N. Fukuhara, H. Nishioka, A. Takeshita, N. Inoshita, J. Ito, Y. Takeuchi, Surgical management and outcomes in patients with cushing disease with negative pituitary magnetic resonance imaging. World Neurosurg. 77(3), 525–532 (2012). https://doi.org/10.1016/j.wneu.2011.06.033CrossRefPubMed

28.

J. Honegger, K. Schmalisch, F. Beuschlein, S. Kaufmann, G. Schnauder, T. Naegele, T. Psaras, Contemporary microsurgical concept for the treatment of Cushing’s disease: endocrine outcome in 83 consecutive patients. Clin. Endocrinol. 76(4), 560–7 (2012). https://doi.org/10.1111/j.1365-2265.2011.04268.xCrossRef

29.

S.J. Monteith, R.M. Starke, J.J. Jane, E.H. Oldfield, Use of the histological pseudocapsule in surgery for Cushing disease: rapid postoperative cortisol decline predicting complete tumor resection. J. Neurosurg. 116(4), 721–7 (2012). https://doi.org/10.3171/2011.12.JNS11886CrossRefPubMed

30.

P. Witek, G. Zielinski, K. Szamotulska, M. Maksymowicz, G. Kaminski, Clinicopathological predictive factors in the early remission of corticotroph pituitary macroadenomas in a tertiary referral centre. Eur. J. Endocrinol. 174(4), 539–49 (2016). https://doi.org/10.1530/EJE-15-1226CrossRefPubMedPubMedCentral

31.

F. Doglietto, G. Maira, Cushing disease and negative magnetic resonance imaging finding: a diagnostic and therapeutic challenge. World Neurosurg. 77(3-4), 445–447 (2012). https://doi.org/10.1016/j.wneu.2011.09.045CrossRefPubMed

32.

Y. Sun, Q. Sun, C. Fan, J. Shen, W. Zhao, Y. Guo, T. Su, W. Wang, G. Ning, L. Bian, Diagnosis and therapy for Cushing’s disease with negative dynamic MRI finding: a single-centre experience. Clin. Endocrinol. 76(6), 868–876 (2012). https://doi.org/10.1111/j.1365-2265.2011.04279.xCrossRef

33.

H. Cebula, B. Baussart, C. Villa, G. Assié, A. Boulin, L. Foubert, S. Aldea, S. Bennis, M. Bernier, F. Proust, S. Gaillard, Efficacy of endoscopic endonasal transsphenoidal surgery for Cushing’s disease in 230 patients with positive and negative MRI. Acta Neurochir. 159(7), 1227–1236 (2017). https://doi.org/10.1007/s00701-017-3140-1CrossRefPubMed

34.

A.G. Ioachimescu, Prognostic factors of long-term remission after surgical treatment of Cushing’s disease. Endocrin. Metab. Clin. 47(2), 335–347 (2018). https://doi.org/10.1016/j.ecl.2018.02.002CrossRef

35.

S.P. Lad, C.G. Patil, E.J. Laws, L. Katznelson, The role of inferior petrosal sinus sampling in the diagnostic localization of Cushing’s disease. Neurosurg. Focus 23(3), E2 (2007). https://doi.org/10.3171/foc.2007.23.3.3CrossRefPubMed

36.

S. Jehle, J.E. Walsh, P.U. Freda, K.D. Post, Selective use of bilateral inferior petrosal sinus sampling in patients with adrenocorticotropin-dependent Cushing’s syndrome prior to transsphenoidal surgery. J. Clin. Endocrinol. Metab. 93(12), 4624–32 (2008). https://doi.org/10.1210/jc.2008-0979CrossRefPubMedPubMedCentral

37.

S.B. Carr, B.K. Kleinschmidt-DeMasters, J.M. Kerr, K. Kiseljak-Vassiliades, M.E. Wierman, K.O. Lillehei, Negative surgical exploration in patients with Cushing’s disease: benefit of two-thirds gland resection on remission rate and a review of the literature. J. Neurosurg. 1260–1267 (2018) https://doi.org/10.3171/2017.5.JNS162901

38.

J. Jagannathan, J.P. Sheehan, J.J. Jane, Evaluation and management of Cushing syndrome in cases of negative sellar magnetic resonance imaging. Neurosurg. Focus 23(3), E3 (2007). https://doi.org/10.3171/foc.2007.23.3.4CrossRefPubMed

39.

P. Valderrabano, J. Aller, L. Garcia-Valdecasas, J. Garcia-Uria, L. Martin, N. Palacios, J. Estrada, Results of repeated transsphenoidal surgery in Cushing’s disease. Long-term follow-up. Endocrinol. Nutr. 61(4), 176–83 (2014). https://doi.org/10.1016/j.endonu.2013.10.008CrossRefPubMed

Titel: Surgical outcome of transsphenoidal surgery in Cushing’s disease: a case series of 1106 patients from a single center over 30 years
verfasst von: Congxin Dai
Ming Feng
Bowen Sun
Xinjie Bao
Yong Yao
Kan Deng
Zuyuan Ren
Binghao Zhao
Lin Lu
Renzhi Wang
Jun Kang
Publikationsdatum: 20.08.2021
Verlag: Springer US
Erschienen in: Endocrine / Ausgabe 1/2022
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-021-02848-1

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

25.04.2024 | Hypotonie | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Surgical outcome of transsphenoidal surgery in Cushing’s disease: a case series of 1106 patients from a single center over 30 years

Abstract

Objective

Methods

Results

Conclusion

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Update Innere Medizin

Springer Medizin

Abstract

Objective

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2022

Is the ghost of brown tumor back again? Features of hypercalcaemic primary hyperparathyroidism we must not forget

Assessment of the AJCC staging system of pheochromocytomas/paragangliomas

Analysis of serum microRNA in exosomal vehicles of papillary thyroid cancer

Occurrence and response to treatment of Graves’ disease after COVID vaccination in two male patients

Blood glucose and epicardial adipose tissue at the hospital admission as possible predictors for COVID-19 severity

Gestational diabetes mellitus in women born small or preterm: Systematic review and meta-analysis

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Update Innere Medizin