Surgical efficacy of Cushing's disease pathologically unconfirmed pituitary adenoma:analysis of 61 cases

Objective To explore the surgical efficacy of transsphenoidal microsurgery for Cushing's disease with negative pathological results. Methods Clinical data of 61 cases of Cushing's disease with negative pathological results were analyzed retrospectively. All the patients had typical clinical manifestations consistent with hypercortisolism. Endocrinological assessment supported the diagnosis of Cushing's disease in 48 cases, and atypical endocrine data were found in 13. MRI showed microadenoma in 33 patients, and normal in 28. Transsphenoidal surgery was underwent in all patients, with selective microadenomectomy accompanied by removal of a part of normal pituitary tissue near the tumor in 31 cases, and partial resection of the adenohypophysis in 30. Follow-up period was from 1.5 to 10 years, averaging 3.3 years. Results Histological examination revealed pituitary ACTH cell hyperplasia in 31 cases including Crooke cell nodelike hyperplasia in 17, and normal pituitary anterior or posterior lobe tissue in 30. Clinical manifestations of hypocortisolism existed in 17 cases. In the series of patients, 19 (31.1%) achieved clinical cure, 16 (26.2%) remission, and 26 (42.6%) had no change. Pituitary radiosurgery was used in 8 cases, while adrenalectomy in 9. Conclusion The clinical efficacy of surgical treatment for Cushing's disease with negative pathological results is inferior to that with positive results. Pituitary radiotherapy or adrenalectomy can be chosen as second line therapy for patients with surgical failure.