The treatment of Cushing's disease via transsphenoidal surgery

Objective To analyze the prognosis of Cushing's disease via transsphenoidal surgery retrospectively and to explore the surgical technique and factors affecting the outcome. Methods Fifty-four patients with Cushing's disease receiving transsphenoidal surgery between Jan.2001 and Dec. 2006, were reviewed. Among them, there were 39 microadenomas, 3 macroadenomas. Twelve cases which had normal image on the MRI scan were diagnosed by Dexamethasone test or/and bilateral inferior petrosal sinus sampling. During the operation, selective resection of adenoma was performed in 38 cases and part or hemi-hypophysectomy in 16 cases. The pathological finding confirmed the ACTH secreting adenoma in forty-nine cases, and pituitary corticotroph hyperplasia in 5 cases. The criteria of remission of patients were a cortisol value of 5 ng/ml or less on postoperative day 1 or day 2. Results The total remission rate was 75.9%. The rate was significantly higher in MRI positive adenomas than MRI negative ones; patients receiving intraoperative selective adenomectomy had a higher remission rate than those receiving hemi-hypophysectomy did; and remission rate was higher in ACTH secreting adenoma than in pituitary corticotroph hyperplasia (P=0.033, 0.035, and 0.01 respectively). There were 2 recurrent cases during the follow-up period. Conclusions Transsphenoidal surgery should be performed on Cushing' s disease, even if negative findings on the MRI scan. The prognosis is associated with the findings on preoperative imaging, intraoperative inspection and pathology.