SFEBES2013 Poster Presentations Pituitary (71 abstracts)
Endocrine remission of Cushing's disease after endoscopic trans-sphenoidal surgery: Retrospective review of a single centre experience
Devon Kennard , Ben Whitelaw , Dorota Dworakowska , Nick Thomas , Sinan Barazi , Peter Bullock , Andrew King , Tim Hampton , Roy Sherwood , Charles Buchanan , Jackie Gilbert , Alan McGregor & Simon Aylwin
King’s College Hospital, London, UK.
Background: Cushing’s disease is caused by corticotroph tumours of the pituitary gland and the standard first-line treatment is trans-sphenoidal surgery. Published data from other centres describes post-operative endocrine remission achieved in 50–90% of cases.
| Remission (cortisol <50) | Cortisol (50–150 nmol/l) | Cortisol (>150 nmol/l) | |
| Microadenoma | 24 | 0 | 4 |
| Macroadenoma | 6 | 2 | 4 |
| All | 30 | 2 | 8 |
Method: We conducted a retrospective audit of patients who had endoscopic pituitary surgery for suspected or proven Cushing’s disease. Data was collected from Jan 2007, when the department commenced endoscopic surgery, until Nov 2012. We analysed patients having their first surgical intervention. For the purpose of this analysis: patients who had surgery followed by a re-exploration during the same admission were treated as having a single surgical intervention. Patients who had undergone previous pituitary surgery were excluded. Post-operative remission was defined as serum cortisol <50 nmol/l within 3 months of the surgical intervention.
Results: We identified 40 cases of suspected or proven Cushing’s disease who proceeded to have a first surgical intervention. Pre-operative radiological evaluation revealed 12 had a pituitary macroadenoma (>10 mm), 28 had either microadenoma (<10 mm), normal appearances or a diffusely abnormal intrasellar appearance. The overall post-operative remission rate was 75% (30/40). For microadenoma the remission rate was 86% (24/28). Of the 10 patients not cured by initial surgical intervention: five proceeded to pituitary radiotherapy, three had (or are planned to have) further pituitary surgery, one was cured by unilateral adrenalectomy for ACTH dependant macronodular adrenal hyperplasia and one died of sepsis in the context of severe Cushing’s.
Conclusion: The endocrine remission rate for endoscopic transphenoidal surgery for microadenoma is 86%. This is comparable to the highest remission rates reported in the international literature.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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