Endocrine Abstracts

Introduction: Cushing’s disease (CD), a hypercorticism caused by an ACTH-secreting pituitary adenoma, was associated with a 5-year survival of only 50%. Although advances in management have significantly reduced mortality, the results of transsphenoidal surgery, the gold standard in the treatment of CD, vary from patient to patient.

Objective: The aim of our study is to evaluate the results of transsphenoidal surgery in CD (evolution, complications) and to determine the factors that can predict this evolution.

Materials and Methods: This is a retrospective study of 12 patients hospitalized in the endocrinology department of CHU Farhat Hached, between 1987 and 2010 who underwent a transsphenoidal surgery for CD.

Results: Our sample consisted of 8 women and 4 men. The average age was 38.3 (24-48). Pituitary MRI came back normal in one case, revealed a microadenoma in 7 cases and a macroadenoma in 4 cases. Pathological examination confirmed the diagnosis in 8 cases, and 4 reports were unavailable. Remission was obtained in 6 cases (50%), Recurrence occurred in 3 cases (25%) with an average time frame of 8 years (3 -17 years), one of which benefited from radiotherapy with remission. Persistent disease was observed in 3 patients, one of whom was a candidate for revision surgery (the patient refused the operation), the other received radiotherapy without remission and died from complications related to hypercorticism. The third required simple monitoring. Two out of the 3 recurrences did not develop adrenal insufficiency (AI) while one developed transient adrenal insufficiency (with a recurrence time frame of 17 years), while 4 of the six remissions developed prolonged AI. Regarding complications of transsphenoidal surgery, there were two uncomplicated meningeal breaches, 3 cases of diabetes insipidus, one of which is definitive, and one case of sinusitis.

Conclusion: Transsphenoidal surgery is an effective means of treatment for Cushing’s disease, however after successful treatment there is an increased risk of recurrence over time warranting prolonged lifelong follow-up. Subjects who have experienced postoperative adrenal insufficiency have a lower risk of recurrence, especially in case of a prolonged one. Depending on the postoperative biological findings, further treatment may be necessary (radiotherapy, surgery).