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Endoscopic transsphenoidal surgery for Cushing's Disease: a single surgeon experience
EANS Academy. Brady Z. Sep 27, 2019; 276000; EP04071
Abstract
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Background: Our aim was to assess the outcomes of endoscopic transspenoidal surgery (ETSS) for Cushing's disease (CD).
Methods: Prospective database of all pituitary operations. Review of clinical and biochemical data during the follow-up period.
Results: Thirty-one ETSS were performed in 29 patients with CD between January 2012 and January 2019 by one surgeon (MJ). Patients with previous TSS prior to the study period were excluded. Twenty-two (76%) were female, median (range) age 37 (8-75) years. Pre-operative MRI localised an adenoma in 18 patients (62%); 3 macroadenoma (1 cavernous sinus invasion). Twenty-six patients (90%) underwent inferior petrosal sinus sampling.
Postoperative remission rates for initial surgery were 86% (25/29) using Endocrine Society criteria (AM serum cortisol < 138 nmol/l within 7 days post-op). Postoperative remission rates were higher in those with a microadenoma/hyperplasia 88% (23/26). Using a stricter cut-off of day 3 cortisol < 50 nmol/L, the initial postoperative remission rate was 57%. Four patients (14%) had persistent hypercortisolemia after initial TSS, of whom two had second TSS, resulting in remission in 1 patient. There was no statistical difference in rates of remission in those patients with or without tumour target on pre-operative MRI (16/18 vs 9/11, p=0.6).
There were no cases of postoperative CSF leak requiring lumbar drain or meningitis. Postoperative transient and permanent diabetes insipidus rates were 38% (11/29) and 24% (7/29), respectively. Post-operatively, there were four cases of new TSH deficiency, and three cases of gonadotrophin deficiency. There were no cases of recurrence of CD during a median (range) follow-up of 25 (19-79) months.
Conclusions: ETSS produces excellent remission rates in CD patients, but longer follow-up period is required to assess recurrence rates. Patients should be counselled regarding risk of post-operative endocrine deficiencies, in particular diabetes insipidus.
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