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The results comparison of transsphenoidal surgery in patients with Cushing´s disease (CD) with micro- and non-visualized pituitary adenoma
EANS Academy. Grigoriev A. Sep 27, 2019; 276127; EP04070
Abstract
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Objective: To compare the efficacy of transsphenoidal intervention in patients with Cushing´s disease with non-visualized and microadenoma of the pituitary gland.
Materials and methods: The study included 462 primary operated patients (369 women (79%) and 93 men (21%)) with central ACTH-dependent hypercorticism for the period from 2008 to 2018. The follow-up period was 6-131 months, median 28. According to preoperative MR-imaging invisible adenoma was detected in 102 (22%) patients, microadenoma - in 360 (88%). 182 (39%) patients had selective blood sampling from inferior petrosal sinus with stimulation Desmopressin. Histological confirmation of adenoma tissue was obtained in 401 of 459 removed biopsies (87%).
Results: Postoperative remission in the group with non-visualizable adenoma observed in 73 cases (72%), of which in 93% (68 pts.) of those patients hypocortisolemia was occurred. In the group with pituitary microadenoma, remission observed in 313 (87%) patients, while hypocortisolemia was verified in 92% of cases (288 out of 313 pts.). Persistence of hypercorticism was noted in 28% (29), and 13% of cases (47 obs.), respectively (two-way Fisher´s exact test P = 0.0004).
Hypopituitary disorders in the groups were as follows: hypothyroidism of 10 and 16 cases of observations, which amounted to 10% and 4% (two-sided Fisher´s exact test P = 0.050); diabetes insipidus 34 and 95 cases of observations, reaching 33% and 30%, (two-sided Fisher´s exact test P = 0.259), respectively.
Persistent remission is saved at 51 of 83 patients (61%) in the group with non-adenomas and at 201 of 275 (73%) in the group with microadenomas. Recurrences were evolved in 5 and 35 patients, reaching 7% and 11%, accordingly (two-sided Fisher´s exact test P = 0.162).
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