Abstract
Objective and design: The endoscopic technique has been recently introduced in the field of transsphenoidal pituitary surgery. This technique allows inspection of sellar, supra- and parasellar structures and removal of the tumor under direct visualization, is minimally traumatic and permits easier reoperations. This is the first report on the results of endoscopic surgery for patients with Cushing's disease. Our aim was to retrospectively analyze the results of pituitary surgery in 3 5 consecutive patients with Cushing's disease operated in our hospital after the introduction of the endoscopic technique (1998-2004). Methods: Remission was defined as suppression of plasma cortisol (≤50 nmol/L) after 1 mg dexamethasone overnight determined in the first 3
months after surgery and disappearance of clinical signs and symptoms
of hypercortisolism. The patients were followed for an average of 27
months (range 4 to 81 months, median 20 months). Results: Pituitary
MRI showed a macroadenoma in 6 patients, a microadenoma in 17 patients
and no adenoma in 12 patients. After the initial surgery 27 patients
(77%) were in remission. None of the patients had a relapse during
follow-up. In the remaining 8 patients hypercortisolemia persisted after
surgery. Three of them had a second endoscopic pituitary surgery
resulting in remission in two patients. In one patient a second
endoscopic pituitary surgery will soon follow. The remaining four
patients were treated with radiotherapy postoperatively. Two of them
were at the time of data collection in remission. One patient from the
remission group had a serious epistaxis and three patients had
cerebrospinal fluid leakage, one requiring an external lumbar drain,
shortly after surgery. No complications were recorded in the failure
group. Postoperatively 34% of all patients required substitution with
levothyroxine, 40% required substitution with glucocorticoids, 17%
received estrogens or testosterone and 6% still required desmopressin. Conclusions: Endoscopic
transsphenoidal pituitary surgery resulted in our series of patients
with Cushings disease in an excellent postoperative remission rate. A
randomized clinical trial, comparing endoscopic and conventional
pituitary surgery in patients with Cushings disease, is needed to
determine the pros and cons of both techniques.
Original language | English |
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Pages (from-to) | 675-684 |
Number of pages | 10 |
Journal | European Journal of Endocrinology |
Volume | 154 |
Issue number | 5 |
DOIs | |
Publication status | Published - May 2006 |
Externally published | Yes |
Bibliographical note
© 2006 Society of the European Journal of EndocrinologyThis article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model