Endoscopic transsphenoidal pituitary surgery: a good and safe primary treatment option for Cushing's disease, even in case of macroadenomas or invasive adenomas

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 88-111-Cushing's Disease & Non-Functioning Hypothalamus-Pituitary Tumors
Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-88
Margreet A.E.M. Wagenmakers*1, Jeroen D. Boogaarts2, Sean H.P.P. Roerink1, J. André Grotenhuis2, Erik J. van Lindert2, Johannes W.A. Smit1, Romana T. Netea-Maier1 and Ad R.M.M. Hermus3
1Radboud University Nijmegen Medical Center, Nijmegen, Netherlands, 2Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands, 3Radboud University Nijmegen Medical Centre, Nijmegen
Context: Although the endoscopic technique of transsphenoidal pituitary surgery (TS) has been widely adopted, reports on the results in Cushing’s disease (CD) are still scarce. Furthermore no studies have investigated long-term recurrence rates of CD after endoscopic TS.

Objective: To gain more insight in the role of endoscopic TS as a primary treatment option for patients with CD, with a focus on patients with MRI negative CD or (invasive) macroadenomas.

Patients and methods: The medical records of 86 patients with CD who underwent endoscopic TS between 1998 and 2011 at the Radboud University Nijmegen Medical Center were examined. Data on preoperative and early postoperative evaluation, perioperative complications and follow-up were collected. Remission was defined as disappearance of clinical symptoms of hypercortisolism with basal plasma cortisol level ≤ 50 nmol/l and/or suppression of plasma cortisol level ≤ 50 nmol/l after a 1-mg overnight dexamethasone suppression test (DST). Remission of CD was confirmed in all patients that were assumed to be in remission at last follow-up with a new 1mg DST.

Results:  The remission rate in different adenoma subclasses varied significantly: 60% in MRI negative CD (n=20), 83% in microadenomas (n=35), 94% in non-invasive macroadenomas (n=16) and 40% in macroadenomas that invaded the cavernous sinus (n=15, p<0.01). The rate of recurrence was 16% after a follow-up of 67 ± 39 months (mean ± SD, range 5-164). All complications of endoscopic TS were relatively mild and did not cause any permanent damage. Thirteen patients (15%) already received hormonal substitution therapy before surgery. At the time of last follow-up 35% of all patients received hormonal substitution.

Conclusions: To our knowledge this is the largest series of results of endoscopic TS in CD reported up till now, with the longest follow-up time. Endoscopic TS is a safe and effective treatment for all patients with CD. Recurrence rates after endoscopic TS are comparable to those published for microscopic TS. Our data suggest that in patients with non-invasive  and invasive macroadenomas the endoscopic technique of TS is the technique of choice as remission rates seem to be higher than remission rates reported for microscopic TS, although no formal comparative study has been performed. In MRI negative CD or microadenomas the preference of  the neurosurgeon and/or the patient should determine the technique of TS that is used, because remission and complication rates that are reported in microscopic TS and endoscopic TS seem to be comparable.

Nothing to Disclose: MAEMW, JDB, SHPPR, JAG, EJV, JWAS, RTN, ARMMH

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: The Dutch Adrenal Society
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