Outcome of Endoscopic Transsphenoidal Approach to Surgical Adenomectomy in Patients with Cushing’s Disease

Background: Diagnosis and treatment of Cushing’s disease is difficult since most tumors are microadenomas, which are difficult to visualize on MRI. Endoscopic transsphenoidal surgery (ETS) has emerged as the surgical treatment of choice; however, the efficacy of ETS in treating Cushing’s disease is unclear. Our aim is to describe our institutions experience and outcome with ETS and to identify surgical risk factors associated with treatment failure.

Methods: We present a retrospective chart review of consecutive Cushing’s disease patients treated at our institution between 2005 and 2016. Data regarding patient demographic, imaging characteristics, biomedical profile before and after surgical intervention, as well as complications were collected. Patients were in postoperative remission if AM cortisol level was < 140 nmol/L.

Results: During the 11-year study period, 39 patients underwent ETS for Cushing’s disease. The mean age was 40 years, and 82% were female. Mean follow-up was 45 months. Based on remission criteria, 64% of patients experienced immediate remission. Another 8% patients demonstrated remission at 3 to 6 months of follow-up. Overall, remission after ETS was 72%. We identified cavernous sinus invasion (14 vs. 84% remission rate, p < 0.05) and previous failed surgery (42 vs. 88%, p < 0.05) as risk factors for failed surgery.

Discussion: Surgeons have increasingly adopted the endoscopic approach for treatment of Cushing’s disease. Our series demonstrates a 64% immediate remission rate, which is comparable to data in the literature. In addition, we have identified that cavernous sinus invasion and recurrent surgery as risk factors for failed surgery. Further studies are needed to establish effective treatment guidelines for Cushing’s disease.

No conflict of interest has been declared by the author(s).