Surgical Outcomes and Comorbidities in Cushing Disease: 30 Years of Experience in a Referral Center
| Autor: | Ariel Kaen, Antonio Jesús Martínez Ortega, Pablo Jesús Remón Ruíz, Francisco Javier Marquez Rivas, Elena Dios, Alfonso Soto-Moreno, Eugenio Cárdenas Valdepeñas, Eva Venegas-Moreno, David A. Cano |
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| Rok vydání: | 2018 |
| Předmět: |
Adenoma
Adult Male medicine.medical_specialty medicine.medical_treatment Hypopituitarism 03 medical and health sciences 0302 clinical medicine Postoperative Complications Interquartile range medicine Humans Pituitary ACTH Hypersecretion Retrospective Studies Transsphenoidal surgery Adjuvant radiotherapy business.industry Retrospective cohort study Endoscopy Middle Aged University hospital Cushing Disease Surgery Radiation therapy ACTH-Secreting Pituitary Adenoma Treatment Outcome 030220 oncology & carcinogenesis Referral center Female Radiotherapy Adjuvant Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | World neurosurgery. 122 |
| ISSN: | 1878-8769 |
| Popis: | Objective Cushing disease (CD) is a rare, poorly understood entity. Our aim was to add our clinical experience of >30 years in a multidisciplinary specialized unit to the global knowledge of CD. Methods This descriptive retrospective study included all patients admitted to the Endocrinology and Nutrition Department of the Virgen del Rocio University Hospital, Seville, Spain, from January 1980 to May 2016. All patients had a definitive diagnosis of CD. Results Total sample included 119 patients; 100 (84%) were female. Median age at diagnosis was 37.97 years (interquartile range [IQR]: 25.89–45.07 years). Median follow-up was 88 months (IQR: 45.50–157.00 months). Most tumors were microadenomas (62/95) (5.1 mm [IQR: 4.0–7.0 mm]) without sinus invasion. Surgical procedures were conventional transsphenoidal surgery (CTSS) (101/108; cured 70 after first attempt) and expanded endoscopic transsphenoidal surgery (EETSS) (7/108; cured 5 after first attempt); 11 patients did not receive surgical treatment. Fourteen patients received radiotherapy after a first surgery and 5 patients after a second surgical removal attempt. In 13 patients (12.04%), CD relapse was demonstrated after initial CTSS (median disease-free period 65 months [IQR: 45–120 months]). Ten patients developed panhypopituitarism owing to the surgical procedure (CTSS); 8 patients developed panhypopituitarism after adjuvant radiotherapy. Conclusions We observed slightly inferior cure rate after first surgery compared with moderately better relapse rates and time to relapse. Radiotherapy after surgery failure seemed to be more effective than CTSS; however, EETSS may be a valid alternative. Postoperative panhypopituitarism rate after first surgery was lower than expected; after radiotherapy, our results were comparable to other series. |
| Databáze: | OpenAIRE |
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