Article

Management of Cushing's disease after failed surgery--a review.

Neuroscience Institute & Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques (impact factor: 0.97). 01/2011; 38(1):12-21. pp.12-21
Source: PubMed

ABSTRACT Selective transsphenoidal adenomectomy is generally recommended for initial treatment of Cushing's disease (CD) because it achieves a high (70-85%) rate of remission. However, if initial surgery is not successful, the approach to persistent or recurrent CD is more complex. Because residual or recurrent adenoma is typically found at the site of the original adenoma, repeat transsphenoidal surgery is recommended including selective adenomectomy, hemihypophysectomy or total hypophysectomy. If repeat pituitary surgery does not achieve remission, then possible adjuvant therapies include radiosurgery or stereotactic radiotherapy, bilateral adrenalectomy, and/or medical therapy. In all cases of persistent or recurrent CD, successful treatment requires close collaboration of endocrinologists, radiation oncologists and neurosurgeons.

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Keywords

bilateral adrenalectomy
 
hemihypophysectomy
 
initial surgery
 
medical therapy
 
neurosurgeons
 
original adenoma
 
persistent
 
possible adjuvant therapies
 
radiosurgery
 
recurrent adenoma
 
recurrent CD
 
remission
 
repeat pituitary surgery
 
repeat transsphenoidal surgery
 
residual
 
Selective transsphenoidal adenomectomy
 
stereotactic radiotherapy
 

Nancy McLaughlin