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Endocrine remission of Cushing's disease after endoscopic trans-sphenoidal surgery: Retrospective review of a single centre experience

Authors:
Endocrine remission of Cushing’s disease after
Endoscopic Transsphenoidal Surgery:
a single centre experience
Devon Kennard, Benjamin Whitelaw, Dorota Dworakowska, Nick Thomas, Sinan Barazi, Peter Bullock,
Andrew King, Tim Hampton, Charles Buchanan, Jackie Gilbert, Alan McGregor, Simon Aylwin
Study, Year, Journal
Initial overall remission
rate (%)
Microadenoma
remission rate (%)
Starke et al., 2012, Neurosurgery
95
97
Leach et al., 2010, Neurosurgery
70
NA
Hwang et al., 2009, J Korean Med Sci
80
73
Dehdashti et al., 2008, Neurosurgery
81
100
Netea-Maier et al., 2006, Eur J Endocrine
77
79
Frank et al., 2006, Neuroendocrinology
68
68
TOTAL AVERAGE
80 (68-95)
84 (68-100)
Trans-sphenoidal surgery (TSS) is
the first line treatment for Cushings
disease (CD).
The newer endoscopic method is
increasingly replacing the traditional
microscopic trans-sphenoidal
approach.
The reported success rates for
endoscopic TSS for CD are highly
variable, averaging around 70-80%
In experienced tertiary centres.
40 cases of Cushing’s Disease that
proceeded to first surgical intervention
12 Macroadenomas
6/12 in remission
28 Microadenomas
24/28 in remission
Our study was a retrospective audit of
the endocrine remission rates for
patients who had endoscopic TSS for
suspected or proven CD.
Data was collected using the
electronic patient database from Jan
2007, when the department
commenced endoscopic surgery, until
Nov 2012.
We also conducted a systematic
review of the international literature
in order to compare our remission
rates with other centres.
For the purpose of this analysis:
1. Patients who had surgery followed
by a re-exploration during the
same admission were treated as
having a single surgical
intervention.
2. Patients who had undergone
previous pituitary surgery were
excluded.
3. Post-operative remission was
defined as serum cortisol
<50nmol/l within 3 months of the
surgical intervention.
Method: An electronic literature search in MEDLINE, EMBASE and Web of Science was performed from 5th November 2012 to 6th December 2012 to identify all studies that answered
the research question of interest. For this purpose, the following key terms were used: adrenocorticotrophic hormone, corticotrophin-releasing hormone, cortisol, Cushings, Cushing’s
disease, disease, endoscopic, hypercortisolism, macroadenoma, meta-analysis, microadenoma, microscopic, microsurgery, neuronavigation, outcome assessment, pituitary adenoma,
pituitary surgery, recurrence, relapse, remission, secretory tumo(u)rs, surgery, treatment, transsphenoidal.
The endocrine remission rate
for endoscopic TSS at KCH for
microadenomas was 86%. The
overall post-operative
remission rate was 75%.
This is comparable to the
highest remission rates
reported in the international
literature.
0
10
20
30
40
50
60
70
80
90
100
King's College Hospital
Systematic review of
International data
Percentage (%)
ENDOCRINE REMISSION RATES FOR
ENDOSCOPIC TSS FOR CD
Microadenoma
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