RECURRENCE OF CUSHING'S DISEASE 10 YEARS AFTER TRANSSPHENOIDAL ADENOMECTOMY: REPORT OF A CASE

1996 ◽  
Vol 2 (3) ◽  
pp. 176-178
Author(s):  
Asumani S. Yeboah, MD ◽  
Joseph R. Tucci, MD, FACE
Keyword(s):  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Transsphenoidal Adenomectomy

Pituitary function before and after transsphenoidal adenomectomy in patients with Cushing's disease

1982 ◽  
Vol 65 (1-2) ◽  
pp. 29-40 ◽  
Author(s):  
B. Ambrosi ◽  
M. Giovanelli ◽  
S. M. Gaini ◽  
D. Bochicchio ◽  
E. Riva ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Pituitary Function ◽  
Cushing's Disease ◽  
Before And After ◽  
Transsphenoidal Adenomectomy

Observations on the Pathophysiology of Nelson's Syndrome: A Report of Three Cases

Neurosurgery ◽  
1990 ◽  
Vol 27 (6) ◽  
pp. 961-968 ◽  
Author(s):  
Michael Buchfelder ◽  
Rudolf Fahlbusch ◽  
Paul Thierauf ◽  
Otto A. Muüller
Keyword(s):  
Cushing’S Disease ◽  
Sella Turcica ◽  
Cushing's Disease ◽  
Nelson’S Syndrome ◽  
Nelson's Syndrome ◽  
Control Tumor Growth ◽  
Transsphenoidal Adenomectomy ◽  
Control Tumor ◽  
Transsphenoidal Operation ◽  
Acth Secreting

Abstract Nelson's syndrome is generally regarded as an unusual sequela of primary bilateral adrenalectomy when performed for Cushing's disease. It is classically defined by cutaneous hyperpigmentation, considerably elevated adrenocorticotropic hormone (ACTH) levels, and an enlarged sella turcica. In this report, we present three cases initially treated by transsphenoidal sellar exploration for Cushing's disease. In two of these cases, remission of hypercortisolism did not occur after the initial pituitary exploration. A microadenomectomy was performed in one case and, in the other, no microadenoma was found. In both, Nelson's syndrome occurred after adrenalectomy. A second transsphenoidal operation and radiotherapy were required to control tumor growth. In another case, transsphenoidal adenomectomy of an ACTH-secreting tumor initially led to a remission of hypercortisolism for 4 years, but recurrent Cushing's disease necessitated adrenalectomy, and again Nelson's syndrome occurred. The documentation of a pre-existing ACTH-secreting basophilic pituitary microadenoma before adrenalectomy, as seen in two of our cases, has not been previously reported, and these observations of “non-classical” courses have major implications for the pathophysiology of Nelson's syndrome.

scholarly journals Management of Cushing's Disease After Failed Surgery - A Review

2011 ◽  
Vol 38 (1) ◽  
pp. 12-21 ◽  
Author(s):  
Nancy McLaughlin ◽  
Amin B. Kassam ◽  
Daniel M. Prevedello ◽  
Daniel F. Kelly
Keyword(s):  
Cushing’S Disease ◽  
Stereotactic Radiotherapy ◽  
Transsphenoidal Surgery ◽  
Pituitary Surgery ◽  
Cushing's Disease ◽  
Close Collaboration ◽  
Adjuvant Therapies ◽  
Initial Surgery ◽  
Transsphenoidal Adenomectomy ◽  
Failed Surgery

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.

Predictors of remission after transsphenoidal adenomectomy in patients with Cushing's disease

2017 ◽  
Author(s):  
Eugenia Marova ◽  
Galina Kolesnicova ◽  
Svetlana Arapova ◽  
Andrey Grigoriev ◽  
Anasteysa Lapshina
Keyword(s):  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Transsphenoidal Adenomectomy

Long Term Results of Transsphenoidal Adenomectomy in Patients with Cushing's Disease

Neurosurgery ◽  
1987 ◽  
Vol 21 (2) ◽  
pp. 218-222 ◽  
Author(s):  
Toshichi Nakane ◽  
Akio Kuwayama ◽  
Masao Watanabe ◽  
Tatsuo Takahashi ◽  
Tetsuo Kato ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Pituitary Adenomas ◽  
Remission Rate ◽  
Hormone Secretion ◽  
Late Recurrence ◽  
Long Term Results ◽  
Cushing's Disease ◽  
Cell Hyperplasia ◽  
Transsphenoidal Adenomectomy

Abstract As part of an ongoing series, 100 patients with Cushing's disease underwent transsphenoidal operations. Pituitary adenomas were confirmed in 93 patients, and initial remission was achieved in 86 (92%) of them. Hypercortisolemia was not corrected in 7 patients, and in 4 this was due to invasive adenomas. These patients were subjected to irradiation, medical treatment, or both after operation. Only 7 of the 100 patients had no pituitary adenoma found at operation, and they obtained no clinical remission even after partial or subtotal hypophysectomy. Follow-up review, with an emphasis on endocrinological studies, was performed on these patients for a mean period of 38 months. Seventy-eight patients were in long term remission after operation and had restoration of noncorticotropic hormone secretion as well as pituitary-adrenal function. Recurrence was noted in 8 patients after 19 to 82 months in remission. In all of these patients, pituitary adenomas were verified by reoperation and no case of corticotrophic cell hyperplasia was noted. We conclude that late recurrence of Cushing's disease may occur after adenoma removal and is due to the regrowth of adenoma cells left behind in the peritumoral tissue at the first operation. In view of the overall remission rate, transsphenoidal adenomectomy is considered a highly effective treatment for Cushing's disease.

scholarly journals Transsphenoidal surgery for Cushing's disease: a review of success rates, remission predictors, management of failed surgery, and Nelson's Syndrome

2007 ◽  
Vol 23 (3) ◽  
pp. 1-6 ◽  
Author(s):  
Daniel F. Kelly
Keyword(s):  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Remission Rate ◽  
Cushing's Disease ◽  
Surgical Morbidity ◽  
Nelson’S Syndrome ◽  
Nelson's Syndrome ◽  
Radio Therapy ◽  
Transsphenoidal Adenomectomy

✓ Cushing's disease is a serious endocrinopathy that, if left untreated, is associated with significant morbidity and mortality rates. After diagnostic confirmation of Cushing's disease has been made, transsphenoidal adenomectomy is the treatment of choice. When a transsphenoidal adenomectomy is performed at experienced transsphenoidal surgery centers, long-term remission rates average 80% overall, surgical morbidity is low, and the mortality rate is typically less than 1%. In patients with well-defined noninvasive microadenomas, the long-term remission rate averages 90%. For patients in whom primary surgery fails, treatment options such as bilateral adrenalectomy, stereotactic radiotherapy or radiosurgery, total hypophysectomy, or adrenolytic medical therapy need to be carefully considered, ideally in a multidisciplinary setting. The management of Nelson's Syndrome often requires both transsphenoidal surgery and radio-therapy to gain disease control.

scholarly journals Cushing’s Disease Presented by Reversible Dilated Cardiomyopathy

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Berna İmge Aydoğan ◽  
Demet Menekşe Gerede ◽  
Asena Gökçay Canpolat ◽  
Murat Faik Erdoğan
Keyword(s):  
Dilated Cardiomyopathy ◽  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Ventricular Hypertrophy ◽  
Cushing's Syndrome ◽  
Left Ventricular ◽  
Cushing's Disease ◽  
Resonance Imaging ◽  
Transsphenoidal Adenomectomy ◽  
Proximal Myopathy

Introduction. Dilated cardiomyopathy is rarely reported among CS patients especially without hypertension and left ventricular hypertrophy.Materials and Methods. We hereby report a Cushing’s syndrome case presenting with dilated cardiomyopathy.Results. A 48-year-old female patient was admitted to our clinic with severe proximal myopathy and dilated cardiomyopathy without ventricular hypertrophy. Cushing’s disease was diagnosed and magnetic-resonance imaging of the pituitary gland revealed a microadenoma. Under diuretic and ketoconazole treatments, she underwent a successful transnasal/transsphenoidal adenomectomy procedure. Full recovery of symptoms and echocardiographic features was achieved after six months of surgery.Conclusion. Cushing’s syndrome must be kept in mind as a reversible cause of dilated cardiomyopathy. Recovery of cardiomyopathy is achieved with successful surgery.

scholarly journals Factors affecting the probability of recurrence of the Cushing’s disease within 3 years after effective neurosurgical treatment

2018 ◽  
Vol 12 (2) ◽  
pp. 70-80 ◽  
Author(s):  
Elena Y. Nadezhdina ◽  
Olga Y. Rebrova ◽  
Oksana V. Ivashenko ◽  
Vilen N. Azizyan ◽  
Svetlana D. Arapova ◽  
...  
Keyword(s):  
Cortisol Level ◽  
Postoperative Period ◽  
Cushing’S Disease ◽  
Roc Analysis ◽  
Early Postoperative Period ◽  
Cushing's Disease ◽  
Acth Level ◽  
Factors Affecting ◽  
Transsphenoidal Adenomectomy ◽  
Neurosurgical Treatment

Background. Cushing’s disease (СD) is а severe neuroendocrine disease that can rapidly progress with the development of severe complications of hypercorticism requiring immediate treatment. The main method of treatment is a neurosurgical operation, the effectiveness of which at the present time can reach 80% or more, however, about a quarter of patients after successful neurosurgical treatment experience reccurence. Aim. The analysis of prognostic factors potentially affecting the occurrence of recurrence of CD after successful primary transnasal adenomectomy. Material and methods. A retrospective monocenter comparative study of treatment outcomes in 219 patients (32 men, 187 women) with confirmed diagnosis of Cushing's disease who underwent endoscopic transsphenoidal adenomectomy between 2007 and 2014 was performed. The inclusion criteria were: the absence of previous pathogenetic treatment for this disease and the development of remission of the disease in the early postoperative period. The duration of follow-up period was three years and more. We used methods of statistical comparison of groups, including survival analysis and ROC-analysis. Results. Within 3 years the remission was preserved in 172 patients, the recurrence of Cushing's disease developed in 47 patients (21.5% [16%; 28%]). The probability of CD recurrence was associated with morning levels of ACTH and cortisol and evening ACTH in the early postoperative period. As a result of the ROC-analysis for morning ACTH and cortisol, the optimal cutting points were 7 pg/ml and 123 nmol/l respectively. In patients with ACTH level less than 7 pg/ml, three years recurrence appeared to be 7%, 95% CI [3%, 14%], while at the level of ≥7 pg/ml recurrence was observed in 31% [23%, 40%] cases, RR 0.22 [0.09; 0.51], ОR – 0.16 [0.06; 0.43]. In patients with cortisol level below 123 nmol/l the recurrence developed in 13% [9%, 20%] of cases, while in patients with cortisol level ≥123 nmol/l, recurrence was equal to 45% [32%, 59%], RR 0.29 [0.18; 0.50], ОR – 0.19 [0.09; 0.39]. Conclusion. The development of adrenal insufficiency (a decrease in ACTH level less than 7 pg/ml and cortisol level less than 123 nmol/l) statistically significantly reduces the probability of the recurrence of CD within three years after surgery.

scholarly journals Three Successful Pregnancies in a Patient with Recurrent Cushing’s Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
W. Benothman ◽  
G. Saad ◽  
M. Kacem ◽  
K. Ach
Keyword(s):  
Cushing’S Disease ◽  
Adrenocorticotropic Hormone ◽  
Hypogonadotropic Hypogonadism ◽  
Specific Treatment ◽  
Cushing's Disease ◽  
Maternal Complications ◽  
Spontaneous Pregnancy ◽  
Transsphenoidal Adenomectomy ◽  
Fetal Complications ◽  
Optimal Approach

The association of pregnancy and Cushing’s disease (CD) is rare. A 28-year-old woman was admitted for clinical suspicion of Cushing’s syndrome. The investigations confirmed the diagnosis of CD with secondary hypogonadotropic hypogonadism due to an invasive pituitary macroadenoma. The patient underwent transsphenoidal adenomectomy, and histopathology showed an adrenocorticotropic hormone pituitary adenoma. Initial remission of CD ensued, and fertility was restored as the patient had 2 uncomplicated pregnancies. Five years and 10 months after surgery, a third spontaneous pregnancy was confirmed with underlying recurrent CD. Having mild hypercortisolism, CD was managed expectantly. The outcome was a healthy full-term neonate with no maternal complications during pregnancy or labor. Our case highlights the challenge faced by physicians of choosing the optimal approach to active CD in pregnancy. In cases where maternal and fetal complications are mild, conservative approach may be used and specific treatment can be postponed until after delivery.

scholarly journals Five years follow up of patients with Сushing’s disease with and without visualized pituitary adenoma on MRI, who underwent transsphenoidal adenomectomy

2017 ◽  
Vol 63 (5) ◽  
pp. 276-281
Author(s):  
Patimat M. Khandaeva ◽  
Zhanna E. Belaya ◽  
Lyudmila Ya. Rozhinskaya ◽  
Aleksandr V. Vorontsov ◽  
Andrey Yu. Grigoriev ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Cushing’S Disease ◽  
Remission Rate ◽  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
Cushing's Disease ◽  
Surgery Complications ◽  
Free Cortisol ◽  
Transsphenoidal Adenomectomy

The remission rate of Cushing’s disease in patients after neurosurgery varies from 59 to 94%, while the recurrence rate is 3 to 46%. Aim — to evaluate the five-year outcome in neurosurgery patients with Cushing’s disease (CD), depending on preoperative MRI-based identification of pituitary adenoma. Material and methods. The study included 105 neurosurgery patients with histologically confirmed CD. CD remission was confirmed by the development of adrenal insufficiency and/or normalization of serum cortisol and 24-hour urinary free cortisol (24h UFC) levels, as well as by clinical remission. Results. Pituitary adenoma was not visualized by gadolinium MRI in 35 cases. The size of visualized pituitary adenoma varied from 0.3 to 29 mm. After first neurosurgery, remission was achieved in 87 (82.8%) patients. After second neurosurgery, remission occurred in 12 patients. Radiation therapy was conducted in 24 patients. Six patients had bilateral adrenalectomy. Two patients died during remission: one patient died from stroke two years after neurosurgery, and the other patient died due to surgery complications. During five-year follow-up after neurosurgery, remission continued in 76 (72.8%) patients, including 27 (77%) of 35 patients without MRI-detected adenoma and 49 (70%) of 70 patients with MRI-detected pituitary adenoma, p=0.15. Sixty-six patients developed recurrence, and 14 patients had active hypercortisolism. Conclusion. There was no correlation between the rate of preoperative MRI-based detection of pituitary adenoma and the rate of remission in neurosurgery patients with Cushing’s disease during the five year follow-up. The size of pituitary adenoma was a risk factor for adenoma recurrence.

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