Top

Published in:

01-01-2014 | Original Article

Early promising results for the endoscopic surgical treatment of Cushing’s disease

Authors: Mustafa Berker, Ilkay Işikay, Dilek Berker, Miyase Bayraktar, Alper Gürlek

Published in: Neurosurgical Review | Issue 1/2014

Abstract

High levels of endogenous cortisol due to Cushing’s disease cause significant mortality and morbidity. Treatment of Cushing’s disease is challenging. For many years, transsphenoidal microsurgical resection of the adenoma has been the treatment of choice. However, recently, neuroendoscope has taken its place in the neurosurgeon’s armamentarium, and the endoscopic transsphenoidal resection of pituitary tumors has become a familiar approach. Our aim was to present the results of pure endoscopic surgery in the treatment of corticotropinomas for comparison with the results of previous endoscopic and microsurgical series. We present a retrospective analysis of 90 patients with diagnosis of Cushing’s disease who were operated between 2006 and 2012. Among 90 patients, a total of 81 (90.0 %) had a remission (28 out of 29 macroadenomas (96.6 %) and 53 out of 61 microadenoma patients (86.9 %)). Of note is that 66 out of 69 (95.7 %) primary patients (i.e., those who were operated in our center) and 15 out of 21 (71.4 %) patients previously operated in other centers reached a hypo/eucortisolemic state. A remission rate comparable with previous endoscopic series was achieved. In nine patients, it was not possible to achieve remission at all. On the other hand, only four of our cases (5.6 %) had a recurrence, and with reoperation, all of these patients entered a re-remission. To our knowledge, our series is the largest series studying endoscopically operated adrenocorticotropic hormone-secreting adenomas. Our results suggest that the endoscopic approach has opened a new avenue in the treatment of Cushing’s disease, previously a therapeutic challenge for both the clinician and the neurosurgeon. Endoscopic approach in the treatment of Cushing’s disease is clearly better for patients because of its low morbidity rates and short duration of hospital stay. On the other hand, long-term follow-up of our patients will show whether these favorable observations will persist.

Alwani RA, de Herder WW, van Aken MO, van den Berge JH, Delwel EJ, Dallenga AH, De Jong FH, Lamberts SW, van der Lely AJ, Feelders RA (2010) Biochemical predictors of outcome of pituitary surgery for Cushing’s disease. Neuroendocrinology 91(2):169–178. doi:10.1159/000258677 PubMedCrossRef

Andrioli M, Pecori Giraldi F, Losa M, Terreni M, Invitti C, Cavagnini F (2010) Cushing's disease due to double pituitary ACTH-secreting adenomas: the first case report. Endocr J 57(9):833–837PubMedCrossRef

Arnaldi G, Angeli A, Atkinson AB, Bertagna X, Cavagnini F, Chrousos GP, Fava GA, Findling JW, Gaillard RC, Grossman AB, Kola B, Lacroix A, Mancini T, Mantero F, Newell-Price J, Nieman LK, Sonino N, Vance ML, Giustina A, Boscaro M (2003) Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 88(12):5593–5602PubMedCrossRef

Berker D, Aydin Y, Işık S, Söylemezoğlu F, Tütüncü Y, Berker M, Delibaşı T, Guler S (2010) Cushing disease associated with Rathke’s cleft cyst. Acta Endocrinol (Copenh) 3:371–376

Berker M, Hazer DB, Yucel T, Gurlek A, Cila A, Aldur M, Onerci M (2012) Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature. Pituitary 15(3):288–300. doi:10.1007/s11102-011-0368-2 PubMedCrossRef

Biller BM, Grossman AB, Stewart PM, Melmed S, Bertagna X, Bertherat J, Buchfelder M, Colao A, Hermus AR, Hofland LJ, Klibanski A, Lacroix A, Lindsay JR, Newell-Price J, Nieman LK, Petersenn S, Sonino N, Stalla GK, Swearingen B, Vance ML, Wass JA, Boscaro M (2008) Treatment of adrenocorticotropin-dependent Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 93(7):2454–2462. doi:10.1210/jc.2007-2734 PubMedCrossRef

Bochicchio D, Losa M, Buchfelder M (1995) Factors influencing the immediate and late outcome of Cushing’s disease treated by transsphenoidal surgery: a retrospective study by the European Cushing’s Disease Survey Group. J Clin Endocrinol Metab 80(11):3114–3120PubMedCrossRef

Cappabianca P, Alfieri A, Colao A, Ferone D, Lombardi G, de Divitiis E (1999) Endoscopic endonasal transsphenoidal approach: an additional reason in support of surgery in the management of pituitary lesions. Skull Base Surg 9(2):109–117PubMedCentralPubMedCrossRef

Cappabianca P, Alfieri A, de Divitiis E (1998) Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg 41(2):66–73. doi:10.1055/s-2008-1052019 PubMedCrossRef

10.

Cappabianca P, Cavallo LM, de Divitiis E (2004) Endoscopic endonasal transsphenoidal surgery. Neurosurgery 55(4):933–940, discussion 940–931PubMedCrossRef

11.

Chen JC, Amar AP, Choi S, Singer P, Couldwell WT, Weiss MH (2003) Transsphenoidal microsurgical treatment of Cushing disease: postoperative assessment of surgical efficacy by application of an overnight low-dose dexamethasone suppression test. J Neurosurg 98(5):967–973. doi:10.3171/jns.2003.98.5.0967 PubMedCrossRef

12.

Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40(2):225–236, discussion 236-227PubMedCrossRef

13.

Dehdashti AR, Gentili F (2007) Current state of the art in the diagnosis and surgical treatment of Cushing disease: early experience with a purely endoscopic endonasal technique. Neurosurg Focus 23(3):E9. doi:10.3171/foc.2007.23.3.11 PubMedCrossRef

14.

Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V, Faustini Fustini M (2006) The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology 83(3–4):240–248. doi:10.1159/000095534 PubMedCrossRef

15.

Hammer GD, Tyrrell JB, Lamborn KR, Applebury CB, Hannegan ET, Bell S, Rahl R, Lu A, Wilson CB (2004) Transsphenoidal microsurgery for Cushing’s disease: initial outcome and long-term results. J Clin Endocrinol Metab 89(12):6348–6357. doi:10.1210/jc.2003-032180 PubMedCrossRef

16.

Hofmann BM, Fahlbusch R (2006) Treatment of Cushing’s disease: a retrospective clinical study of the latest 100 cases. Front Horm Res 34:158–184. doi:10.1159/000091580 PubMedCrossRef

17.

Jagannathan J, Smith R, DeVroom HL, Vortmeyer AO, Stratakis CA, Nieman LK, Oldfield EH (2009) Outcome of using the histological pseudocapsule as a surgical capsule in Cushing disease. J Neurosurg 111(3):531–539. doi:10.3171/2008.8.JNS08339 PubMedCentralPubMedCrossRef

18.

Jankowski R, Auque J, Simon C, Marchal JC, Hepner H, Wayoff M (1992) Endoscopic pituitary tumor surgery. Laryngoscope 102(2):198–202. doi:10.1288/00005537-199202000-00016 PubMedCrossRef

19.

Jho HD (2001) Endoscopic transsphenoidal surgery. J Neurooncol 54(2):187–195PubMedCrossRef

20.

Jho HD, Alfieri A (2001) Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minim Invasive Neurosurg 44(1):1–12. doi:10.1055/s-2001-13590 PubMedCrossRef

21.

Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87(1):44–51. doi:10.3171/jns.1997.87.1.0044 PubMedCrossRef

22.

Lindholm J, Juul S, Jorgensen JO, Astrup J, Bjerre P, Feldt-Rasmussen U, Hagen C, Jorgensen J, Kosteljanetz M, Kristensen L, Laurberg P, Schmidt K, Weeke J (2001) Incidence and late prognosis of Cushing’s syndrome: a population-based study. J Clin Endocrinol Metab 86(1):117–123PubMedCrossRef

23.

Lindsay JR, Oldfield EH, Stratakis CA, Nieman LK (2011) The postoperative basal cortisol and CRH tests for prediction of long-term remission from Cushing’s disease after transsphenoidal surgery. J Clin Endocrinol Metab 96(7):2057–2064. doi:10.1210/jc.2011-0456 PubMedCrossRef

24.

Ludecke DK, Niedworok G (1985) Results of microsurgery in Cushing’s disease and effect on hypertension. Cardiology 72(Suppl 1):91–94PubMed

25.

Netea-Maier RT, van Lindert EJ, den Heijer M, van der Eerden A, Pieters GF, Sweep CG, Grotenhuis JA, Hermus AR (2006) Transsphenoidal pituitary surgery via the endoscopic technique: results in 35 consecutive patients with Cushing’s disease. Eur J Endocrinol 154(5):675–684. doi:10.1530/eje.1.02133 PubMedCrossRef

26.

Oldfield EH, Vortmeyer AO (2006) Development of a histological pseudocapsule and its use as a surgical capsule in the excision of pituitary tumors. J Neurosurg 104(1):7–19. doi:10.3171/jns.2006.104.1.7 PubMedCrossRef

27.

Oruckaptan HH, Senmevsim O, Ozcan OE, Ozgen T (2000) Pituitary adenomas: results of 684 surgically treated patients and review of the literature. Surg Neurol 53(3):211–219PubMedCrossRef

28.

Prevedello DM, Pouratian N, Sherman J, Jane JA Jr, Vance ML, Lopes MB, Laws ER Jr (2008) Management of Cushing’s disease: outcome in patients with microadenoma detected on pituitary magnetic resonance imaging. J Neurosurg 109(4):751–759. doi:10.3171/JNS/2008/109/10/0751 PubMedCrossRef

29.

Ram Z, Nieman LK, Cutler GB Jr, Chrousos GP, Doppman JL, Oldfield EH (1994) Early repeat surgery for persistent Cushing’s disease. J Neurosurg 80(1):37–45. doi:10.3171/jns.1994.80.1.0037 PubMedCrossRef

30.

Rees DA, Hanna FW, Davies JS, Mills RG, Vafidis J, Scanlon MF (2002) Long-term follow-up results of transsphenoidal surgery for Cushing’s disease in a single centre using strict criteria for remission. Clin Endocrinol (Oxf) 56(4):541–551CrossRef

31.

Rollin G, Ferreira NP, Czepielewski MA (2007) Prospective evaluation of transsphenoidal pituitary surgery in 108 patients with Cushing’s disease. Arq Bras Endocrinol Metabol 51(8):1355–1361PubMedCrossRef

32.

Schrell U, Fahlbusch R, Buchfelder M, Riedl S, Stalla GK, Muller OA (1987) Corticotropin-releasing hormone stimulation test before and after transsphenoidal selective microadenomectomy in 30 patients with Cushing’s disease. J Clin Endocrinol Metab 64(6):1150–1159PubMedCrossRef

33.

Shimon I, Ram Z, Cohen ZR, Hadani M (2002) Transsphenoidal surgery for Cushing’s disease: endocrinological follow-up monitoring of 82 patients. Neurosurgery 51(1):57–61, discussion 61–52PubMedCrossRef

34.

Storr HL, Afshar F, Matson M, Sabin I, Davies KM, Evanson J, Plowman PN, Besser GM, Monson JP, Grossman AB, Savage MO (2005) Factors influencing cure by transsphenoidal selective adenomectomy in paediatric Cushing’s disease. Eur J Endocrinol 152(6):825–833. doi:10.1530/eje.1.01921 PubMedCrossRef

35.

Trainer PJ, Lawrie HS, Verhelst J, Howlett TA, Lowe DG, Grossman AB, Savage MO, Afshar F, Besser GM (1993) Transsphenoidal resection in Cushing’s disease: undetectable serum cortisol as the definition of successful treatment. Clin Endocrinol (Oxf) 38(1):73–78CrossRef

36.

Wagenmakers MA, Netea-Maier RT, van Lindert EJ, Timmers HJ, Grotenhuis JA, Hermus AR (2009) Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing’s disease (CD). Clin Endocrinol (Oxf) 70(2):274–280. doi:10.1111/j.1365-2265.2008.03334.x CrossRef

37.

Yap LB, Turner HE, Adams CB, Wass JA (2002) Undetectable postoperative cortisol does not always predict long-term remission in Cushing’s disease: a single centre audit. Clin Endocrinol (Oxf) 56(1):25–31CrossRef

Title: Early promising results for the endoscopic surgical treatment of Cushing’s disease
Authors: Mustafa Berker
Ilkay Işikay
Dilek Berker
Miyase Bayraktar
Alper Gürlek
Publication date: 01-01-2014
Publisher: Springer Berlin Heidelberg
Published in: Neurosurgical Review / Issue 1/2014
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-013-0506-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Early promising results for the endoscopic surgical treatment of Cushing’s disease

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2014

Postoperative fever specific to neuroendoscopic procedures

Posterior condylar canals and posterior condylar emissary veins—a microsurgical and CT anatomical study

Endoscopic third ventriculostomy: can we predict success during surgery?

Referees 2013

Schmorl's nodes: current pathophysiological, diagnostic, and therapeutic paradigms

Endovascular treatment of 170 consecutive cranial dural arteriovenous fistulae: results and complications