Twenty years of neurosurgical experience with Cushing's disease: surgical strategies, endocrine outcomes, and remission predictors in 346 patients
Authors' conclusion
Transsphenoidal surgery remains an effective and safe treatment for CD, with high remission rates and long-term control, strongly associated with tumor characteristics and surgical approach.
Study context
- Population
- Patients with confirmed Cushing's disease (CD) undergoing pituitary surgery, University Hospital of Tübingen, 2004–2024
- Participants
- 346 patients376 surgeries
- Exposure
- Primary vs repeat transsphenoidal surgery
- Outcome
- Early remission
- Follow-up
- Discharge and first
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Early remission at discharge
81.9%
Early remission at first follow-up
89.8%
Recurrence rate during long-term follow-up (mean 109.7 months)
9.4%
Observational data: associations, not effects.
Further findings
Remission, primary vs repeat surgery · first follow-up
P < 0.001
Remission, primary vs repeat surgery · long-term
P < 0.001
Preoperative predictors of remission
- Detectable microadenoma on magnetic resonance imaging (MRI)
- P = 0.001
- Smaller adenoma size (mean 7.5 mm vs 12.6 mm)
- P = 0.001
- Invasive adenoma growth on MRI correlated with lower remission rates
Intraoperative factors associated with remission
- Shorter surgical duration (82.1 vs 101.3 min)
- P < 0.001
- Clear adenoma visualization
- P < 0.001
- Histopathological confirmation
- P = 0.003
- Selective adenomectomy
- P < 0.001
- Absence of intraoperative invasiveness
- P = 0.003
Comorbidity improvement with remission
- Greater improvement in hypertension
- P < 0.001
- Greater improvement in T2D
- P = 0.030
- Weight loss
- P < 0.001
Safety
- New pituitary hormone deficiencies occurred mainly after extensive surgery
Original publication
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