Introduction: Both initial and long term endocrinological outcomes after endoscopic endonasal surgery (EES) on Cushing’s disease patients are reported.
Methods: Retrospective review of patients from April 2002 to October 2012 was conducted. Only the patients with follow up at least 2 months postoperatively were assessed. Patients were considered to be in initial postoperative remission from Cushing’s disease if they had symptoms of adrenal insufficiency requiring glucocorticoid replacement and a nadir cortisol = 5 mcg/dl during the first 36 hr after surgery and/or an 8 am cortisol = 5 mcg/dl. Remission was considered to be maintained during the follow up period if they had resolution of Cushing’s symptoms and met one or more of the following criteria: 1.) 8 am cortisol = 5 mcg/dl with continued requirement for glucocorticoid replacement, 2.) 8 am cortisol = 1.8 mcg/dl after 1 mg Dexamethasone, 3.) a normal 24 urine free cortisol and creatinine, and 4.) two normal late night salivary cortisol levels.
Results: Among 47 patients with endocrinological data, 42 (89.4%) achieved remission at initial follow up, and 33 (70.2%) achieved remission at last follow up. Mean follow up time was 38.0 months (range:8 weeks-10.2 years). Complications included panhypopituitarism (n=3), hypothyroidism (n=3), growth hormone deficiency (n=1), hypogonadism (n=1), and postoperative cerebrospinal fluid leak (n=1). Nine cases had previous surgery, and 2 cases had previous radiotherapy. Three of the patients received radiotherapy after EES. Three patients were on ketoconazole at the last follow up. There were 35 cases (74.5%) with microadenomas, and 12 cases (25.5%) with macroadenomas. Remission rate at the last follow up was 71.4% (25 of 35) for microadenomas and 66.6% (8 of 12) for macroadenomas.
Conclusions: EES offers a safe and effective treatment option for Cushing’s disease. Further analysis can guide clinicians in predicting long term endocrinological outcome after EES.
Patient Care: This study will guide clinicians in realistic insight into the rates of disease remission and common complications for EES.
Learning Objectives: By the conclusion of this session, participants should be able to: 1. Describe some of the criteria for remission of Cushing's disease, 2. Describe the complication rates and types of complications after EEA for Cushing's disease