This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Patil, C. G. Articles by Laws, E. R. Search for Related Content PubMed PubMed Citation Articles by Patil, C. G. Articles by Laws, E. R., Jr. Related Collections Adrenal and Hypertension Neuroendocrinology and Pituitary Endocrine Oncology

Late Recurrences of Cushing’s Disease after Initial Successful Transsphenoidal Surgery

Department of Neurosurgery (C.G.P., S.P.L., L.K., E.R.L.), Stanford University School of Medicine, Stanford, California 94305; Department of Neurological Surgery (D.M.P.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213; and Department of Internal Medicine-Endocrinology (M.L.V., M.O.T.), University of Virginia Health System, Charlottesville, Virginia 22908

Address all correspondence and requests for reprints to: Chirag G. Patil, M.D., Stanford Hospital, Department of Neurosurgery, 300 Pasteur Drive, Room R281 MC5327, Stanford, California 94305. E-mail: chiragpatil{at}gmail.com.

Context: Few studies have systematically analyzed the long-term recurrence rates of Cushing’s disease after initial successful transsphenoidal surgery.

Setting: This was a retrospective review of patients treated at the University of Virginia Medical Center.

Patients: A total of 215 subjects with Cushing’s disease who underwent initial transsphenoidal surgery for resection of a presumed pituitary microadenoma from 1992–2006 were included.

Main Outcome Measures: Remission and recurrence rates of Cushing’s disease were examined. Recurrence was defined as an elevated 24-h urine free cortisol with clinical symptoms consistent with Cushing’s disease.

Results: Of the 215 patients who underwent transsphenoidal surgery for Cushing’s disease, surgical remission was achieved in 184 (85.6%). The mean length of follow-up was 45 months. Actuarial recurrence rates of Cushing’s disease after initially successful transsphenoidal surgery at 1, 2, 3, and 5 yr were 0.5, 6.7, 10.8, and 25.5%, respectively. Among the 184 patients who achieved remission, 32 (17.4%) patients followed for more than 6 months ultimately had a recurrence of Cushing’s disease. The median time to recurrence was 39 months. Immediate postoperative hypocortisolemia (serum cortisol 2 µg/dl within 72-h surgery) was achieved in 97 (45.1%) patients. Patients who had postoperative serum cortisol of more than 2 µg/dl were 2.5 times more likely to have a recurrence than patients who had serum cortisol less than or equal to 2 µg/dl (odds ratio = 2.5; 95% confidence interval 1.12–5.52; P = 0.022).

Conclusions: A quarter of the patients with Cushing’s disease who achieve surgical remission after transsphenoidal surgery, recur with long-term follow-up. This finding emphasizes the need for continued biochemical and clinical follow-up to ensure remission after surgery.

This article has been cited by other articles:

				F. Castinetti, M. Martinie, I. Morange, H. Dufour, N. Sturm, J.-G. Passagia, B. Conte-Devolx, O. Chabre, and T. Brue A Combined Dexamethasone Desmopressin Test as an Early Marker of Postsurgical Recurrence in Cushing's Disease J. Clin. Endocrinol. Metab., June 1, 2009; 94(6): 1897 - 1903. [Abstract] [Full Text] [PDF]

				C. de Bruin, A. M. Pereira, R. A. Feelders, J. A. Romijn, F. Roelfsema, D. M. Sprij-Mooij, M. O. van Aken, A.-J. van der Lelij, W. W. de Herder, S. W. J. Lamberts, et al. Coexpression of Dopamine and Somatostatin Receptor Subtypes in Corticotroph Adenomas J. Clin. Endocrinol. Metab., April 1, 2009; 94(4): 1118 - 1124. [Abstract] [Full Text] [PDF]

				M.-L. Nunes, S. Vattaut, J.-B. Corcuff, A. Rault, H. Loiseau, B. Gatta, N. Valli, L. Letenneur, and A. Tabarin Late-Night Salivary Cortisol for Diagnosis of Overt and Subclinical Cushing's Syndrome in Hospitalized and Ambulatory Patients J. Clin. Endocrinol. Metab., February 1, 2009; 94(2): 456 - 462. [Abstract] [Full Text] [PDF]

				S. Jehle, J. E. Walsh, P. U. Freda, and K. D. Post Selective Use of Bilateral Inferior Petrosal Sinus Sampling in Patients with Adrenocorticotropin-Dependent Cushing's Syndrome Prior to Transsphenoidal Surgery J. Clin. Endocrinol. Metab., December 1, 2008; 93(12): 4624 - 4632. [Abstract] [Full Text] [PDF]