engleski

Cushing's disease at University Hospital Center Zagreb - Results of transsphenoidal surgery treatment (Retrospective study)

Cushing's disease is a hypercortisolemic state due to an adrenocorticotropic hormone producing pituitary adenoma. Transsphenoidal surgery is a treatment of choice for Cushing's disease. A retrospective study of 12 patients (8 women, 4 men) with Cushing's disease undergoing transsphenoidal surgery at the University Hospital Centre Zagreb, from 1991 to 1998, is presented. There were 10 microadenomas and 2 macroadenomas. Selective surgery was done if tumor was seen, and more extensive surgery if has not, or if tumor was diffuse. Patients were followed for a median time of 31 months (range: 6-84). Remission rate was 50 percent.Criteria for failures were loss of the normal circadian rhythm of serum cortisol and urinary free cortisol above 250 nmol/day, within the first year after operation. Of all six failures, two underwent succesful operation, other two underwent bilateral adrenalectomy and one is still awaiting surgery. Two patients (16 percent) had cerebrovascular fluid leak, but none developed meningitis. All but one patient developed postoperative pituitary insufficiency which is diagnosed on the basis of low hormone answers in stimulation tests (TRH, LH-RH and insulin test). Two patients (16 percent) developed permanent diabetes insipidus, 11/12 patients (91 percent) had ACTH deficiency, 9/12 patients (75 percent) developed hypogonadism and 8/12 patients (66 percent) became hypothyroid. Our results, with a cumulative remission rate of 66 percent, are comparable to those of other studies, but the rate of postoperative pituitary insufficiency was unexpectedly high.

Cushing's disease; pituitary insufficiency

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