Cushing's disease: results of Ibn Sina neurosurgical department and review of the literature

ABSTRACT

Cushing's disease in an excessive secretion of adrenocorticotrophic hormone [ACTH] by a pituitary corticotroph tumour, which is responsible for two-thirds of all cases of Cushing's syndrome. We attempt in this paper to present our results, and to review the literature for a better understanding of this pathology that poses many problems in diagnosis and treatment. The authors report 15 cases of Cushing's disease from a series of 174 pituitary adenomas admitted in Neurosurgical department of Ibn Sina hospital, between January 1987 and December 1999. These 15 corticotroph adenomas, only 13 of which have sufficient data and follow-up are retained in our survey. We noted a female preponderance [11/2], with a mean age of 33 years. In our series and by reason of selection methods, surgical treatment was indicated according to focal lesions on magnetic resonance imaging and not on clinical and biological findings alone. All of these patients underwent trans-sphenoidal approach as a primary choice. Five [5] patients developed recurrence of high level cortisol in blood * 2 refused subsequent operations * 2 underwent irradiation * 1 underwent removal of tumour by successful sub-frontal approach. There was no mortality in this series and the only case of morbidity consisted of one rhinoliquorrhea that improved after surgical treatment