Cushing's Disease: Clinical Analysis and Surgical Outcome in 16 Cases

ABSTRACT

From March, 1984 to August, 1991, 16 patient were diagnosed as Cushing's disease and 14 of them were treated by transsphenoidal microsurgical procedure. Preoperrative endocrinological evaluation included plasma level of ACTH, serum cortisol concentration, urinary free cortisol and 17-hydroxycorticosteroid, dexamethasone suppression test and bilateral sampling of the inferior petrosal sinuses(IPS). The sensitivity of the last method was 88% for Cushing's disease but the expected laterality with the test was not always consistent with the surgical results. High resolution computed tomography(CT) and high field magnetic resonance imaging(MRI) were done as imaging devices. We cannot tell MRI is superior to CT is diagnosing microadenomas. All operations were performed through transsphenoidal approach. A selective microadenomectomy was done in 8 patients and all of them showed remission. A partial adenomectomy was done in 4 cases. Hypophysectomy was done in 2 cases, one of which was a failed case after the first trial and the other was one with no apparent tumor tissue in 7 successive frozen biopsies during operation. Overall surgical remission rate was 86.