Surgical Outcomes and Comorbidities in Cushing Disease: 30 Years of Experience in a Referral Center

Objective: Transsphenoidal surgery (TSS) is a first-line treatment for Cushing disease (CD). However, a subset of patients with CD have no visible adenoma on magnetic resonance imaging (MRI), and whether MRI results affect surgical outcomes is controversial. The aim of this study was to compare the surgical outcomes of CD patients with negative MRI findings to those of patients with positive MRI findings. Methods: The clinical features and outcomes of CD patients who underwent TSS between January 2000 and July 2019 at Peking Union Medical College Hospital were collected from medical records. The clinical, endocrinologic, histopathologic, surgical outcomes, and a minimum 12-month follow-up of 125 consecutive CD patients with negative MRI findings were compared with those of 1,031 consecutive CD patients with MRI-visible adenomas. Results: The total remission rate was 73.3% after TSS, and 11.8% of patients experienced recurrence. Of 1,031 patients with MRI-visible adenomas, postoperative remission was achieved in 762 patients (73.9%), and the recurrence of CD was observed in 94 (12.3%) patients. Of the 125 patients with negative MRI findings, postoperative remission was achieved in 85 (68%) patients, and recurrence was observed in 6 (7.1%) patients. The remission rate and recurrence rate were not significantly different between patients with negative MRI findings and those with positive MRI findings (all P>.05). The remission rate was not significantly different between patients who did or did not undergo bilateral inferior petrosal sinus sampling (BIPSS) in patients with negative MRI findings ( P>.05). In the patients with negative MRI findings who underwent BIPSS, the remission rate of patients with positive BIPSS results was not different from that in patients with negative BIPSS results ( P>.05). The lack of prior TSS, the detection of a tumor during operation, and pathologic confirmation of adenoma were associated with a higher surgical remission rate in patients with negative MRI findings (all P<.05). Similar results were observed in the patients with positive MRI findings (all P<.05). In addition, the major perioperative complications, including intraoperative cerebrospinal fluid leakage, hypopituitarism, and transient diabetes insipidus, were not related to the MRI results (all P>.05). Conclusion: The remission rate and recurrence rate were not different between patients with negative MRI findings and those with positive MRI findings. If CD is clearly diagnosed according to biochemical tests, radiologic examinations, and BIPSS, we recommend TSS as the first-line treatment for patients, even if the MRI results are negative. Abbreviations: ACTH = adrenocorticotropic hormone; BIPSS = bilateral inferior petrosal sinus sampling; CD = Cushing disease; 18F-FDG = 18F-fluorodeoxyglucose; IQR = interquartile range; MRI = magnetic resonance imaging; PET = positron emission tomography; PUMCH = Peking Union Medical College Hospital; TSS = transsphenoidal surgery; UFC = urine free cortisol

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Prevalence, assessment and surgical correction of penile curvature in hypospadias patients treated at one European Referral Center: description of the technique and surgical outcomes

World Journal of Urology ◽

10.1007/s00345-019-02961-x ◽

2019 ◽

Vol 38 (8) ◽

pp. 2041-2048 ◽

Cited By ~ 1

Author(s):

Marco Bandini ◽

Sasha Sekulovic ◽

Bogdan Spiridonescu ◽

Pramod Krishnappa ◽

Anuj Deep Dangi ◽

...

Keyword(s):

Surgical Outcomes ◽

Surgical Correction ◽

Penile Curvature ◽

Referral Center

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Transsphenoidal surgery in Cushing disease: 10 years of experience in 34 consecutive cases

Journal of Neurosurgery ◽

10.3171/jns.2004.100.4.0634 ◽

2004 ◽

Vol 100 (4) ◽

pp. 634-638 ◽

Cited By ~ 34

Author(s):

Charlotte Höybye ◽

Eva GrenbäcK ◽

Marja Thorén ◽

Anna-Lena Hulting ◽

Lars Lundblad ◽

...

Keyword(s):

Mr Imaging ◽

Transsphenoidal Surgery ◽

Cushing Syndrome ◽

Preoperative Evaluation ◽

Clinical Signs ◽

Pituitary Hormone ◽

Years Of Experience ◽

Cushing Disease ◽

Content Type ◽

Fine Print

Object. Cushing disease is a rare disorder. Because of their small size the adrenocorticotropic hormone (ACTH)—producing tumors are often not detectable on neuroimaging studies. To obtain a cure with transsphenoidal surgery (TSS) may therefore be difficult. In this report the authors present 10 years of experience in the treatment of patients with Cushing disease who were followed up with the same protocol and treated by the same surgeon. Methods. Thirty-four patients, 26 of them female and eight of them male (mean age 40 years, range 13–74 years) were studied. All had obvious clinical signs and symptoms of Cushing syndrome. Magnetic resonance (MR) imaging was performed in all patients, and inferior petrosal sinus (IPS) sampling was done in 14. In 12 patients MR imaging indicated a pituitary tumor; 10 were microadenomas and two were macroadenomas. In six patients with no visible tumor, the results of IPS sampling supported the diagnosis. All patients underwent TSS; the mean follow-up duration was 6 ± 0.5 years. Selective adenomectomy was performed in 32 and hemihypophysectomy in the other two patients. A cure was obtained in 31 patients (91%) after one TSS and in two more patients after further TSS; one patient was not cured despite two TSSs and one underwent bilateral adrenalectomy. Disease recurrence was seen in two patients after 3 years, and they were successfully treated with stereotactic gamma knife surgery. Half of the patients had an ACTH deficiency postoperatively, whereas one third had other pituitary hormone insufficiencies. There were no serious complications attributable to the surgical intervention. Conclusions. Transsphenoidal surgery with selective adenomectomy is an effective and safe treatment for Cushing disease. In the patients presented in this study, the surgical outcome seemed to depend on careful preoperative evaluation and the surgeon's experience. For optimal results in this rare disease the authors therefore suggest that the endocrinological, radiological, and surgical procedures be coordinated in a specialized center.

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A Comprehensive Review Emphasizing Anatomy, Etiology, Diagnosis, and Treatment of Male Urethral Stricture Disease

BioMed Research International ◽

10.1155/2019/9046430 ◽

2019 ◽

Vol 2019 ◽

pp. 1-20 ◽

Cited By ~ 4

Author(s):

Wesley Verla ◽

Willem Oosterlinck ◽

Anne-Françoise Spinoit ◽

Marjan Waterloos

Keyword(s):

Literature Review ◽

Urethral Stricture ◽

Diagnosis And Treatment ◽

Years Of Experience ◽

Tertiary Referral ◽

Comprehensive Review ◽

Tertiary Referral Center ◽

Referral Center ◽

Urethral Stricture Disease ◽

Existing Data

To date, urethral stricture disease in men, though relatively common, represents an often poorly managed condition. Therefore, this article is dedicated to encompassing the currently existing data upon anatomy, etiology, symptoms, diagnosis, and treatment of the disease, based on more than 40 years of experience at a tertiary referral center and a PubMed literature review enclosing publications until September 2018.

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