Outcomes After Repeat Transsphenoidal Surgery for Recurrent Cushing Disease: Updated

Neurosurgery ◽  
2019 ◽  
Vol 85 (6) ◽  
pp. E1030-E1036 ◽  
Author(s):  
William T Burke ◽  
David L Penn ◽  
Caroline S Repetti ◽  
Sherry Iuliano ◽  
Edward R Laws
Keyword(s):  
Published Data ◽  
First Line ◽  
Recurrence Rates ◽  
Cushing Disease ◽  
Repeat Surgery ◽  
Historical Cohort ◽  
Preoperative Magnetic Resonance ◽  
Magnetic Resonance Imaging Mri ◽  
Prior Operation

Abstract BACKGROUND Transspheniodal surgery (TSS) for Cushing disease (CD) is considered the first-line treatment; however, reported recurrence rates are high. OBJECTIVE To systemically review indications and outcomes for repeat TSS in recurrent CD. METHODS Retrospective review of patients undergoing TSS from 2008 to 2018 was performed. Patients undergoing repeat TSS for clinical and/or biochemically recurrent CD with follow-up at least 12 mo postoperatively were included. These data were analyzed in our “current cohort” and combined with our previously published data in a “combined cohort.” RESULTS The current cohort of patients undergoing operations from 2008 to 2018 with repeat surgery following a prior operation included 15 patients. Pathology at the time of first operation was positive for adrenocortiotrophic hormone (ACTH) adenoma in 13/15 (86.7%) and 9/15 (60%) had evidence of recurrence after a previous surgical procedure on preoperative magnetic resonance imaging (MRI). Remission was achieved immediately postoperatively in 13/15 (86.7%). Over an average follow-up of 34.7 mo (range: 12-116), 11/15 (68.8%) achieved persistent remission. When combined with the historical cohort that underwent an operation during 1992−2006, 44/51 (86.3%) patients had a prior operation demonstrating ACTH adenoma and 35/51 (68.6%) had evidence of recurrent disease on preoperative MRI. Thirty-five (68.6%) patients went into remission immediately postoperatively. Thirty one (60.8%) had continued remission at most recent reported follow-up. CONCLUSION Recurrent CD can be a therapeutic challenge; however, these data demonstrate that in many patients repeat surgery can be an effective and safe next step prior to radiation or medical therapy.

scholarly journals Efficacy of cryotherapy as first line therapy in patients with Barrett's neoplasia: a systematic review and pooled analysis

2019 ◽  
Vol 32 (11) ◽  
Author(s):  
N Hamade ◽  
M Desai ◽  
V Thoguluva Chandrasekar ◽  
J Chalhoub ◽  
M Patel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intestinal Metaplasia ◽  
Primary Treatment ◽  
Published Data ◽  
Stricture Formation ◽  
First Line ◽  
Recurrence Rates ◽  
Complete Eradication ◽  
Primary Modality

SUMMARY Cryotherapy has been used as salvage therapy; however, its efficacy as first line treatment in patients with Barrett's esophagus (BE) neoplasia has not been well studied. The aim of this paper was to perform a systematic review to look at the efficacy of cryotherapy as the primary treatment of BE. An electronic database search was performed (PubMed, Embase, Cochrane, and Google Scholar) to search for studies with cryotherapy as the initial primary modality of ablation in patients with BE neoplasia. Studies that included patients with other prior forms of therapy were excluded. The primary outcomes were the pooled rates of complete eradication of intestinal metaplasia (CE-IM) and CE of neoplasia (CE-N). Secondary outcomes were recurrence rates of neoplasia and intestinal metaplasia (IM) and adverse events. The statistical software OpenMetaAnalyst was used for analysis with pooled estimates reported as proportions (%) with 95% confidence intervals (CI) with heterogeneity (I2) among studies. The search revealed 6 eligible studies with a total of 282 patients (91.5% male, average age 65.3 years) with 459 person years of follow-up. 69.35% [95% CI (52.1%–86.5%)] of patients achieved CE-IM and 97.9% (95% CI: 95.5%–100%) had CE-N. 7.3% of patients had persistent dysplasia with 4% progressing to cancer. The recurrence rate of neoplasia was 10.4 and that of IM was 19.1 per 100 patient years of follow-up. The overall rate of stricture formation was 4.9%. There are scarce data on the use of cryotherapy as the primary modality for the treatment of BE dysplasia. The published data demonstrate efficacy rates of 69% and 98% for complete eradication of metaplasia and neoplasia, respectively. These results need to be assessed in prospective, comparative trials with other forms of therapy.

scholarly journals Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases

2021 ◽  
Vol 09 (02) ◽  
pp. E258-E262
Author(s):  
Christian Suchy ◽  
Moritz Berger ◽  
Ingo Steinbrück ◽  
Tsuneo Oyama ◽  
Naohisa Yahagi ◽  
...  
Keyword(s):  
Case Series ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Published Data ◽  
Low Grade ◽  
Recurrence Rates ◽  
En Bloc ◽  
Long Term Follow Up

Abstract Background and study aims We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1). Patients and methods Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians. Results Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15–6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically. Conclusions The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.

scholarly journals Orbital Subperiosteal Hematoma in the Newborn Causing Unilateral Proptosis: Ultrasound as First-Line Imaging Modality

2017 ◽  
Vol 07 (02) ◽  
pp. e138-e143 ◽  
Author(s):  
Florencia Angkasa ◽  
Leila Mohammadi ◽  
Deepa Taranath ◽  
Ajay Taranath ◽  
Marcus Brecht
Keyword(s):  
Imaging Modality ◽  
Ultrasound Images ◽  
First Line ◽  
Common Causes ◽  
Line Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Management Approaches ◽  
Unilateral Proptosis ◽  
Orbital Hematoma

Proptosis in the neonatal period is relatively infrequent and has diverse underlying etiologies. One of the more common causes appears to be orbital subperiosteal hematoma. Early detection, differentiation from other causes, and regular follow-up are essential as loss of vision can occur. We describe two cases of neonatal proptosis caused by orbital subperiosteal hematoma highlighting different diagnostic and management approaches, and provide a summary of previously reported cases. Spontaneous resolution occurs in most cases; however, emergent surgical evacuation is warranted in cases of optic nerve compression. This is the first report to provide orbital ultrasound images of uncomplicated neonatal orbital subperiosteal hematoma. Orbital ultrasound followed by magnetic resonance imaging (MRI) is a valid nonradiation approach for assessing neonatal proptosis due to subperiosteal orbital hematoma.

FORAMEN MAGNUM MENINGIOMAS

Neurosurgery ◽  
2006 ◽  
Vol 59 (6) ◽  
pp. 1177-1187 ◽  
Author(s):  
Hischam Bassiouni ◽  
Vasilios Ntoukas ◽  
Siamak Asgari ◽  
Erol I. Sandalcioglu ◽  
Dietmar Stolke ◽  
...  
Keyword(s):  
Foramen Magnum ◽  
Consecutive Series ◽  
Surgical Morbidity ◽  
Simpson Grade ◽  
Dural Attachment ◽  
Preoperative Magnetic Resonance ◽  
Magnetic Resonance Imaging Mri ◽  
Tumor Remnant

Abstract OBJECTIVE We analyzed a consecutive series of patients operated for a foramen magnum (FM) meningioma located on the ventral aspect of the medulla oblongata via a posterolateral suboccipital retrocondylar approach with regard to long-term surgical outcome. METHODS Clinical data in a consecutive series of 25 patients experiencing a meningioma attached to dura of the anterior or anterolateral FM rim were retrospectively reviewed. RESULTS The most common symptoms of the 19 women and six men (mean age, 59.2 yr) was cervico-occipital pain (72%) and gait disturbance (32%). Clinical examination revealed gait ataxia in 48% of the patients. As depicted from preoperative magnetic resonance imaging (MRI), dural attachment of the meningioma at the FM rim was anterior in 36% and anterolateral in 64% of cases. Tumor removal was accomplished via a posterolateral suboccipital retrocondylar approach in all patients. A Simpson Grade 2 resection was achieved in 96% of the patients. Permanent surgical morbidity and mortality rates were 8 and 4%, respectively. No tumor recurrence was observed after a mean follow-up period of 6.1 years (range, 1–14 yr) with clinical and MRI examination, and 80% of the patients have regained full daily activity. CONCLUSION Anterior and anterolateral FM meningiomas that displace the medulla/spinal cord can be safely and completely resected via a posterolateral suboccipital retrocondylar approach. A tumor remnant should be left on critical neurovascular structures in cases with poor arachnoid dissection planes.

scholarly journals Frontalis Sling Operation using Silicone Rod Compared with Autogenous Fascia Lata for Simple Congenital Ptosis

2014 ◽  
Vol 52 (195) ◽  
pp. 897-901
Author(s):  
Purnima Rajkarnikar Sthapit ◽  
Rohit Saiju ◽  
Ben Limbu
Keyword(s):  
Fascia Lata ◽  
Recurrence Rates ◽  
Repeat Surgery ◽  
Congenital Ptosis ◽  
Cosmetic Results ◽  
Sling Surgery ◽  
Silicone Rod ◽  
The Difference ◽  
Retrospective Comparative Study

Introduction: To evaluate the cosmetic results and recurrence of unilateral frontalis sling surgery using a silicone rod compared with autogenous fascia lata in cases of simple congenital ptosis. Methods: This is a retrospective comparative study of 59 patients who underwent a frontalis sling operation for congenital ptosis. Patients were divided into two groups according to the sling material used; an autogeneous fascia lata (fl) group (n = 24) and a silicone rod group (sl) (n = 35). Cosmetic results and recurrence rates were compared between these 2 groups. The cosmetic results of the frontalis sling operation were assessed as good, fair, or poor based on the difference between the Margin Reflex Distance of both eyelids and graded as good if the difference in two eyes was ≤1mm and poor if it was 2mm or more. Recurrence was defined as the conversion of the cosmetic result from good or fair to poor category. Results: At postoperative day seven and 30, MRD of both the groups were good but on three months follow-up MRD of silicon rod group dropped, however it was not statistically significant .Lid contour was good in both the groups, however, lid symmetry was poor in two cases of fascia lata at three months follow-up. Repeat surgery for poor outcome was done in 8.6% of cases in silicon rod and 8.3% of fascia lata group. Conclusions: The frontalis sling operation using either a silicone rod or autogenous fascia lata showed equally good cosmetic results and lower recurrence rate at three months follow up.  Keywords: congenital ptosis; fascia lata; frontalis sling surgery; margin reflex distance; silicone rod.  

Axitinib and avelumab (AA) as first-line treatment of metastatic renal cell carcinoma (mRCC): A real-world outcome review in the Northwest of England, United Kingdom.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 294-294
Author(s):  
Jennifer Allison ◽  
Natalie Charnley ◽  
Robert Stevenson ◽  
Tom Waddell ◽  
Manon Rhys Pillai
Keyword(s):  
Adverse Events ◽  
Real World ◽  
Kinase Inhibitor ◽  
Checkpoint Inhibitor ◽  
Risk Scores ◽  
Published Data ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

294 Background: The combination of the immune checkpoint inhibitor avelumab and VEGF-targeted, antiangiogenic tyrosine kinase inhibitor axitinib (AA) has demonstrated superior PFS and ORR compared to sunitinib in patients with mRCC and is an option for first line treatment across all IMDC risk scores. In this retrospective review we report our real world experience of this combination in three cancer centres in the Northwest of England. Methods: Treatment naïve mRCC patients receiving AA through the Early Access to Medicine Scheme at 3 cancer sites in the UK between May 2019 and July 2020 were identified. Primary outcomes of interest include overall response rate (ORR), adverse events (AEs) and preliminary survival observations. Results: A total of 44 patients were identified with a median follow up of 6.9 months (0.8-13.5 mo). Median age was 68 (48-81); 68% were male. The patients’ adult comorbidity evaluation score (ACE-27) was calculated: 0 = 43%, 1 = 30%, 2 = 7% and 3 = 20% . 45%, 48% and 7% of patients had favourable (F), intermediate (I) and poor (P) IMDC risk scores respectively. All had clear cell histology with 16% demonstrating sarcomatoid change. Most patients had undergone a nephrectomy (70%) and 36% had a single organ site of metastatic disease. ORR in the whole cohort was 60% (CR 5%, PR 55%, SD 25%, PD 2%, NE 13 %). Median time to first response was 2.6 months (0.6- 8.2mo). At time of data cut-off, 64% of patients remain on treatment (80% F, 48% I and 67% P). 14% of patients discontinued treatment due to disease progression while 22% stopped due to toxicity. The majority of patients (68%) continued axitinib at the starting dose of 5mg BD. Dose escalation of axitinib was possible in 9% patients while 23% needed a dose reduction due to toxicities. AEs were observed in 36 (82%) patients (G3 36%); the commonest being mucositis 30%; hypertension 23% (G3 11%); fatigue 25%; thyroid dysfunction 18%; diarrhoea 20% (G3 5%); hepatitis 20% (G3 11%). 9% of patients experienced an infusion reaction to avelumab. Overall, 9 (20%) patients received steroids for suspected immune related adverse events (irAEs); 6 (14%) were managed as G3≤ irAEs. 9 (20%) patients required inpatient admission due to AEs; 5 (11%) were associated with irAEs. Of the patients who discontinued AA treatment, 50% received subsequent therapy (12.5%, 75% and 12.5% receiving combination checkpoint inhibitor therapy, other VEFG TKi and TKi/MTOR combination respectively). 4 patients remain on active surveillance with no evidence of progression. Conclusions: Our early experience of AA in this real world setting reports comparable clinical responses to the published data. Treatment is well tolerated, with lower than expected levels of G3 or above AEs which is reassuring in a non-trial selected population. Follow-up is ongoing and updated efficacy and safety outcomes will be presented.

scholarly journals First-line lesional aspiration in acute stroke thrombectomy using a novel intermediate catheter: Initial experiences with the SOFIA

2016 ◽  
Vol 22 (3) ◽  
pp. 333-339 ◽  
Author(s):  
C Kabbasch ◽  
M Möhlenbruch ◽  
S Stampfl ◽  
A Mpotsaris ◽  
D Behme ◽  
...  
Keyword(s):  
Median Time ◽  
Clinical Status ◽  
Multimodality Treatment ◽  
Published Data ◽  
First Line ◽  
Anterior Circulation ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Clot Aspiration ◽  
Major Stroke

Introduction Five randomized controlled trials (RCTs) on endovascular therapy (EVT) of stroke have proven a clinical benefit over conservative treatment or IV-thrombolysis alone. Lesional clot aspiration with a dedicated system can achieve revascularization without an additional retriever (a direct-aspiration first-pass technique, ADAPT), and the SOFIA has been shown to be both safe and efficacious in a multicentric retrospective study. We have evaluated a subset of these data acquired in two major stroke centers with regard to using the SOFIA for first-line lesional aspiration. Methods Thirty patients with large-vessel occlusions treated with first-line lesional aspiration were identified. Procedural data, clot length, reperfusion success (mTICI), procedural timings, complications, and clinical status at admission, discharge and at 90 days were analyzed. Results The median baseline NIHSS was 16. IV thrombolysis was administered in 15/30 patients. Ninety-three percent of occlusions were in the anterior circulation. TICI ≥ 2b was achieved in 90% of multimodality treatments; lesional aspiration was successful in 67% within a median time of 20 minutes. The highest first-attempt success rate was in MCA occlusions (median time to recanalization 10 minutes). There were no device-related events. Symptomatic intracerebral hemorrhage (sICH) occurred in 10%, but never with sole lesional aspiration. Embolization to new territories was recorded in 1/30 (3%). Median discharge NIHSS was 7; 30% were mRS ≤ 2 at discharge and 43% at 90-day follow-up. Conclusions Lesional aspiration with SOFIA is in line with published data. The SOFIA may be used as a first-line device, aiming at fast recanalization by sole aspiration with good safety and efficacy. If unsuccessful, it converts into part of a stent retriever-based multimodality treatment.

Clinical Experience Of Lenalidomide Plus Low Dose Dexamethasone As First-Line Therapy For Multiple Myeloma At a Large County Hospital Caring For An Indigent Population

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5399-5399
Author(s):  
Yehuda E. Deutsch ◽  
Daniel J Dammrich ◽  
Jesus C Fabregas ◽  
Agustin Pimentel ◽  
Alexandra Stefanovic ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clinical Trials ◽  
Real World ◽  
Patient Population ◽  
County Hospital ◽  
Published Data ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

Abstract Background There is ample data for the response rates and clinical outcomes for patients with newly diagnosed multiple myeloma (MM) treated with first-line lenalidomide and dexamethasone (LEN/DEX). Phase II and III studies have reported objective response rates (ORR) in the range of 70-90%.  However, extrapolating from clinical trials to ‘real world' clinical practice is sometimes difficult. This is particularly so when it comes to large city hospital systems such as Jackson Memorial Hospital (JMH) in Miami, Florida. JMH is the third-largest public hospital and third-largest teaching hospital in the United States. Patients are primarily uninsured or insured through Medicaid. Additionally, one might surmise, that for a medication like LEN- with a relatively narrow therapeutic index, high cost, and cumbersome prescribing/dispensing requirements- outcomes in the ‘real world' might be inferior to those cited in clinical study. We endeavored to explore such outcomes in JMH to determine whether the benefits of this high cost drug in this setting are concordant with published data. Methods We conducted a retrospective analysis of all patients enrolled into the Celgene patient assistance program and prescribed LEN from January 1, 2010 through July 30, 2013 at JMH. We identified 96 patients enrolled into this program, 35 patients received LEN/DEX as first-line therapy for MM and are evaluable for this analysis. The primary end-point for analysis was response at 4 months. Results Medical records of 35 patients were reviewed. The mean age was 59 (46-75), majority of patients were female (60%), and 29% were black. Consistent with our patient population, 71.4% of patients were Hispanic, 44% were uninsured, and 64% had Medicaid. IgG (60%) was the most common heavy chain involved while 3 patients had light chain disease only. The majority of patients (88.6%) had stage III disease by the Durie-Salmon criteria, and 37.1% had ISS stage III disease. Cytogenetic studies were evaluable in 30 patients: 66.7% were standard-risk, 30% intermediate-risk and 3.3 % high-risk according to mSMART risk classification. At 4-month follow-up, 26 (74.3%) patients had an OR: 6 (17.1%) patients had CR, 7 (20%) had VGPR, and 13 (37.1%) had PR. 6 (17.1%) patients had progressive disease, change in therapy, or were lost to follow-up. There were no documented deep venous thromboses, a known risk of LEN therapy. Only 8 patients (23%) underwent autologous stem cell transplant following primary therapy. Conclusion Responses with upfront LEN/DEX in MM at JMH, were relatively similar to published data in large clinical studies. This provides support for the extrapolation of data from well supported clinical trials at fully-resourced medical institutions, for an oral chemotherapy drug with significant potential toxicities and logistical barriers, to a primarily Medicaid patient population in a county hospital. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Patient Reported Outcomes and Recurrence following 127 Primary Lapidus Surgeries for Hallux Valgus

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0022
Author(s):  
Sara H. Galli ◽  
Nick Johnson ◽  
W. Hodges Davis ◽  
Robert B. Anderson ◽  
Carroll P. Jones ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Recurrence Rate ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Recurrence Rates ◽  
Repeat Surgery ◽  
Radiographic Outcomes ◽  
Patient Reported ◽  
Fair Poor

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Treatment for symptomatic hallux valgus encompasses a spectrum of surgical options to appropriately address the degree of deformity. The modified Lapidus has emerged as a powerful surgical option to address moderate to severe deformity as well as hallux valgus with 1st ray hypermobility. Unlike metatarsal osteotomies, the literature is lacking in clinical and radiographic outcomes. Previous retrospective series have reported recurrence rates less than 15%, but our experience found a higher recurrence rate. We aimed to evaluate the effect of radiographic recurrence on patient reported outcome measures and satisfaction. Methods: After obtaining institutional board review approval, patients were identified by procedural billing codes from 2012- 2016. Only primary Lapidus surgeries were included. All patients were contacted and invited to return to obtain patient reported outcome scores (AOFAS, FAAM) and assess satisfaction. HVA>=20 at final follow-up was used to define recurrence. Data was analyzed utilizing statistical analysis software (SAS v9.4).328 surgeries were identified with 255 eligible and contacted for follow-up. 77 surveys were completed in person and 50 were completed over the phone or via email with total response rate of 50%. Results: Average follow-up was 59 months. 38% had radiographic recurrence (48/127), 24% perceived recurrence (30/125), and 9.5% had reoperation for recurrence (12/126). AOFAS scores were lower with radiographic recurrence (p=0.01) and perceived recurrence (p=0.003). FAAM-ADL scores were not different in radiographic recurrence (p=0.79) but were lower in perceived recurrence (p=0.001). Overall, satisfaction was good-excellent in 74% and fair-poor in 26%. For radiographic (p=0.03) and perceived recurrence (p<0.0001), there was lower satisfaction reported. 78% would repeat surgery. Decision to repeat surgery was not different for radiographic recurrence with 81% without vs 74% with recurrence (p=0.37) saying they would have surgery again. However, it was different for perceived recurrence with 84% without vs 59% with recurrence saying they would have surgery again (p=0.01). Conclusion: Despite a high radiographic recurrence rate (38%), only a portion perceived a recurrence (24%) and an even smaller proportion (9.5%) had a reoperation for the recurrence. Nonetheless, these results suggest radiographic and clinical outcomes are not as high as previously reported for the modified Lapidus procedure.

scholarly journals Transsphenoidal Surgery for Cushing Disease

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 70-81 ◽  
Author(s):  
Ivan Ciric ◽  
Jin-Cheng Zhao ◽  
Hongyan Du ◽  
James W. Findling ◽  
Mark E. Molitch ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
Statistical Significance ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
Cushing Disease ◽  
Transsphenoidal Microsurgery ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND This is a retrospective study of 136 patients with Cushing disease treated with transsphenoidal microsurgery. OBJECTIVE To evaluate factors influencing immediate postoperative results and long-term outcomes. METHODS Data regarding clinical presentation, endocrine evaluation, imaging studies, surgical technique, immediate postoperative biochemical remission (IPBR), and long-term results were entered into a database and analyzed statistically. IPBR was based on biochemical evidence of adrenal cortical insufficiency and clinical evidence of such insufficiency. RESULTS IPBR for the entire series was 83.4%. In microadenomas, IPBR was 89.8% with a mean immediate postoperative plasma cortisol (IPPC) of 2.1 μg/dL (range, &lt;0.5-5.3). Positive magnetic resonance imaging (MRI) was associated with 18 times greater odds of finding microadenoma at surgery (P &gt; .001) and with 4.1 times greater odds of IPBR (P = .07). In patients with a negative MRI, a positive inferior petrosal sinus sampling (IPSS) test was associated with 93% of IPBR (P = .004). IPBR in macroadenomas was 30.7%. Of patients followed for 12 months or longer, 34.8% required glucocorticoid replacement for the duration of follow-up. The mean follow-up in microadenomas was 68.4 months with a 9.67% incidence of recurrences. The estimated actuarial incidence of recurrences increased with the passage of time and IPPC of greater than 2 μg/dL was associated with higher incidence of recurrences, although without statistical significance (P = .08). CONCLUSION In microadenomas, a positive MRI and positive IPSS test were associated with a higher incidence of IPBR. Recurrences increased with the passage of time, and an IPPC of greater than 2 μg/dL may be associated with higher incidence of recurrences.

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