Outcomes of Therapy for Cushing’s Disease due to Adrenocorticotropin-Secreting Pituitary Macroadenomas1

We reviewed our experience with 21 patients who had Cushing’s disease due to ACTH-secreting macroadenomas to clarify the natural history of this disease. All patients had typical clinical and biochemical features of ACTH-dependent hypercortisolism. Their mean maximal tumor diameter was 1.6 ± 0.1 cm, and the range was 1.0–2.7 cm. Six patients had cavernous sinus invasion, three had invasion of the floor of their sella, and nine had suprasellar extension. The observed remission rate was significantly lower in macroadenoma patients than in microadenoma patients (67% vs. 91%; χ2 = 5.7; P < 0.02). Cavernous sinus invasion (odds ratio, 35; 95% confidence interval, 2.6–475; P < 0.008) and presence of a maximum tumor diameter 2.0 cm or more (odds ratio, 12.9; 95% confidence interval, 1.4–124; P< 0.02) emerged as the only predictors of residual disease after surgery. The observed recurrence rate was significantly higher in macroadenoma patients than in microadenoma patients (36% vs. 12%; χ2 = 4.2; P< 0.05). Macroadenoma patients tended to suffer from recurrences earlier than did microadenoma patients (16 vs. 49 months). Stepwise multiple logistic regression did not identify any predictors of disease recurrence in macroadenoma patients. Eight macroadenoma patients underwent a total of nine repeat surgical procedures, but none of these resulted in clinical remissions. Only four of seven (57%) patients followed for a sufficient period of time achieved normal urinary free cortisol levels after conventional radiotherapy. Three (75%) of these four patients had re-recurrent hypercortisolism after brief periods of eucortisolism. Pharmacological agents and adrenalectomy were effective in the management of hypercortisolism in patients with residual and recurrent disease. Our results indicate that ACTH-secreting macroadenomas are more refractory to conventional treatments than are ACTH-secreting microadenomas.

Download Full-text

Long-term results of treatment in patients with ACTH-secreting pituitary macroadenomas

Acta Endocrinologica ◽

10.1530/eje.0.1490195 ◽

2003 ◽

pp. 195-200 ◽

Cited By ~ 56

Author(s):

S Cannavo ◽

B Almoto ◽

C Dall'Asta ◽

S Corsello ◽

RM Lovicu ◽

...

Keyword(s):

Cavernous Sinus ◽

Cushing’S Disease ◽

Long Term Results ◽

Cushing's Disease ◽

Tumor Diameter ◽

Pituitary Macroadenoma ◽

Second Surgery ◽

Acth Secreting

OBJECTIVE: Since Cushing's disease due to large pituitary tumors is rare, we evaluated biochemical characteristics at entry and the results of first surgical approach and of adjuvant therapeutic strategies during a long-term follow-up period. DESIGN: We studied 26 patients (nine male, 17 female; 42.5+/-12.7 years, mean+/-s.e.) with ACTH-secreting pituitary macroadenoma (tumor diameter: 11-40 mm). METHODS: At entry, plasma ACTH, serum cortisol and 24-h urinary free cortisol (UFC) levels were measured in all patients, a high-dose dexamethasone (dexa) suppression test was evaluated in 22 cases and a corticotrophin releasing hormone (CRH) test in 20 cases. Patients were re-evaluated after operation and, when not cured, they underwent second surgery, radiotherapy and/or ketoconazole treatment. The follow-up period was 78+/-10 months. RESULTS: Before surgery, dexa decreased ACTH (>50% of baseline) in only 14/22 patients. The CRH-stimulated ACTH/cortisol response was normal in six patients, impaired in six patients and exaggerated in eight patients. After operation eight patients were cured, nine had normalized cortisol levels and nine were not cured. Pre-surgery, mean ACTH values were significantly higher in the not cured patients than in those normalized (P<0.05) and cured (P<0.01); the ACTH response to CRH was impaired in only six patients of the not cured group. The tumour diameter was significantly less in cured patients (P<0.02) and in normalized patients (P<0.05) than in the not cured ones. Magnetic resonance imaging (MRI) showed invasion of the cavernous sinus in 2/9 normalized, and in 6/9 not cured patients. After surgery, ACTH, cortisol and UFC were significantly lower than at entry in cured and in normalized patients, but not in not cured patients. In the cured group, the disease recurred in one patient who was unsuccessfully treated with ketoconazole. In the normalized group, a relapse occurred in eight patients: radiotherapy and ketoconazole induced cortisol normalization in one case, hypoadrenalism in one case and were ineffective in another one, while five patients were lost at follow-up. In the not cured group, eight patients underwent second surgery, radiotherapy and/or ketoconazole, while one patient was lost at follow-up. These therapies induced cortisol normalization in two patients and hypoadrenalism in one. CONCLUSIONS: (i) A sub-set of patients with ACTH-secreting pituitary macroadenoma showed low sensitivity to high doses of dexamethasone and to CRH, (ii) pituitary surgery cured Cushing's disease in a minority of patients, (iii) high baseline ACTH levels, impaired ACTH response to CRH, increased tumor size or invasion of the cavernous sinus were unfavourable prognostic factors for surgical therapy, and (iv) second surgery, radiotherapy and/or ketaconazole cured or normalized hypercortisolism in half of the patients with recurrence or not cured.

Download Full-text

Racial disparities in acromegaly and Cushing’s disease: a referral center study in 241 patients

Journal of the Endocrine Society ◽

10.1210/jendso/bvab176 ◽

2021 ◽

Author(s):

Adriana G Ioachimescu ◽

Neevedita Goswami ◽

Talin Handa ◽

Adlai Pappy ◽

Emir Veledar ◽

...

Keyword(s):

Cushing’S Disease ◽

Census Data ◽

Remission Rate ◽

Black Population ◽

Postoperative Outcomes ◽

Cushing's Disease ◽

Tumor Diameter ◽

Cavernous Sinus Invasion ◽

Black Patients ◽

The Impact

Abstract Purpose The impact of race on presentation and postoperative outcomes in adults with acromegaly (ACM) and Cushing’s disease (CD) has not been evaluated. Methods This is a retrospective study of consecutive patients operated at a large-volume pituitary center. We evaluated: 1) racial distribution of patients residing in the metropolitan area (Metro, N=124) versus 2010 U.S. Census data, 2) presentation and postoperative outcomes in Black versus White for patients from the entire catchment area (N=241). Results For Metro area (32.4% Black population), Black patients represented 16.75% ACM (p=0.006) and 29.2% CD (p=0.56).Among 112 total ACM patients, presentations with headaches or incidentaloma were more common in Black patients (76.9% versus 31% White, p=0.01). Black patients had a higher prevalence of diabetes (54% versus 16% White, p=0.005), significantly lower IGF-1 deviation from normal (p=0.03) and borderline lower median GH levels (p=0.09). Mean tumor diameter and proportion of tumors with cavernous sinus invasion were similar. Three-month biochemical remission (46% Black, 55% White, p=0.76) and long-term IGF-1 control by multimodality therapy (92.3% Black, 80.5% White, p=0.45) were similar. Among 129 total CD patients, Black patients had more hypopituitarism (69% vs 45% White, p=0.04) and macroadenomas (33% vs 15% White, p=0.05). At 3 months, remission rate was borderline higher in White (92% vs 78% Black, p=0.08) which was attributed to macroadenomas by logistic regression. Conclusion We identified disparities regarding racial distribution, clinical and biochemical characteristics in ACM, suggesting late or missed diagnosis in Black patients. Large nationwide studies are necessary to confirm our findings.

Download Full-text

Machine Learning in Preoperative Prediction of Postoperative Immediate Remission of Histology-Positive Cushing’s Disease

Frontiers in Endocrinology ◽

10.3389/fendo.2021.635795 ◽

2021 ◽

Vol 12 ◽

Author(s):

Wentai Zhang ◽

Mengke Sun ◽

Yanghua Fan ◽

He Wang ◽

Ming Feng ◽

...

Keyword(s):

Machine Learning ◽

Cavernous Sinus ◽

Cushing’S Disease ◽

Remission Rate ◽

Tumour Size ◽

Univariate Analysis ◽

Cushing's Disease ◽

College Hospital ◽

Cavernous Sinus Invasion ◽

Preoperative Prediction

BackgroundThere are no established accurate models that use machine learning (ML) methods to preoperatively predict immediate remission after transsphenoidal surgery (TSS) in patients diagnosed with histology-positive Cushing’s disease (CD).PurposeOur current study aims to devise and assess an ML-based model to preoperatively predict immediate remission after TSS in patients with CD.MethodsA total of 1,045 participants with CD who received TSS at Peking Union Medical College Hospital in a 20-year period (between February 2000 and September 2019) were enrolled in the present study. In total nine ML classifiers were applied to construct models for the preoperative prediction of immediate remission with preoperative factors. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the performance of the models. The performance of each ML-based model was evaluated in terms of AUC.ResultsThe overall immediate remission rate was 73.3% (766/1045). First operation (p<0.001), cavernous sinus invasion on preoperative MRI(p<0.001), tumour size (p<0.001), preoperative ACTH (p=0.008), and disease duration (p=0.010) were significantly related to immediate remission on logistic univariate analysis. The AUCs of the models ranged between 0.664 and 0.743. The highest AUC, i.e., the best performance, was 0.743, which was achieved by stacking ensemble method with four factors: first operation, cavernous sinus invasion on preoperative MRI, tumour size and preoperative ACTH.ConclusionWe developed a readily available ML-based model for the preoperative prediction of immediate remission in patients with CD.

Download Full-text

Outcome of transsphenoidal surgery for Cushing's disease: A high remission rate in ACTH-secreting macroadenomas

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2008.12.011 ◽

2009 ◽

Vol 111 (5) ◽

pp. 442-449 ◽

Cited By ~ 36

Author(s):

Edward Fomekong ◽

Dominique Maiter ◽

Cécile Grandin ◽

Christian Raftopoulos

Keyword(s):

Cushing’S Disease ◽

Transsphenoidal Surgery ◽

Remission Rate ◽

Cushing's Disease ◽

Acth Secreting

Download Full-text

Transsphenoidal Surgery for Cushing's Disease: Endocrinological Follow-up Monitoring of 82 Patients

Neurosurgery ◽

10.1097/00006123-200207000-00008 ◽

2002 ◽

Vol 51 (1) ◽

pp. 57-62 ◽

Cited By ~ 109

Author(s):

Ilan Shimon ◽

Zvi Ram ◽

Zvi R. Cohen ◽

Moshe Hadani

Keyword(s):

Cushing’S Disease ◽

Transsphenoidal Surgery ◽

Adrenocorticotropic Hormone ◽

Remission Rate ◽

The United States ◽

Cushing's Disease ◽

Free Cortisol ◽

Remission Rates ◽

Surgical Failure

Abstract OBJECTIVE Transsphenoidal surgery is the preferred treatment modality for adrenocorticotropic hormone-secreting pituitary adenomas. In the past 2 decades, several institutions in the United States and Europe have reported remission rates of 70 to 85% after transsphenoidal surgery for treatment of Cushing's disease. We analyzed our postoperative results for a large cohort of patients with Cushing's disease. METHODS Eighty-two patients with adrenocorticotropic hormone-secreting adenomas (79 microadenomas and 3 macroadenomas) underwent transsphenoidal surgery between 1990 and 2000. Seventy-seven patients were surgically treated for the first time, and 13 patients underwent reoperations (5 had undergone the first operation elsewhere) because of previous surgical failure (10 patients) or recurrence (3 patients). The mean postoperative follow-up period was 4.2 ± 2.8 years. Biochemical remission was defined as postoperative normalization of elevated 24-hour urinary free cortisol secretion and suppression of morning cortisol levels with 1 mg of dexamethasone. RESULTS Remission was achieved for 78% of all patients after one operation and for 62% of patients who underwent a second operation. The recurrence rate was 5%. Ten patients did not exhibit a visible tumor on magnetic resonance imaging scans, and the other patients were divided according to adenoma size (2–5 or 6–10 mm). Remission rates were similar for the three groups of patients (78–80%). Pituitary tumor stained for adrenocorticotropic hormone was detected in 78% of resected pituitary tissue specimens obtained from patients who achieved remission, compared with 53% from patients who experienced surgical failure (P = 0.06). CONCLUSION Our series demonstrates the efficacy of transsphenoidal surgery for Cushing's disease resulting from pituitary microadenomas. Microadenoma size had no effect on the remission rate. Reoperations are indicated after initial surgical failures.

Download Full-text

Efficacy and Safety of Stereotactic Radiotherapy in Cushing’s Disease: A Single Center Experience

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1217-7365 ◽

2020 ◽

Author(s):

Tugce Apaydin ◽

Hande Mefkure Ozkaya ◽

Sebnem Memis Durmaz ◽

Rasim Meral ◽

Pinar Kadioglu

Keyword(s):

Medical Therapy ◽

Cushing’S Disease ◽

Remission Rate ◽

Gamma Knife Radiosurgery ◽

Cushing's Disease ◽

Efficacy And Safety ◽

Single Center ◽

Biochemical Control ◽

Single Center Experience ◽

Free Cortisol

Abstract Objective To determine the efficacy and safety of stereotactic RT in patients with Cushing’s disease (CD). Methods The study included 38 patients [31 patients who received gamma knife radiosurgery (GKS) and 7 patients who received cyberknife hypofractionated RT (HFRT)] with CD. Hormonal remission was considered if the patient had suppressed cortisol levels after low dose dexamethasone, normal 24-hour urinary free cortisol (UFC), and lack or regression of clinical features. Results Biochemical control after RT was observed in 52.6% of the patients with CD and median time to hormonal remission was 15 months. Tumor size control was obtained in all of the patients. There was no significant relationship between remission rate and laboratory, radiological and pathological variables except for preoperative UFC. Remission rate was higher in patients with lower preoperative UFC. Time to remission increased in parallel to postoperative cortisol and 1mg DST level. Although medical therapy before RT did not affect the rate of- and time to remission, medical therapy after RT prolonged the time to hormonal remission. Conclusion In this current single center experience, postoperative cortisol and 1mg DST levels were found as the determinants of time to remission. Although medical therapy before RT did not affect the rate of- and time to remission, medical therapy after RT prolonged the time to biochemical control . This latter finding might suggest a radioprotective effect of cortisol lowering medication use on peri-RT period.

Download Full-text

MON-310 Factors Associated with Remission After Surgery for Acromegaly

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.932 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Clara Cunha ◽

Cátia Ferrinho ◽

Eugénia Silva ◽

Catarina Saraiva ◽

Conceição Marques ◽

...

Keyword(s):

Cavernous Sinus ◽

Remission Rate ◽

Serum Insulin ◽

Magnetic Resonance Images ◽

Oral Glucose ◽

Surgical Removal ◽

Tumor Diameter ◽

Cavernous Sinus Invasion ◽

First Choice ◽

Average Maximum

Abstract Background: Acromegaly is a disorder characterized by excessive growth hormone (GH) secretion, which, in most cases, is caused by a GH secreting adenoma. Surgical removal of the tumor via a transsphenoidal approach is the first choice treatment for most patients. The remission rate after an initial resection is 80 to 90 percent for microadenomas and less than 50 percent for macroadenomas. Objective: To analyze predictive factors of remission in acromegaly patients who underwent transsphenoidal surgery for GH secreting adenoma. Methods: From January 2006 to October 2019, 75 patients with GH secreting pituitary adenoma were evaluated at our center. Patients who had undergone medical treatment or radiotherapy as first treatment were excluded. A total of 60 patients were included in the analysis. Remission was defined as normal serum insulin-like growth factor-1 (IGF-1) age and sex adjusted and a random serum GH less than 1 ng/mL and/or nadir GH during oral glucose tolerance test <0.4 ng/mL. Results: We evaluated 60 patients (41 females and 19 males), with a mean age at diagnosis of 49.6 (ranged from 23 to 77 years). Mean initial IGF-1 was 905.3 ng/mL (range 100-324) and mean initial GH was 25.0 ng/mL (<2.5). Macroadenomas were more common than microadenomas (48 vs 12). The average maximum tumor diameter was 15.6 mm and 21 patients were graded as Knosp 3 or 4, which indicated cavernous sinus invasion. Patients were follow for 11.8 years. Overall, the remission rate was 50.0% after surgery. Mean age of patients in surgical remission (51.6 years) was higher than those patients not in remission (47.5 years) (p=0.439). Remission rates for microadenomas and macroadenomas were 75.0% and 44.9%, respectively (p=0.04). Patients who achieved remission had smaller tumors compared with those who failed to attain remission (mean diameter 11.6mm versus 17.8 mm). Using the Knosp classification system and preoperative magnetic resonance images to determine cavernous sinus invasion, Knosp grade 3 to 4 tumors were found in 5 patients in remission and in 16 patients with persistence of disease (p=0.003). Patients who achieved remission had a significantly lower preoperative IGF-1 level (650.5 ng/mL) compared with those who did not (1211.0 ng/mL) (p=0.04). Preoperative GH levels were lower for the patients who achieved remission (18.7 ng/mL) than for those who did not (32.5 ng/mL, p=0.006). Conclusions: In our study, predictors of biochemical remission after surgery were smaller tumor size, lower Knosp grade, and lower preoperative GH and IGF-1 levels.

Download Full-text

Five years follow up of patients with Сushing’s disease with and without visualized pituitary adenoma on MRI, who underwent transsphenoidal adenomectomy

Problems of Endocrinology ◽

10.14341/probl2017635276-281 ◽

2017 ◽

Vol 63 (5) ◽

pp. 276-281

Author(s):

Patimat M. Khandaeva ◽

Zhanna E. Belaya ◽

Lyudmila Ya. Rozhinskaya ◽

Aleksandr V. Vorontsov ◽

Andrey Yu. Grigoriev ◽

...

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Remission Rate ◽

Serum Cortisol ◽

Urinary Free Cortisol ◽

Cushing's Disease ◽

Surgery Complications ◽

Free Cortisol ◽

Transsphenoidal Adenomectomy

The remission rate of Cushing’s disease in patients after neurosurgery varies from 59 to 94%, while the recurrence rate is 3 to 46%. Aim — to evaluate the five-year outcome in neurosurgery patients with Cushing’s disease (CD), depending on preoperative MRI-based identification of pituitary adenoma. Material and methods. The study included 105 neurosurgery patients with histologically confirmed CD. CD remission was confirmed by the development of adrenal insufficiency and/or normalization of serum cortisol and 24-hour urinary free cortisol (24h UFC) levels, as well as by clinical remission. Results. Pituitary adenoma was not visualized by gadolinium MRI in 35 cases. The size of visualized pituitary adenoma varied from 0.3 to 29 mm. After first neurosurgery, remission was achieved in 87 (82.8%) patients. After second neurosurgery, remission occurred in 12 patients. Radiation therapy was conducted in 24 patients. Six patients had bilateral adrenalectomy. Two patients died during remission: one patient died from stroke two years after neurosurgery, and the other patient died due to surgery complications. During five-year follow-up after neurosurgery, remission continued in 76 (72.8%) patients, including 27 (77%) of 35 patients without MRI-detected adenoma and 49 (70%) of 70 patients with MRI-detected pituitary adenoma, p=0.15. Sixty-six patients developed recurrence, and 14 patients had active hypercortisolism. Conclusion. There was no correlation between the rate of preoperative MRI-based detection of pituitary adenoma and the rate of remission in neurosurgery patients with Cushing’s disease during the five year follow-up. The size of pituitary adenoma was a risk factor for adenoma recurrence.

Download Full-text

Prediction of cavernous sinus invasion in patients with Cushing’s disease by magnetic resonance imaging

Journal of Neurosurgery ◽

10.3171/2018.2.jns172704 ◽

2019 ◽

Vol 130 (5) ◽

pp. 1593-1598 ◽

Cited By ~ 1

Author(s):

Panagiotis Mastorakos ◽

Davis G. Taylor ◽

Ching-Jen Chen ◽

Thomas Buell ◽

Joseph H. Donahue ◽

...

Keyword(s):

Cavernous Sinus ◽

Cushing’S Disease ◽

Predictive Value ◽

Radiographic Finding ◽

Positive Likelihood Ratio ◽

Cushing's Disease ◽

Preoperative Imaging ◽

Mri Findings ◽

Cavernous Sinus Invasion ◽

Pituitary Lesion

OBJECTIVECavernous sinus invasion (CSI) in Cushing’s disease (CD) negatively affects the probability of complete resection, biochemical cure, and need for adjuvant therapy. However, the prediction of CSI based on MRI findings has been inconsistent and variable. Among macroadenomas, the Knosp classification is the most widely utilized radiographic predictor of CSI, but its accuracy in predicting CSI and the probability of gross-total resection is limited in the setting of microadenomas or Knosp grade 0–2 macroadenomas. The authors noticed that the presence of a triangular shape of adenomas adjacent to the cavernous sinus on coronal MR images is frequently associated with CSI. The authors aimed to determine the correlation of this radiographic finding (“sail sign” [SS]) with CSI.METHODSThe authors performed a retrospective review of all patients with a pituitary lesion < 20 mm and a biochemical diagnosis of CD treated with endoscopic or microscopic transsphenoidal resection from November 2007 to May 2017. Overall 185 patients with CD were identified: 27 were excluded for negative preoperative imaging, 32 for lacking tumors adjacent to the sinus, 7 for Knosp grade 3 or higher, and 4 for inadequate intraoperative assessment of the CSI. Following application of inclusion and exclusion criteria, 115 cases were available for statistical analysis. Intraoperative CSI was prospectively evaluated at the time of surgery by one of two neurosurgical attending surgeons, and MRI data were evaluated retrospectively by a neurosurgical resident and attending neuroradiologist blinded to the intraoperative results.RESULTSA positive SS was identified in 23 patients (20%). Among patients with positive SS, 91% demonstrated CSI compared to 10% without an SS (p < 0.001). Using the SS as a predictor of CSI provided a sensitivity of 0.7 and a specificity of 0.98, with a positive predictive value (PPV) of 0.91 and a negative predictive value of 0.9. Among patients with positive SS, 30% did not achieve immediate postoperative remission, compared to 3.3% of patients without an SS (p < 0.001).CONCLUSIONSThe presence of a positive SS among Cushing’s adenomas adjacent to the CS provides strong PPV, specificity, and positive likelihood ratio for the prediction of CSI. This can be a useful tool for preoperative planning and for predicting the likelihood of long-term biochemical remission and the need for adjuvant radiosurgery.

Download Full-text

Increased Risk of Ocular Hypertension in Patients with Cushing’s Disease: An Underestimated Comorbidity

10.21203/rs.3.rs-64004/v1 ◽

2020 ◽

Author(s):

Zhengyuan Chen ◽

Yichen Ma ◽

Zengyi Ma ◽

Zhao Ye ◽

Wenqiang He ◽

...

Keyword(s):

Ocular Hypertension ◽

Cushing’S Disease ◽

Odds Ratio ◽

Cushing's Disease ◽

Control Groups ◽

Fiber Layer ◽

Nerve Fiber Layer Thickness ◽

Increased Risk ◽

Free Cortisol

Abstract BackgroundThe association between ocular hypertension and endogenous hypercortisolemia, as well as the ophthalmological outcomes after endocrine remission due to a surgical resection were still unknown. MethodsIntraocular pressure (IOP), visual field and peripapillary retinal nerve fiber layer thickness were documented in all patients with Cushing’s disease (CD) admitted to a tertiary pituitary center for surgery from Jan to Jul 2019. Patients with acromegaly and patients with nonfunctioning pituitary adenoma (NFPA) during the same study period were served as controls. We calculated the odds ratio and identified risk factors of developing ocular hypertension, and presented postoperative trends of IOP.Results52 patients (38.4±12.4 years old) with CD were included. IOP was higher in patients with CD (left 19.4 ± 5.4 mmHg and right 20.0 ± 7.1 mmHg) than patients with acromegaly (left 17.5 ± 2.3 mmHg and right 18.6 ± 7.0 mmHg, p = 0.033) and patients with NFPA (left 17.8 ± 2.6 mmHg and right 17.4 ± 2.4 mmHg, p = 0.005). 21 eyes (20.2%) in patients with CD were diagnosed with ocular hypertension comparing to 4 eyes (4.7%) in the acromegaly group and 4 eyes (4.5%) in the NFPA group. The odds ratio of developing ocular hypertension in patients with CD was 5.1 (95% CI, 1.3 – 25.1, p = 0.029) and 6.6 (95% CI, 1.8 – 30.3, p = 0.007), comparing with the two control groups, respectively. Among patients with CD, those with higher urine free cortisol were more likely to develop ocular hypertension (OR 19.4, 95% CI 1.7 – 72.6). IOP decreased at one-month follow-up in patients with CD and the change sustained at three-month follow-up. ConclusionsIn conclusion, patients with CD had increased risk of developing ocular hypertension comparing to other types of pituitary adenomas, which warrant the discretion of both ophthalmologists and neuroendocrinologists.

Download Full-text