Purpose

To assess outcomes and predictors of early and long-term remission in patients with Cushing’s disease (CD) due to ACTH-secreting adenomas treated via endoscopic endonasal approach (EEA).

Methods

This is a retrospective study. Consecutive patients operated for CD from 1998 to 2017 in an Italian referral Pituitary Center were enrolled. Clinical, radiological, and histological data at enrollment and follow-up were collected.

Results

151 patients (107 F) were included; 88.7% were naïve for treatment, 11.3% had been treated surgically and 11.2% medically. At pre-operative magnetic resonance imaging (MRI), 35 had a macroadenoma and 80 a microadenoma, while tumor was undetectable in 36 patients. Mean age at surgery was 41.1 ± 16.6 years. Diagnosis was confirmed histologically in 82.4% of the cases. Patients with disease persistence underwent second surgery and/or medical and/or radiation therapy. Mean follow-up was 92.3 ± 12.0 (range 12–237.4) and median 88.2 months. Remission rate was 88.1% after the first surgery and 90.7% at last follow-up. One patient died of pituitary carcinoma. Post-surgical cortisol drop (p = 0.004), tumor detection at MRI (p = 0.03) and size < 1 cm (p = 0.045) increased the chance of disease remission; cavernous sinus invasion was a negative predictor of outcome (p = 0.002). Twenty-seven patients developed diabetes insipidus and 18 hypopituitarism. Surgery repetition increased the risk of hypopituitarism (p = 0.03), but not of other complications, which included epistaxis (N = 2), cerebrospinal fluid leakage (1), pneumonia (3), myocardial infarction (1), and pulmonary embolisms (2).

Conclusions

Selective adenomectomy via EEA performed by experienced surgeons, supported by a multidisciplinary dedicated team, allows long-term remission in the vast majority of CD patients with low complication rate.

中文翻译：

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在库欣病中进行内窥镜鼻内窥镜手术的结果和结果的预测指标：意大利转诊垂体中心20年的经验。

目的

评估通过内窥镜鼻内镜入路（EEA）治疗的ACTH分泌性腺瘤导致的库欣病（CD）患者的结果和早期和长期缓解的预测指标。

方法

这是一项回顾性研究。研究对象是1998年至2017年在意大利脑垂体转诊中心接受CD手术的连续患者。在入组和随访时收集临床，放射学和组织学数据。

结果

其中包括151例患者（107 F）；初次接受治疗的比例为88.7％，接受手术治疗的比例为11.3％，药物治疗的比例为11.2％。在术前磁共振成像（MRI）中，有35例有大腺瘤，有80例有微腺瘤，而在36例患者中未发现肿瘤。手术的平均年龄为41.1±16.6岁。组织学确诊的病例占82.4％。具有疾病持续性的患者接受第二次手术和/或药物和/或放射疗法。平均随访时间为92.3±12.0（范围12-237.4），中位数为88.2个月。首次手术后缓解率为88.1％，最后一次随访为90.7％。1例患者死于垂体癌。手术后皮质醇下降（p  = 0.004），MRI肿瘤检出（p  = 0.03）和尺寸<1 cm（p = 0.045）增加了疾病缓解的机会；海绵窦浸润是预后的阴性指标（p  = 0.002）。27名患者发生尿崩症和18个垂体功能减退。重复手术增加了垂体功能低下的风险（p  = 0.03），但没有其他并发症，包括鼻出血（N  = 2），脑脊液漏（1），肺炎（3），心肌梗塞（1）和肺栓塞（ 2）。

结论

由经验丰富的外科医生通过EEA进行的选择性腺切除术，在一个多学科的专门团队的支持下，可以使绝大多数并发症发生率低的CD患者获得长期缓解。