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Results and predictors of outcome of endoscopic endonasal surgery in Cushing’s disease: 20-year experience of an Italian referral Pituitary Center

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Abstract

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.

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Acknowledgements

We thank Dr. Giorgio Frank for his fundamental clinical and scientific support over the past 20 years. The study received no financial support.

Funding

The authors declare that the study has received no funding.

Author information

Authors and Affiliations

  1. IRCCS Istituto delle Science Neurologiche di Bologna, Bologna, Italy

    F. Guaraldi, M. Zoli & D. Mazzatenta

  2. Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Altura 3, 40139, Bologna, Italy

    F. Guaraldi, M. Zoli, D. Gori, F. Friso & D. Mazzatenta

  3. Department of Biomedical and Neuromuscular Sciences, Section of Anatomic Pathology ‘M. Malpighi’ at Bellaria Hospital, University of Bologna, Bologna, Italy

    S. Asioli

  4. Division of Endocrinology, Ospedale Maggiore, Bologna, Italy

    G. Corona & A. Sforza

  5. ENT Division, Bellaria Hospital, Bologna, Italy

    E. Pasquini

  6. Division of Neuroradiology, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy

    A. Bacci

Authors
  1. F. Guaraldi
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  2. M. Zoli
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  4. G. Corona
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  7. E. Pasquini
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  9. A. Sforza
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  10. D. Mazzatenta
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Correspondence to F. Guaraldi.

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All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the inter-hospital Ethical Committee of Bologna City (Protocol No. CE17143, February 2018) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All patients gave written informed consent after detailed explanation of the study purpose and procedures.

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Guaraldi, F., Zoli, M., Asioli, S. et al. Results and predictors of outcome of endoscopic endonasal surgery in Cushing’s disease: 20-year experience of an Italian referral Pituitary Center. J Endocrinol Invest 43, 1463–1471 (2020). https://doi.org/10.1007/s40618-020-01225-5

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  • DOI: https://doi.org/10.1007/s40618-020-01225-5

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