1The role of reoperation after recurrence of Cushing’s disease
Section snippets
Background
Cushing’s disease (CD) results from excess secretion of adrenocorticotropic hormone (ACTH) from a pituitary adenoma, leading to hypersecretion of cortisol from the adrenal glands [1]. Prolonged cortisol exposure leads to a host of cardiovascular, musculoskeletal, and neuropsychiatric comorbidities, as well as increased mortality [1,2]. First-line treatment of CD is typically transsphenoidal surgical resection of the ACTH-secreting pituitary adenoma, which has been shown to restore normal
Repeat transsphenoidal surgery
The final option for treatment of recurrent Cushing’s disease, and the focus of this review, is redo transsphenoidal surgery. Reoperation is typically considered based on preoperative imaging findings including visible tumor, tumor size and extension, confirmed histology from first surgery, and the experience of the first surgeon [8]. It has been shown that inappropriate exposure and identification of the adenoma during first surgery is a reliable predictor of surgical failure [22].
Discussion
Cushing’s disease is thought to recur in patients at a rate of up to 50% after first-line treatment with transsphenoidal resection based on current literature [6]. This risk increases with time, with 20–25% of patients experiencing recurrence 10 years postoperatively [8]. Additionally, while initial transsphenoidal surgery results in hormonal remission in a large majority of patients (42–97%), some patients will experience persistence of disease [6]. The most widely used criteria for recurrence
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