We undertook trans-sphenoidal microsurgical pituitary exploration in 20 consecutive patients with Cushing's disease, eight of whom had normal sellar polytomography. Pituitary adenomas were selectively resected in 17 and histologically confirmed in 14. In one patient total hypophysectomy revealed a 1.5-mm basophilic adenoma, and in two patients vascular anomalies prevented sellar exploration. Hypercortisolism was corrected in 17 patients (i.e., in 16 of the 17 undergoing selective tumor removal and in the one with total hypophysectomy). Panhypopituitarism occurred only in this patient, and transient diabetes insipidus occurred in five. Most patients became glucocorticoid deficient and required replacement therapy. We conclude that pituitary tumors are present in the great majority of patient with Cushing's disease, even in the absence of demonstrable tomographic changes in the sella turcica, and that selective removal corrects hypercortisolism with little morbidity.
This article has been cited by other articles:
Hammer, G. D., Tyrrell, J. B., Lamborn, K. R., Applebury, C. B., Hannegan, E. T., Bell, S., Rahl, R., Lu, A., Wilson, C. B.
(2004). Transsphenoidal Microsurgery for Cushing's Disease: Initial Outcome and Long-Term Results. J. Clin. Endocrinol. Metab.
89: 6348-6357
[Abstract][Full Text]
Simpson, D. J., McNicol, A. M., Murray, D. C., Bahar, A., Turner, H. E., Wass, J. A. H., Esiri, M. M., Clayton, R. N., Farrell, W. E.
(2004). Molecular Pathology Shows p16 Methylation in Nonadenomatous Pituitaries from Patients with Cushing's Disease. Clin. Cancer Res.
10: 1780-1788
[Abstract][Full Text]
Heaney, A., Loughrey, G., McCance, D., Mcilrath, E., Hadden, D., Kennedy, L., Sheridan, B., Atkinson, A.B.
(1999). Is whole-lung CT scanning still necessary in all cases of ACTH-dependent Cushing's syndrome in the era of petrosal sinus sampling?. QJM
92: 335-340
[Abstract][Full Text]
Devoe, D. J., Miller, W. L., Conte, F. A., Kaplan, S. L., Grumbach, M. M., Rosenthal, S. M., Wilson, C. B., Gitelman, S. E.
(1997). Long-Term Outcome in Children and Adolescents after Transsphenoidal Surgery for Cushing's Disease. J. Clin. Endocrinol. Metab.
82: 3196-3202
[Abstract][Full Text]
Massoud, A F, Powell, M, Williams, R A, Hindmarsh, P C, Brook, C G D
(1997). Transsphenoidal surgery for pituitary tumours. Arch. Dis. Child.
76: 398-404
[Abstract][Full Text]
Magiakou, M. A., Mastorakos, G., Oldfield, E. H., Gomez, M. T., Doppman, J. L., Cutler, G. B., Nieman, L. K., Chrousos, G. P.
(1994). Cushing's Syndrome in Children and Adolescents -- Presentation, Diagnosis, and Therapy. NEJM
331: 629-636
[Abstract][Full Text]
Tahir, A. H., Sheeler, L. R.
(1992). Recurrent Cushing's Disease After Transsphenoidal Surgery. Arch Intern Med
152: 977-981
[Abstract]
Melby, J. C.
(1988). Therapy of Cushing Disease: A Consensus for Pituitary Microsurgery. ANN INTERN MED
109: 445-446
[Abstract]
Mampalam, T. J., Tyrrell, J. B., Wilson, C. B.
(1988). Transsphenoidal Microsurgery for Cushing Disease: A Report of 216 Cases. ANN INTERN MED
109: 487-493
[Abstract]
Cappa, M., Stoner, E., DiMartino-Nardi, J., Pang, S., Temeck, J., New, M. I.
(1987). Recurrence of Cushing's Disease in Childhood After Radiotherapy-Induced Remission. Arch Pediatr Adolesc Med
141: 736-740
[Abstract]
Findling, J. W., Tyrrell, J. B.
(1986). Occult Ectopic Secretion of Corticotropin. Arch Intern Med
146: 929-933
[Abstract]
TYRRELL, J. B., FINDLING, J. W., ARON, D. C., FITZGERALD, P. A., FORSHAM, P. H.
(1986). An Overnight High-Dose Dexamethasone Suppression Test for Rapid Differential Diagnosis of Cushing's Syndrome. ANN INTERN MED
104: 180-186
[Abstract]
Burch, W. M.
(1985). Cushing's Disease: A Review. Arch Intern Med
145: 1106-1111
[Abstract]
ASA, S. L., KOVACS, K., TINDALL, G. T., BARROW, D. L., HORVATH, E., VECSEI, P.
(1984). Cushing's Disease Associated with an lntrasellar Gangliocytoma Producing Corticotrophin-Releasing Factor. ANN INTERN MED
101: 789-793
[Abstract]
Ambrosi, B., Nissim, M., Arosio, M., Faglia, G.
(1982). Effect of Bromocriptine on Pituitary Tumors. JAMA
248: 1064-1065
[Abstract]
DLUHY, R. G., WILLIAMS, G. H.
(1982). Cushing's Syndrome and the Changing Times. ANN INTERN MED
97: 131-133
[Abstract]
ENDOCRINOLOGY AND METABOLISM COMMITTEE, , MEDICAL KNOWLEDGE SELF-ASSESSMENT PROGRAM VI, , AMERICAN COLLEGE OF PHYSICIANS,
(1982). Endocrinology and Metabolism: An Annotated Bibliography of Recent Literature: References to Journal Articles and Other Papers. ANN INTERN MED
97: 151-157
[Abstract]
FINDLING, J. W., ARON, D. C., TYRRELL, J. B., SHINSAKO, J. H., FITZGERALD, P. A., NORMAN, D., WILSON, C. B., FORSHAM, P. H.
(1981). Selective Venous Sampling for ACTH in Cushing's Syndrome: Differentiation Between Cushing's Disease and the Ectopic ACTH Syndrome. ANN INTERN MED
94: 647-652
[Abstract]
Taylor, H. C., Velasco, M. E., Brodkey, J. S.
(1980). Remission of Pituitary-Dependent Cushing's Disease After Removal of Nonneoplastic Pituitary Gland. Arch Intern Med
140: 1366-1368
[Abstract]
Young, R. L., Nusynowitz, M. L.
(1980). Endocrinology. JAMA
243: 2181-2182
[Abstract]
SCHTEINGART, D. E., TSAO, H. S., TAYLOR, C. I., MCKENZIE, A., VICTORIA, R., THERRIEN, B. A.
(1980). Sustained Remission of Cushing's Disease with Mitotane and Pituitary Irradiation. ANN INTERN MED
92: 613-619
[Abstract]
Pont, A., Gutierrez-Hartman, A.
(1979). Cushing's Disease: Recurrence After a Surgically Induced Remission. Arch Intern Med
139: 938-940
[Abstract]
GOLD, E. M.
(1979). The Cushing Syndromes: Changing Views of Diagnosis and Treatment. ANN INTERN MED
90: 829-844
[Abstract]
Prinz, R. A., Brooks, M. H., Lawrence, A. M., Paloyan, E.
(1979). The Continued Importance of Adrenalectomy in the Treatment of Cushing's Disease. Arch Surg
114: 481-484
[Abstract]
Baue, A. E.
(1979). Surgery. JAMA
241: 1365-1369
[Abstract]
Jordan, R. M., Cook, D. M., Kendall, J. W., Kerber, C. W.
(1979). Nelson's Syndrome and Spontaneous Pituitary Tumor Infarction. Arch Intern Med
139: 340-342
[Abstract]
Vaisrub, S.
(1978). Cushing's Syndrome--Still a Conundrum. JAMA
240: 865-865
[Abstract]
