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Transsphenoidal surgery related to 72% cure rate in Cushing’s disease
Hassan-Smith ZK. J Clin Endocrinol Metab. 2012;doi:10.1210/jc.2011-2957.
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Transsphenoidal surgery was associated with long-term cure rates of more than 70% in patients with Cushing’s disease, according to researchers from the University of Birmingham in England.
“In early series, adrenal surgery and pituitary radiotherapy were the mainstays of treatment for Cushing’s disease,” the researchers wrote. “Subsequently, transsphenoidal surgery was established as the first-line treatment of choice. However, a survey of 30 US centers found that remission rates varied greatly, [ranging] from between 90% to 100% to as low as 10%.”
The researchers conducted a single-center study to define outcome in patients with Cushing’s disease treated with transsphenoidal surgery for 20 years. The retrospective cohort study included 80 patients who underwent the surgery from 1988 to 2009. In 72 patients, data on clinical features and outcome were collected from medical records. In the other eight patients, there were no records available, but mortality cases were obtained from the National Health Service (NHS) registry.
The cure rate was 72%, the persistent disease rate was 17% and the disease recurrence rate was 11%. The median time to recurrence after remission was 2.1 years. The mean follow-up for mortality was 10.9 years. Thirteen of the 80 patients had died: five in the cure group, two in the disease recurrence group, two with persistent disease and four of the patients with only NHS registry data.
The overall standardized mortality rate was 3.17 (95% CI, 1.7-5.43). In the cure group, the standardized mortality rate was 2.47 (95% CI, 0.8-5.77), and in the disease recurrence/persistent disease groups, the standardized mortality rate was 4.12 (95% CI, 1.12-10.54).
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