open access

Vol 46, No 1 (2012)
ARTYKUŁ ORYGINALNY
Submitted: 2011-04-04
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The relationship between efficacy of surgical treatment of Cushing disease and pathological – immunohistochemical and ultrastructural – confirmation of corticotroph tumour presence

Przemysław Witek, Grzegorz Zieliński, Maria Maksymowicz, Wojciech Zgliczyński
DOI: 10.5114/ninp.2012.27177
·
Neurol Neurochir Pol 2012;46(1):37-46.

open access

Vol 46, No 1 (2012)
ARTYKUŁ ORYGINALNY
Submitted: 2011-04-04

Abstract

Background and purpose

The most common cause of Cushing disease (CD) is ACTH-secreting pituitary adenoma. Transsphenoidal selective adenomectomy is the treatment of choice. Frequency of remission varies from 60% to 90%, depending on the site and the surgeon's experience. This study aims to answer the question whether confirmation of corticotroph adenoma in pathological examinations increases the probability of surgical cure for CD.

Material and methods

The prospective study involved 36 patients with CD operated on with the transsphenoidal approach and followed up for at least 18 months. Following the surgical procedure, the specimen was examined by a pathologist. The study evaluated the significance of positive histological (immunohistochemical and ultrastructural) examination results for achieving surgical cure for CD.

Results

Twenty-three of 36 patients (63.9%) were regarded as being surgically cured of CD. Persistent CD was confirmed in 13 patients (36.1%). Pituitary insufficiency was found in 5 patients (13.9%), whereas 3 patients (8.3%) were diagnosed with diabetes insipidus. A significant difference was demonstrated between the cured and the non-cured group with reference to the results of pathological examination of surgical specimens. Pathomorphological confirmation of corticotroph adenoma was significantly more frequently observed in the cured group in comparison with the non-cured group (p = 0.028).

Conclusions

Pathological confirmation of corticotroph pituitary adenoma may be regarded as an important predictor of the surgical cure of CD.

Abstract

Background and purpose

The most common cause of Cushing disease (CD) is ACTH-secreting pituitary adenoma. Transsphenoidal selective adenomectomy is the treatment of choice. Frequency of remission varies from 60% to 90%, depending on the site and the surgeon's experience. This study aims to answer the question whether confirmation of corticotroph adenoma in pathological examinations increases the probability of surgical cure for CD.

Material and methods

The prospective study involved 36 patients with CD operated on with the transsphenoidal approach and followed up for at least 18 months. Following the surgical procedure, the specimen was examined by a pathologist. The study evaluated the significance of positive histological (immunohistochemical and ultrastructural) examination results for achieving surgical cure for CD.

Results

Twenty-three of 36 patients (63.9%) were regarded as being surgically cured of CD. Persistent CD was confirmed in 13 patients (36.1%). Pituitary insufficiency was found in 5 patients (13.9%), whereas 3 patients (8.3%) were diagnosed with diabetes insipidus. A significant difference was demonstrated between the cured and the non-cured group with reference to the results of pathological examination of surgical specimens. Pathomorphological confirmation of corticotroph adenoma was significantly more frequently observed in the cured group in comparison with the non-cured group (p = 0.028).

Conclusions

Pathological confirmation of corticotroph pituitary adenoma may be regarded as an important predictor of the surgical cure of CD.

Get Citation

Keywords

Cushing disease, transsphenoidal surgery, corticotrophic adenoma, immunohistochemistry, electron microscopy

About this article
Title

The relationship between efficacy of surgical treatment of Cushing disease and pathological – immunohistochemical and ultrastructural – confirmation of corticotroph tumour presence

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 46, No 1 (2012)

Pages

37-46

DOI

10.5114/ninp.2012.27177

Bibliographic record

Neurol Neurochir Pol 2012;46(1):37-46.

Keywords

Cushing disease
transsphenoidal surgery
corticotrophic adenoma
immunohistochemistry
electron microscopy

Authors

Przemysław Witek
Grzegorz Zieliński
Maria Maksymowicz
Wojciech Zgliczyński

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