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The relationship between efficacy of surgical treatment of Cushing disease and pathological – immunohistochemical and ultrastructural – confirmation of corticotroph tumour presence
Affiliations- Department of Endocrinology, Medical Centre of Postgraduate Education, Warsaw
- Department of Endocrinology and Radioisotope Treatment, Military Institute of Medicine, Warsaw
- Department of Neurosurgery, Military Institute of Medicine, Warsaw
- Acibadem Hospital, Department of Pathology, Istanbul/TURKEY, 34718 Istanbul, Türkiye
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Abstract
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 methodsThe 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.
ResultsTwenty-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).
ConclusionsPathological confirmation of corticotroph pituitary adenoma may be regarded as an important predictor of the surgical cure of CD.
Abstract
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 methodsThe 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.
ResultsTwenty-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).
ConclusionsPathological confirmation of corticotroph pituitary adenoma may be regarded as an important predictor of the surgical cure of CD.
Keywords
Cushing disease, transsphenoidal surgery, corticotrophic adenoma, immunohistochemistry, electron microscopy
About this articleTitle
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
Pages
37-46
Page views
272
Article views/downloads
297
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
