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J R Soc Med. 1986 May; 79(5): 262–269.
PMCID: PMC1290309

Transsphenoidal surgery for Cushing's disease.


A series of 101 patients with Cushing's disease underwent transsphenoidal surgery. Diagnosis was fundamentally based on dynamic testing, mainly on the dosage-dependent suppression of cortisol after dexamethasone. The effect of surgery was monitored by intraoperative ACTH measurements. In 96 out of 101 patients a microadenoma of the pituitary was identified and removed selectively. In 74% of patients there was a clinical and endocrinological remission of Cushing's disease. Four 'operative failures' after selective adenomectomy underwent hypophysectomy in a second operation and each remitted. Thus the overall remission rate was 77%. In general, bilateral adrenalectomy was performed in patients who had failed to remit after selective adenomectomy. Although there is a considerable mortality and morbidity in patients with Cushing's syndrome, complications attributed to surgery were low. Two patients died postoperatively. In general, an improvement of disturbed pituitary function was noted after selective adenomectomy.

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Selected References

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  • MARKS V. Cushing's syndrome occurring with pituitary chromophobe tumors. Acta Endocrinol (Copenh) 1959 Dec;32:527–535. [PubMed]
  • Gold EM. The Cushing syndromes: changing views of diagnosis and treatment. Ann Intern Med. 1979 May;90(5):829–844. [PubMed]
  • Hardy J. Transphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg. 1969;16:185–217. [PubMed]
  • Müller OA, Stalla GK, von Werder K. Corticotropin releasing factor: a new tool for the differential diagnosis of Cushing's syndrome. J Clin Endocrinol Metab. 1983 Jul;57(1):227–229. [PubMed]
  • Mashiter K, van Noorden S, de Marco L, Adams E, Joplin GF. Hormone secretion by human somatotrophic, lactotrophic, and mixed pituitary adenomas in culture. J Clin Endocrinol Metab. 1979 Jan;48(1):108–113. [PubMed]
  • White MC, Adams EF, Loizou M, Mashiter K, Fahlbusch R. Corticotropin releasing factor stimulates ACTH release from human pituitary corticotropic tumour cells in culture. Lancet. 1982 May 29;1(8283):1251–1252. [PubMed]
  • Martin R, Cetin Y, Fehm HL, Fahlbusch R, Voigt KH. Multiple cellular forms of corticotrophs in surgically removed pituitary adenomas and periadenomatous tissue in Cushing's disease. Am J Pathol. 1982 Mar;106(3):332–341. [PubMed]
  • Lamberts SW, de Lange SA, Stefanko SZ. Adrenocorticotropin-secreting pituitary adenomas originate from the anterior or the intermediate lobe in Cushing's disease: differences in the regulation of hormone secretion. J Clin Endocrinol Metab. 1982 Feb;54(2):286–291. [PubMed]
  • Orth DN, Liddle GW. Results of treatment in 108 patients with Cushing's syndrome. N Engl J Med. 1971 Jul 29;285(5):243–247. [PubMed]
  • Lagerquist LG, Meikle AW, West CD, Tyler FH. Cushing's disease with cure by resection of a pituitary adenoma. Evidence against a primary hypothalamic defect. Am J Med. 1974 Nov;57(5):826–830. [PubMed]
  • Krieger DT, Glick SM. Growth hormone and cortisol responsiveness in Cushing's syndrome. Relation to a possible central nervous system etiology. Am J Med. 1972 Jan;52(1):25–40. [PubMed]
  • Guthrie FW, Jr, Ciric I, Hayashida S, Kerr WD, Jr, Murphy ED. Pituitary Cushing's syndrome and Nelson's syndrome: diagnostic criteria, surgical therapy, and results. Surg Neurol. 1981 Nov;16(5):316–323. [PubMed]
  • King LW, Post KD, Yust I, Reichlin S. Suppression of cortisol secretion by low-dose dexamethasone testing in Cushing's disease. Case report. J Neurosurg. 1983 Jan;58(1):129–132. [PubMed]
  • Chrousos GP, Schulte HM, Oldfield EH, Gold PW, Cutler GB, Jr, Loriaux DL. The corticotropin-releasing factor stimulation test. An aid in the evaluation of patients with Cushing's syndrome. N Engl J Med. 1984 Mar 8;310(10):622–626. [PubMed]
  • Findling JW, Aron DC, Tyrrell JB, Shinsako JH, Fitzgerald PA, Norman D, Wilson CB, Forsham PH. Selective venous sampling for ACTH in Cushing's syndrome: differentiation between Cushing disease and the ectopic ACTH syndrome. Ann Intern Med. 1981 May;94(5):647–652. [PubMed]
  • Domingue JN, Wing SD, Wilson CB. Coexisting pituitary adenomas and partially empty sellas. J Neurosurg. 1978 Jan;48(1):23–28. [PubMed]
  • Ganguly A, Stanchfield JB, Roberts TS, West CD, Tyler FH. Cushing's syndrome in a patient with an empty sella turcica and a microadenoma of the adenohypophysis. Am J Med. 1976 Feb;60(2):306–309. [PubMed]
  • Hardy J. Presidential address: XVII Canadian Congress of Neurological Sciences. Cushing's disease: 50 years later. Can J Neurol Sci. 1982 Nov;9(4):375–380. [PubMed]
  • Boggan JE, Tyrrell JB, Wilson CB. Transsphenoidal microsurgical management of Cushing's disease. Report of 100 cases. J Neurosurg. 1983 Aug;59(2):195–200. [PubMed]
  • Salassa RM, Laws ER, Jr, Carpenter PC, Northcutt RC. Transsphenoidal removal of pituitary microadenoma in Cushing's disease. Mayo Clin Proc. 1978 Jan;53(1):24–28. [PubMed]
  • Burch W. A survey of results with transsphenoidal surgery in Cushing's disease. N Engl J Med. 1983 Jan 13;308(2):103–104. [PubMed]
  • Styne DM, Grumbach MM, Kaplan SL, Wilson CB, Conte FA. Treatment of Cushing's disease in childhood and adolescence by transsphenoidal microadenomectomy. N Engl J Med. 1984 Apr 5;310(14):889–893. [PubMed]
  • Jennings AS, Liddle GW, Orth DN. Results of treating childhood Cushing's disease with pituitary irradiation. N Engl J Med. 1977 Nov 3;297(18):957–962. [PubMed]
  • Cassar J, Doyle FH, Mashiter K, Joplin GF. Treatment of Cushing's disease in juveniles with interstitial pituitary irradiation. Clin Endocrinol (Oxf) 1979 Sep;11(3):313–321. [PubMed]
  • Ambrosi B, Giovanelli M, Gaini SM, Bochicchio D, Riva E, Tomei G, Zavanone M, Faglia G. Pituitary function before and after transsphenoidal adenomectomy in patients with Cushing's disease. Acta Neurochir (Wien) 1982;65(1-2):29–40. [PubMed]
  • Kuwayama A, Kageyama N, Nakane T, Watanabe M, Kanie N. Anterior pituitary function after transsphenoidal selective adenomectomy in patients with Cushing's disease. J Clin Endocrinol Metab. 1981 Jul;53(1):165–173. [PubMed]
  • Tyrrell JB, Brooks RM, Fitzgerald PA, Cofoid PB, Forsham PH, Wilson CB. Cushing's disease. Selective trans-sphenoidal resection of pituitary microadenomas. N Engl J Med. 1978 Apr 6;298(14):753–758. [PubMed]

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