Acta Neurochirurgica

, Volume 161, Issue 1, pp 119–127 | Cite as

Long-term outcome of trans-sphenoidal surgery for Cushing’s disease in Indian patients

  • S. Saini
  • J. Kanwar
  • S. Gupta
  • S. Behari
  • E. Bhatia
  • Subhash YadavEmail author
Original Article - Pituitaries
Part of the following topical collections:
  1. Pituitaries



The results of trans-sphenoidal surgery (TSS) in Cushing’s disease (CD) vary widely depending upon patient characteristics as well as surgical experience. Patients in India are often referred late to referral centers. We studied the rates of remission and endocrine deficiencies after TSS in patients with CD presenting to a referral hospital in India.


Sixty consecutive patients (45 females, median age 24.5 years) who underwent TSS between 2000 and 2015 were studied. The median (range) duration of follow-up was 40 (3–138) months. Initial and long-term remission and relapse rates and pituitary hypofunction post-TSS were evaluated.


Eighteen (30%) patients harbored macroadenomas. Twenty-eight (47%) patients achieved remission in the immediate post-operative period (8 AM serum cortisol < 140 nmol/l), while a higher remission rate was noted at 6 months (39/54 patients, 72%). At 1 year 70% patients and at final follow-up [median duration 40 (range 3–138) months], 58% of patients were in remission. No pre- or post-surgical variables were consistently associated with remission, except for the 8-AM serum cortisol level on the fifth day after surgery. Seven (18%) patients relapsed on follow-up, including five patients who had fifth post-operative day 8 AM serum cortisol < 140 nmol/l. Twelve (25%) patients newly developed hypothyroidism and one (1.6%) patient developed amenorrhoea after TSS.


Remission rate at 6 months was higher than immediately after TSS. A significant proportion of patients relapsed, thus necessitating life-long follow-up. New-onset hypothyroidism was frequent after TSS.


Cushing’s disease Trans-sphenoidal surgery Remission Relapse 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

701_2018_3736_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 15 kb)


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Departments of EndocrinologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia
  2. 2.Department of NeurosurgerySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia
  3. 3.Department of EndocrinologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

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