Skip to main content
SpringerLink
Log in

The Surgical Management of Cushing’s Disease

  • Chapter
  • First Online:
Cushing's Syndrome

Part of the book series: Contemporary Endocrinology ((COE))

  • 2045 Accesses

Abstract

The prompt and effective lowering of increased cortisol becomes essential for the well-being of patient’s with Cushing’s disease. As 80% of patients with the clinical signs and symptoms of Cushing’s disease have a pituitary source of excessive and uncontrolled adrenocorticotropic hormone (ACTH) secretion, well-trained pituitary surgeons are required to deal with this complex disease. At present, surgical removal of a pituitary adenoma which is the source of excessive ACTH provides the most reliable method of reducing cortisol, with the potential for “cure” of the tumor and immediate remission of disease. The most popular methods are endonasal microsurgical or endoscopic approaches, which have become increasingly safe and effective. The goals of surgery are to reverse the endocrinopathy and restore normal pituitary function; eliminate mass effect and restore normal neurological function; eliminate or minimize the possibility of tumor recurrence; and obtain a definitive histologic diagnosis. Reported long-term recurrence rates mandate close monitoring in this patient population.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Atkinson AB, Kennedy A, Wiggam MI, McCance DR, Sheridan B. Long-term remission rates after pituitary surgery for Cushing’s disease: the need for long-term surveillance. Clin Endocrinol (Oxf) 2005;63:549–559.

    Article  Google Scholar 

  2. Batista D, Gennari M, Riar J, Chang R, Keil MF, Oldfield EH, Stratakis CA. An assessment of petrosal sinus sampling for localization of pituitary microadenomas in children with Cushing disease. J Clin Endocrinol Metab 2006;91:221–224.

    Article  PubMed  CAS  Google Scholar 

  3. Bigos ST, Robert F, Pelletier G, Hardy J. Cure of Cushing’s disease by transsphenoidal removal of a microadenoma from a pituitary gland despite a radiographically normal sella turcica. J Clin Endocrinol Metab 1977;45:1251–1260.

    Article  PubMed  CAS  Google Scholar 

  4. Cavagnini F, Pecori Giraldi F. Epidemiology and follow-up of Cushing’s disease. Ann Endocrinol (Paris) 2001;62:168–172.

    CAS  Google Scholar 

  5. Chee GH, Mathias DB, James RA, Kendall-Taylor P. Transsphenoidal pituitary surgery in Cushing’s disease: can we predict outcome? Clin Endocrinol (Oxf) 2001;54:617–626.

    Article  CAS  Google Scholar 

  6. Chen JC, Amar AP, Choi S, Singer P, Couldwell WT, Weiss MH. Transsphenoidal microsurgical treatment of Cushing disease: postoperative assessment of surgical efficacy by application of an overnight low-dose dexamethasone suppression test. J Neurosurg 2003;98:967–973.

    Article  PubMed  Google Scholar 

  7. Davis WL, Lee JN, King BD, Harnsberger HR. Dynamic contrast-enhanced MR imaging of the pituitary gland with fast spin-echo technique. J Magn Reson Imaging 1994;4:509–511.

    Article  PubMed  CAS  Google Scholar 

  8. De Tommasi C, Vance ML, Okonkwo DO, Diallo A, Laws ER, Jr. Surgical management of adrenocorticotropic hormone-secreting macroadenomas: outcome and challenges in patients with Cushing’s disease or Nelson’s syndrome. J Neurosurg 2005;103:825–830.

    Article  PubMed  Google Scholar 

  9. Esposito F, Dusick JR, Cohan P, Moftakhar P, McArthur D, Wang C, Swerdloff RS, Kelly DF. Clinical review: early morning cortisol levels as a predictor of remission after transsphenoidal surgery for Cushing’s disease. J Clin Endocrinol Metab 2006;91:7–13.

    Article  PubMed  CAS  Google Scholar 

  10. Flitsch J, Knappe UJ, Ludecke DK. The use of postoperative ACTH levels as a marker for successful transsphenoidal microsurgery in Cushing’s disease. Zentralbl Neurochir 2003;64:6–11.

    Article  PubMed  CAS  Google Scholar 

  11. Fomekong E, Maiter D, Grandin C, Raftopoulos C. Outcome of transsphenoidal surgery for Cushing’s disease: a high remission rate in ACTH-secreting macroadenomas. Clin Neurol Neurosurg 2009;111:442–9.

    Google Scholar 

  12. Hammer GD, Tyrrell JB, Lamborn KR, Applebury CB, Hannegan ET, Bell S, Rahl R, Lu A, Wilson CB. Transsphenoidal microsurgery for Cushing’s disease: initial outcome and long-term results. J Clin Endocrinol Metab 2004;89:6348–6357.

    Article  PubMed  CAS  Google Scholar 

  13. Hardy J. Transsphenoidal microsurgery for selective removal of functional pituitary microadenomas. Invited commentary. World J Surg 1977;1:84.

    Article  PubMed  CAS  Google Scholar 

  14. Hardy J. Presidential address: XVII Canadian Congress of Neurological Sciences. Cushing’s disease: 50 years later. Can J Neurol Sci 1982;9:375–380.

    PubMed  CAS  Google Scholar 

  15. Hofmann BM, Hlavac M, Kreutzer J, Grabenbauer G, Fahlbusch R. Surgical treatment of recurrent Cushing’s disease. Neurosurgery 2006;58:1108–1118; discussion 1117–8.

    Google Scholar 

  16. Hofmann BM, Hlavac M, Martinez R, Buchfelder M, Muller OA, Fahlbusch R. Long-term results after microsurgery for Cushing disease: experience with 426 primary operations over 35 years. J Neurosurg 2008;108:9–18.

    Article  PubMed  Google Scholar 

  17. Invitti C, Pecori Giraldi F, de Martin M, Cavagnini F. Diagnosis and management of Cushing’s syndrome: results of an Italian multicentre study. Study Group of the Italian Society of Endocrinology on the Pathophysiology of the Hypothalamic-Pituitary-Adrenal Axis. J Clin Endocrinol Metab 1999;84:440–448.

    Article  PubMed  CAS  Google Scholar 

  18. Jagannathan J, Kanter AS, Olson C, Sherman JH, Laws ER, Jr, Sheehan JP. Applications of radiotherapy and radiosurgery in the management of pediatric Cushing’s disease: a review of the literature and our experience. J Neurooncol 2008;90:117–124.

    Article  PubMed  Google Scholar 

  19. Jagannathan J, Sheehan JP, Pouratian N, Laws ER, Steiner L, Vance ML. Gamma Knife surgery for Cushing’s disease. J Neurosurg 2007;106:980–987.

    Article  PubMed  Google Scholar 

  20. Jane JA, Jr., Laws ER, Jr. The surgical management of pituitary adenomas in a series of 3,093 patients. J Am Coll Surg 2001;193:651–659.

    Article  PubMed  Google Scholar 

  21. Kane LA, Leinung MC, Scheithauer BW, Bergstralh EJ, Laws ER, Jr., Groover RV, Kovacs K, Horvath E, Zimmerman D. Pituitary adenomas in childhood and adolescence. J Clin Endocrinol Metab 1994;79:1135–1140.

    Article  PubMed  CAS  Google Scholar 

  22. Kanter AS, Diallo AO, Jane JA, Jr., Sheehan JP, Asthagiri AR, Oskouian RJ, Okonkwo DO, Sansur CA, Vance ML, Rogol AD, Laws ER, Jr. Single-center experience with pediatric Cushing’s disease. J Neurosurg 2005;103:413–420.

    PubMed  Google Scholar 

  23. Kim LJ, Lekovic GP, White WL, Karis J. Preliminary experience with 3-Tesla MRI and Cushing’s disease. Skull Base 2007;17:273–277.

    Article  PubMed  Google Scholar 

  24. Knappe UJ, Ludecke DK. Persistent and recurrent hypercortisolism after transsphenoidal surgery for Cushing’s disease. Acta Neurochir Suppl 1996;65:31–34.

    PubMed  CAS  Google Scholar 

  25. Lanzino G, Maartens NF, Laws ER, Jr. Cushing’s case XLV: Minnie G. J Neurosurg 2002;97:231–234.

    Article  PubMed  Google Scholar 

  26. Laws ER, Jr. Multiple pituitary adenomas. J Neurosurg 2000;93:909–911.

    PubMed  Google Scholar 

  27. Laws ER, Jr. Pituitary pseudocapsule. J Neurosurg 2006;104:1–2; discussion 2–3.

    Article  PubMed  Google Scholar 

  28. Laws ER, Jr, Abboud CF, Kern EB. Perioperative management of patients with pituitary microadenoma. Neurosurgery 1980;7:566–570.

    Article  PubMed  Google Scholar 

  29. Laws ER, Reitmeyer M, Thapar K, Vance ML. Cushing’s disease resulting from pituitary corticotrophic microadenoma. Treatment results from transsphenoidal microsurgery and gamma knife radiosurgery. Neurochirurgie 2002;48:294–299.

    PubMed  CAS  Google Scholar 

  30. Laws ER, Scheithauer BW, Groover RV. Pituitary adenomas in childhood and adolescence. Prog Exp Tumor Res 1987;30:359–361.

    PubMed  CAS  Google Scholar 

  31. Lefournier V, Martinie M, Vasdev A, Bessou P, Passagia JG, Labat-Moleur F, Sturm N, Bosson JL, Bachelot I, Chabre O. Accuracy of bilateral inferior petrosal or cavernous sinuses sampling in predicting the lateralization of Cushing’s disease pituitary microadenoma: influence of catheter position and anatomy of venous drainage. J Clin Endocrinol Metab 2003;88:196–203.

    Article  PubMed  CAS  Google Scholar 

  32. Leinung MC, Kane LA, Scheithauer BW, Carpenter PC, Laws ER, Jr, Zimmerman D. Long term follow-up of transsphenoidal surgery for the treatment of Cushing’s disease in childhood. J Clin Endocrinol Metab 1995;80:2475–2479.

    Article  PubMed  CAS  Google Scholar 

  33. Locatelli M, Vance ML, Laws ER. Clinical review: the strategy of immediate reoperation for transsphenoidal surgery for Cushing’s disease. J Clin Endocrinol Metab 2005;90:5478–5482.

    Article  PubMed  CAS  Google Scholar 

  34. Meij BP, Lopes MB, Vance ML, Thorner MO, Laws ER, Jr. Double pituitary lesions in three patients with Cushing’s disease. Pituitary 2000;3:159–168.

    Article  PubMed  CAS  Google Scholar 

  35. Oldfield EH, Doppman JL, Nieman LK, Chrousos GP, Miller DL, Katz DA, Cutler GB, Jr, Loriaux DL. Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing’s syndrome. N Engl J Med 1991;325:897–905.

    Article  PubMed  CAS  Google Scholar 

  36. Partington MD, Davis DH, Laws ER, Jr, Scheithauer BW. Pituitary adenomas in childhood and adolescence. Results of transsphenoidal surgery. J Neurosurg 1994;80:209–216.

    Article  PubMed  CAS  Google Scholar 

  37. Patil CG, Lad SP, Katznelson L, Laws ER, Jr. Brain atrophy and cognitive deficits in Cushing’s disease. Neurosurg Focus 2007;23:E11.

    PubMed  Google Scholar 

  38. Patil CG, Prevedello DM, Lad SP, Vance ML, Thorner MO, Katznelson L, Laws ER, Jr. Late recurrences of Cushing’s disease after initial successful transsphenoidal surgery. J Clin Endocrinol Metab 2008;93:358–362.

    Article  PubMed  CAS  Google Scholar 

  39. Patil CG, Veeravagu A, Prevedello DM, Katznelson L, Vance ML, Laws ER, Jr. Outcomes after repeat transsphenoidal surgery for recurrent Cushing’s disease. Neurosurgery 2008;63:266–270; discussion 270–1.

    Article  PubMed  Google Scholar 

  40. Pereira AM, van Aken MO, van Dulken H, Schutte PJ, Biermasz NR, Smit JW, Roelfsema F, Romijn JA. Long-term predictive value of postsurgical cortisol concentrations for cure and risk of recurrence in Cushing’s disease. J Clin Endocrinol Metab 2003;88:5858–5864.

    Article  PubMed  CAS  Google Scholar 

  41. Pouratian N, Prevedello DM, Jagannathan J, Lopes MB, Vance ML, Laws ER, Jr. Outcomes and management of patients with Cushing’s disease without pathological confirmation of tumor resection after transsphenoidal surgery. J Clin Endocrinol Metab 2007;92:3383–3388.

    Article  PubMed  CAS  Google Scholar 

  42. Prevedello DM, Pouratian N, Sherman J, Jane JA, Jr, Vance ML, Lopes MB, Laws ER, Jr. Management of Cushing’s disease: outcome in patients with microadenoma detected on pituitary magnetic resonance imaging. J Neurosurg 2008;109:751–759.

    Article  PubMed  Google Scholar 

  43. Rees DA, Hanna FW, Davies JS, Mills RG, Vafidis J, Scanlon MF. Long-term follow-up results of transsphenoidal surgery for Cushing’s disease in a single centre using strict criteria for remission. Clin Endocrinol (Oxf) 2002;56:541–551.

    Article  CAS  Google Scholar 

  44. Rollin GA, Ferreira NP, Junges M, Gross JL, Czepielewski MA. Dynamics of serum cortisol levels after transsphenoidal surgery in a cohort of patients with Cushing’s disease. J Clin Endocrinol Metab 2004;89:1131–1139.

    Article  PubMed  CAS  Google Scholar 

  45. Salassa RM, Laws ER, Carpenter PC, Northcutt RC. Cushing’s disease-50 years later. Trans Am Clin Climatol Assoc 1983;94:122–129.

    PubMed  CAS  Google Scholar 

  46. Salassa RM, Laws ER, Jr., Carpenter PC, Northcutt RC. Transsphenoidal removal of pituitary microadenoma in Cushing’s disease. Mayo Clin Proc 1978;53:24–28.

    PubMed  CAS  Google Scholar 

  47. Semple PL, Laws ER, Jr. Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing’s disease. J Neurosurg 1999;91:175–179.

    Article  PubMed  CAS  Google Scholar 

  48. Semple PL, Vance ML, Findling J, Laws ER. Transsphenoidal surgery for Cushing’s disease: outcome in patients with a normal MRI scan. Neurosurgery 2000;46:553–559.

    Article  Google Scholar 

  49. Sheehan JM, Vance ML, Sheehan JP, Ellegala DB, Laws ER, Jr. Radiosurgery for Cushing’s disease after failed transsphenoidal surgery. J Neurosurg 2000;93:738–742.

    Article  PubMed  CAS  Google Scholar 

  50. Shimon I, Ram Z, Cohen ZR, Hadani M. Transsphenoidal surgery for Cushing’s disease: endocrinological follow-up monitoring of 82 patients. Neurosurgery 2002;51:57–61; discussion 61–2.

    Google Scholar 

  51. Simmons NE, Alden TD, Thorner MO, Laws ER, Jr. Serum cortisol response to transsphenoidal surgery for Cushing disease. J Neurosurg 2001;95:1–8.

    Article  PubMed  CAS  Google Scholar 

  52. Simmons NE, Do HM, Lipper MH, Laws ER, Jr. Cerebral atrophy in Cushing’s disease. Surg Neurol 2000;53:72–76.

    Article  PubMed  CAS  Google Scholar 

  53. Swearingen B, Biller BM, Barker FG, 2nd, Katznelson L, Grinspoon S, Klibanski A, Zervas NT. Long-term mortality after transsphenoidal surgery for Cushing disease. Ann Intern Med 1999;130:821–824.

    PubMed  CAS  Google Scholar 

  54. Yap LB, Turner HE, Adams CB, Wass JA. Undetectable postoperative cortisol does not always predict long-term remission in Cushing’s disease: a single centre audit. Clin Endocrinol (Oxf) 2002;56:25–31.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurosurgery Department, Brigham & Women’s Hospital, Boston, MA, 02115, USA

    Ian F. Dunn MD (Clinical Instructor in Surgery)

  2. Department of Neurological Surgery, Brigham & Women’s Hospital, Boston, MA, USA

    Edward R. Laws Jr MD

Authors
  1. Ian F. Dunn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edward R. Laws Jr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. , Division of Endocrinology and Metabolism, Hospital das Clínicas, University of Sao, Sao Paulo, 05403-000, Brazil

    Marcello D. Bronstein

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Dunn, I.F., Laws, E.R. (2010). The Surgical Management of Cushing’s Disease. In: Bronstein, M. (eds) Cushing's Syndrome. Contemporary Endocrinology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-449-4_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-449-4_10

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60327-448-7

  • Online ISBN: 978-1-60327-449-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation