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Surgery for Cushing’s Disease

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Pituitary Disorders of Childhood

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

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Abstract

Transsphenoidal surgery is considered a first-line therapy for Cushing’s disease in children. Preoperative evaluation includes appropriate biochemical testing, MRI imaging, and inferior petrosal sinus sampling, to confirm a pituitary source. Remission rates between 50% and 95% have been reported in various series, depending on the size and invasiveness of the tumor, with acceptably low surgical morbidity. Recurrence remains an issue despite initial indications of remission, and adjunctive therapy, including radiosurgery, medical treatment, and adrenalectomy, is sometimes required.

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References

  1. Magiakou MA, Chrousos GP. Cushing’s syndrome in children and adolescents: current diagnostic and therapeutic strategies. J Endocrinol Investig. 2002;25(2):181–94.

    Article  CAS  Google Scholar 

  2. Yordanova G, Martin L, Afshar F, Sabin I, Alusi G, Plowman NP, Riddoch F, Evanson J, Matson M, Grossman AB, Akker SA, Monson JP, Drake WM, Savage MO, Storr HL. Long-term outcomes of children treated for Cushing’s disease: a single center experience. Pituitary. 2016;19(6):612–24.

    Google Scholar 

  3. Libuit LG, Karageorgiadis A, Sinaii N, Nguyen May NM, Keil MF, Lodish MB, Stratakis CA. A gender-dependent analysis of Cushing’s disease in childhood: pre- and postoperative follow-up. Clin Endocrinol. 2015;83(1):72–7. https://doi.org/10.1111/cen.12644; Epub 2015 Feb 2.

    Article  Google Scholar 

  4. Storr HL, Savage MO. Management of endocrine disease: paediatric cushing’s disease. Eur J Endocrinol. 2015;173(1):R35–45. https://doi.org/10.1530/EJE-15-0013.

    Article  CAS  PubMed  Google Scholar 

  5. Storr HL, Alexandraki KI, Martin L, Isidori AM, Kaltsas GA, Monson JP, Besser GM, Matson M, Evanson J, Afshar F, Sabin I, Savage MO, Grossman AB. Comparisons in the epidemiology, diagnostic features and cure rate by transsphenoidal surgery between paediatric and adult-onset Cushing’s disease. Eur J Endocrinol. 2011;164(5):667–74. https://doi.org/10.1530/EJE-10-1120; Epub 2011 Feb 10.

    Article  CAS  PubMed  Google Scholar 

  6. Lonser RR, Wind JJ, Nieman LK, Weil RJ, DeVroom HL, Oldfield EH. Outcome of surgical treatment of 200 children with Cushing’s disease. J Clin Endocrinol Metab. 2013;98(3):892–901. https://doi.org/10.1210/jc.2012-3604; Epub 2013 Jan 31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Chandler WF, Barkan AL, Hollon T, Sakharova A, Sack J, Brahma B, Schteingart DE. Outcome of transsphenoidal surgery for cushing disease: a single-center experience over 32 years. Neurosurgery. 2016;78(2):216–23. https://doi.org/10.1227/NEU.0000000000001011.

    Article  PubMed  Google Scholar 

  8. 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(1):221–4; Epub 2005 Oct 11.

    Article  CAS  Google Scholar 

  9. Lienhardt A, Grossman AB, Dacie JE, Evanson J, Huebner A, Afshar F, Plowman PN, Besser GM, Savage MO. Relative contributions of inferior petrosal sinus sampling and pituitary imaging in the investigation of children and adolescents with ACTH-dependent Cushing’s syndrome. J Clin Endocrinol Metab. 2001;86(12):5711–4.

    CAS  PubMed  Google Scholar 

  10. Lodish M, Dunn SV, Sinaii N, Keil MF, Stratakis CA. Recovery of the hypothalamic-pituitary-adrenal axis in children and adolescents after surgical cure of Cushing’s disease. J Clin Endocrinol Metab. 2012;97(5):1483–91. https://doi.org/10.1210/jc.2011-2325; Epub 2012 Mar 7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Valassi E, Biller BM, Swearingen B, Pecori Giraldi F, Losa M, Mortini P, Hayden D, Cavagnini F, Klibanski A. Delayed remission after transsphenoidal surgery in patients with Cushing’s disease. J Clin Endocrinol Metab. 2010;95(2):601–10. https://doi.org/10.1210/jc.2009-1672; Epub 2010 Jan 15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Ram Z, Nieman LK, Cutler GB Jr, Chrousos GP, Doppman JL, Oldfield EH. Early repeat surgery for persistent Cushing’s disease. J Neurosurg. 1994;80(1):37–45.

    Article  CAS  Google Scholar 

  13. Sughrue ME, Shah JK, Devin JK, Kunwar S, Blevins LS Jr. Utility of the immediate postoperative cortisol concentrations in patients with Cushing’s disease. Neurosurgery. 2010;67(3):688–95.

    Article  Google Scholar 

  14. Leinung MC, Kane LA, Scheithauer BW, Carpenter PC, Laws ERJ, Zimmerman D. Long term follow-up of transsphenoidal surgery for the treatment of Cushing’s disease in childhood. J Clin Endocrinol Metab. 1995;80(8):2475–9.

    CAS  PubMed  Google Scholar 

  15. Katavetin P, Cheunsuchon P, Swearingen B, Hedley-Whyte ET, Misra M, Levitsky LL. Review: pituitary adenomas in children and adolescents. J Pediatr Endocrinol Metab. 2010;23(5):427–31.

    Article  Google Scholar 

  16. 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(5 Suppl):413–20.

    PubMed  Google Scholar 

  17. Knappe UJ, Ludecke DK. Transnasal microsurgery in children and adolescents with Cushing’s disease. Neurosurgery. 39:484–92; discussion 492-483, 1996.

    Google Scholar 

  18. Tarapore PE, Sughrue ME, Blevins L, Auguste KI, Gupta N, Kunwar S. Microscopic endonasal transsphenoidal pituitary adenomectomy in the pediatric population. J Neurosurg Pediatr. 2011;7(5):501–9. https://doi.org/10.3171/2011.2.PEDS10278.

    Article  PubMed  Google Scholar 

  19. Storr HL, Drake WM, Evanson J, Matson M, Berney DM, Grossman AB, Akker SA, Monson JP, Alusi G, Savage MO, Sabin I. Endonasal endoscopic transsphenoidal pituitary surgery: early experience and outcome in paediatric Cushing’s disease. Clin Endocrinol. 2014;80(2):270–6. https://doi.org/10.1111/cen.12275; Epub 2013 Jul 19.

    Article  Google Scholar 

  20. Kiehna EN, Keil M, Lodish M, Stratakis C, Oldfield EH. Pseudotumor cerebri after surgical remission of Cushing’s disease. J Clin Endocrinol Metab. 2010;95(4):1528–32. https://doi.org/10.1210/jc.2009-2449; Epub 2010 Feb 17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Amlashi FG, Swearingen B, Faje AT, Nachtigall LB, Miller KK, Klibanski A, Biller BM, Tritos NA. Accuracy of late-night salivary cortisol in evaluating postoperative remission and recurrence in cushing’s disease. J Clin Endocrinol Metab. 2015;100(10):3770–7.

    Article  CAS  Google Scholar 

  22. 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(2):266–70; discussion 270-1.

    Article  Google Scholar 

  23. Assié G, Bahurel H, Coste J, Silvera S, Kujas M, Dugué MA, Karray F, Dousset B, Bertherat J, Legmann P, Bertagna X. Corticotroph tumor progression after adrenalectomy in Cushing’s Disease: a reappraisal of Nelson’s Syndrome. J Clin Endocrinol Metab. 2007;92(1):172–9; Epub 2006 Oct 24.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA

    Brooke Swearingen

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  1. Brooke Swearingen
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Correspondence to Brooke Swearingen .

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Editors and Affiliations

  1. Division of Pediatric Endocrinology, New York University, New York, NY, USA

    Brenda Kohn

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Swearingen, B. (2019). Surgery for Cushing’s Disease. In: Kohn, B. (eds) Pituitary Disorders of Childhood. Contemporary Endocrinology. Humana Press, Cham. https://doi.org/10.1007/978-3-030-11339-1_6

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  • DOI: https://doi.org/10.1007/978-3-030-11339-1_6

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  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-030-11338-4

  • Online ISBN: 978-3-030-11339-1

  • eBook Packages: MedicineMedicine (R0)

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