Endoscopic management of Cushing’s disease caused by pituitary adenomas

Darwish, Mohab; Abdallah, Mohamed K.M; Elsawy, Medhat Mmtaz; Hamead, Khalaf; Ismail, Mostafa; Moawad, Ahmed Mohamed

doi:10.21608/mjmr.2023.250747.1548

Endoscopic management of Cushing’s disease caused by pituitary adenomas

Document Type : Original Article

Authors

¹ department of neurosurgery, faculty of medicine, minia university

² dapertment of neurosurgery, minia university

³ neurosurgery unit , department of surgery , Faculty of Medicine , Minia university , Minia , Egypt

⁴ Department of ENT , Faculty of medicine , Minia university

⁵ Department of ENT , Faculty of medicine, Minina university

10.21608/mjmr.2023.250747.1548

Abstract

Background: Cushing’s syndrome is an endocrinopathy, resulting in distinctive clinical features and associated systemic changes. Cushing’s disease is the name given to the disorder when it is caused by a pituitary source, usually an adrenocorticotrophic hormone (ACTH)-secreting pituitary microadenoma. The hypersecretion of ACTH by the pituitary adenoma, usually a microadenoma, results in bilateral adrenocortical hyperplasia and hypercortisolism. Cushing’s disease is a rare disorder with a reported incidence of between 0.7 and 2.4 cases per million inhabitants.

OBJECTIVES: Studying the outcome , remission rates , complications of transsphenoidal endoscopic surgery in treating Cushing’ disease .

METHODS: This is a retrospective and prospective study on first successive 20 patients from January 2015 to July 2021 with Cushing’s disease due to pituitary adenoma. Patients were admitted and operated by transnasal transsphenoidal endoscopic approach in Neurosurgery Department, Minia University hospital, Minia University, El-Minia, Egypt.

RESULTS: this study included twenty patients of different ages with mean of 37.8 yrs , 16 of them were females and 4 males. The study showed significant reduction of cortisol levels postoperative as the mean cortisol level preoperative was 32.67 ug/dl while the mean cortisol postoperative was equal to 3.60. 90% percentage of patients showed remission after transsphenoidal endoscopic excision of adenoma at the one year follow up.

CONCLUSIONS: The endonasal trassphenoidal endoscopic surgical management of the ACTH-secreting pituitary adenomas in those patients succeeded in amelioration of the altered clinical, endocrinological and radiological findings. It achieves high remission and low relapse rates with noticeable low postoperative complications. .

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