TRANSSPHENOIDAL MICROSURGERY FOR CUSHING'S DISEASE

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Abstract
Nineteen patients thought to have Cushing''s disease were treated by transsphenoidal microsurgery; the type of operation performed depended upon the findings in the individual patient. Seventeen patients remitted. Failures occurred in a patient with an invasive macroadenoma and in a patient who was subsequently found to have a thymic carcinoid tumor secreting ACTH. One patient who remitted suffered a recurrence during pregnancy, 30 mo. after operation. The 10 patients who had a selective removal of a microadenoma or a limited resection of the gland were often growth hormone deficient, but 7 regained cortisol reserve and all 10 regained normal pituitary-thyroid and pituitary-gonadal responses. Abnormalities of pituitary function were common in 9 patients who had a radical or total hypophysectomy. Thus, transsphenoidal microsurgery apparently is the best treatment for Cushing''s disease and when feasible, a selective microadenomectomy is the most appropriate operation.