• Ivan Ciric, Jin-Cheng Zhao, Hongyan Du, James W Findling, Mark E Molitch, Roy E Weiss, Samuel Refetoff, William D Kerr, and Joel Meyer.
• NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, Evanston, Illinois 60201, USA. iciric@northshore.org
• Neurosurgery. 2012 Jan 1; 70 (1): 708170-80; discussion 80-1.

BackgroundThis is a retrospective study of 136 patients with Cushing disease treated with transsphenoidal microsurgery.ObjectiveTo evaluate factors influencing immediate postoperative results and long-term outcomes.MethodsData regarding clinical presentation, endocrine evaluation, imaging studies, surgical technique, immediate postoperative biochemical remission (IPBR), and long-term results were entered into a database and analyzed statistically. IPBR was based on biochemical evidence of adrenal cortical insufficiency and clinical evidence of such insufficiency.ResultsIPBR for the entire series was 83.4%. In microadenomas, IPBR was 89.8% with a mean immediate postoperative plasma cortisol (IPPC) of 2.1 μg/dL (range, <0.5-5.3). Positive magnetic resonance imaging (MRI) was associated with 18 times greater odds of finding microadenoma at surgery (P < .001) and with 4.1 times greater odds of IPBR (P = .07). In patients with a negative MRI, a positive inferior petrosal sinus sampling (IPSS) test was associated with 93% of IPBR (P = .004). IPBR in macroadenomas was 30.7%. Of patients followed for 12 months or longer, 34.8% required glucocorticoid replacement for the duration of follow-up. The mean follow-up in microadenomas was 68.4 months with a 9.67% incidence of recurrences. The estimated actuarial incidence of recurrences increased with the passage of time and IPPC of greater than 2 μg/dL was associated with higher incidence of recurrences, although without statistical significance (P = .08).ConclusionIn microadenomas, a positive MRI and positive IPSS test were associated with a higher incidence of IPBR. Recurrences increased with the passage of time, and an IPPC of greater than 2 μg/dL may be associated with higher incidence of recurrences.

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