Stephan Petersenn1, Albert Beckers2, Diego Ferone2, Aart van der Lely2, Jens Bollerslev2, Marco Boscaro2, Thierry Brue3, Paolo Bruzzi2, Felipe F Casanueva2, Philippe Chanson3, Annamaria Colao2, Martin Reincke2, Günter Stalla2, Stelios Tsagarakis2. 1. ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece stephan.petersenn@endoc-med.de. 2. ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece. 3. ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Inter
Abstract
OBJECTIVE: A number of factors can influence the reported outcomes of transsphenoidal surgery (TSS) for Cushing's disease - including different remission and recurrence criteria, for which there is no consensus. Therefore, a comparative analysis of the best treatment options and patient management strategies is difficult. In this review, we investigated the clinical outcomes of initial TSS in patients with Cushing's disease based on definitions of and assessments for remission and recurrence. METHODS: We systematically searched PubMed and identified 44 studies with clear definitions of remission and recurrence. When data were available, additional analyses by time of remission, tumor size, duration of follow-up, surgical experience, year of study publication and adverse events related to surgery were performed. RESULTS: Data from a total of 6400 patients who received microscopic TSS were extracted and analyzed. A variety of definitions of remission and recurrence of Cushing's disease after initial microscopic TSS was used, giving broad ranges of remission (42.0-96.6%; median, 77.9%) and recurrence (0-47.4%; median, 11.5%). Better remission and recurrence outcomes were achieved for microadenomas vs macroadenomas; however, no correlations were found with other parameters, other than improved safety with longer surgical experience. CONCLUSIONS: The variety of methodologies used in clinical evaluation of TSS for Cushing's disease strongly support the call for standardization and optimization of studies to inform clinical practice and maximize patient outcomes. Clinically significant rates of failure of initial TSS highlight the need for effective second-line treatments.
OBJECTIVE: A number of factors can influence the reported outcomes of transsphenoidal surgery (TSS) for Cushing's disease - including different remission and recurrence criteria, for which there is no consensus. Therefore, a comparative analysis of the best treatment options and patient management strategies is difficult. In this review, we investigated the clinical outcomes of initial TSS in patients with Cushing's disease based on definitions of and assessments for remission and recurrence. METHODS: We systematically searched PubMed and identified 44 studies with clear definitions of remission and recurrence. When data were available, additional analyses by time of remission, tumor size, duration of follow-up, surgical experience, year of study publication and adverse events related to surgery were performed. RESULTS: Data from a total of 6400 patients who received microscopic TSS were extracted and analyzed. A variety of definitions of remission and recurrence of Cushing's disease after initial microscopic TSS was used, giving broad ranges of remission (42.0-96.6%; median, 77.9%) and recurrence (0-47.4%; median, 11.5%). Better remission and recurrence outcomes were achieved for microadenomas vs macroadenomas; however, no correlations were found with other parameters, other than improved safety with longer surgical experience. CONCLUSIONS: The variety of methodologies used in clinical evaluation of TSS for Cushing's disease strongly support the call for standardization and optimization of studies to inform clinical practice and maximize patient outcomes. Clinically significant rates of failure of initial TSS highlight the need for effective second-line treatments.
Authors: A L Serban; G Del Sindaco; E Sala; G Carosi; R Indirli; G Rodari; C Giavoli; M Locatelli; G Carrabba; G Bertani; G Marfia; G Mantovani; M Arosio; E Ferrante Journal: J Endocrinol Invest Date: 2019-11-26 Impact factor: 4.256
Authors: M C Machado; A E E Alcantara; A C L Pereira; V A S Cescato; N R Castro Musolino; B B de Mendonça; M D Bronstein; M C B V Fragoso Journal: J Endocrinol Invest Date: 2016-06-30 Impact factor: 4.256
Authors: Lynnette K Nieman; Beverly M K Biller; James W Findling; M Hassan Murad; John Newell-Price; Martin O Savage; Antoine Tabarin Journal: J Clin Endocrinol Metab Date: 2015-07-29 Impact factor: 5.958
Authors: Elena Y Nadezhdina; Olga Yu Rebrova; Andrey Y Grigoriev; Oksana V Ivaschenko; Vilen N Azizyan; Galina A Melnichenko; Ivan I Dedov Journal: Pituitary Date: 2019-12 Impact factor: 4.107