Carmine Antonio Donofrio1, Marco Losa2, Marco Gemma3, Lodoviga Giudice2, Lina Raffaella Barzaghi2, Pietro Mortini2. 1. Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. donofrio.carmine@hsr.it. 2. Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. 3. Service of Anesthesia and Intensive Care Unit, Head and Neck Department, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
Abstract
PURPOSE: Patients affected by Cushing's disease often have important comorbidities directly linked to hypercortisolism that might enhance the operative risk. We report the safety of transsphenoidal surgery in patients affected by Cushing's disease as compared with patients with nonfunctioning pituitary adenoma. METHODS: We have retrospectively analyzed 142 patients with Cushing's disease and 299 patients with nonfunctioning pituitary adenoma who underwent transsphenoidal surgery performed by a single experienced neurosurgeon between September 2007 and December 2014. For all of them, an intraoperative computerized anesthetic record for the automatic storage of data was available. RESULTS: The intraoperative vital parameters and the frequency of drugs administered during anesthesia were comparable between Cushing's disease and nonfunctioning pituitary adenoma groups. The duration of surgery was similar between the two groups (41.2 ± 11.8 vs. 42.9 ± 15.6 min), while the duration of anesthesia was slightly shorter in Cushing's disease patients (97.6 ± 18.1 min) than in nonfunctioning pituitary adenoma patients (101.6 ± 20.6 min, p = 0.04). The total perioperative mortality rate was 0.2% (0% in Cushing's disease vs. 0.3% in nonfunctioning pituitary adenoma). Cushing's disease patients had surgical and medical complication rates of 3.5% each, not different from those occurring in nonfunctioning pituitary adenoma. The postoperative incidence of diabetes insipidus (10.6%) and isolated hyponatremia (10.6%) in Cushing's disease patients was significantly higher than in nonfunctioning pituitary adenoma patients (4.4 and 4.1%; p = 0.02 and p = 0.01, respectively). CONCLUSIONS: In a large series of unselected and consecutive patients with Cushing's disease, transsphenoidal surgery performed by one dedicated experienced neurosurgeon had a reasonably low risk of complications. In particular, despite the higher burden of comorbidities typically associated with hypercortisolism, medical complications are rare and no more frequent than in patients with nonfunctioning pituitary adenoma.
PURPOSE:Patients affected by Cushing's disease often have important comorbidities directly linked to hypercortisolism that might enhance the operative risk. We report the safety of transsphenoidal surgery in patients affected by Cushing's disease as compared with patients with nonfunctioning pituitary adenoma. METHODS: We have retrospectively analyzed 142 patients with Cushing's disease and 299 patients with nonfunctioning pituitary adenoma who underwent transsphenoidal surgery performed by a single experienced neurosurgeon between September 2007 and December 2014. For all of them, an intraoperative computerized anesthetic record for the automatic storage of data was available. RESULTS: The intraoperative vital parameters and the frequency of drugs administered during anesthesia were comparable between Cushing's disease and nonfunctioning pituitary adenoma groups. The duration of surgery was similar between the two groups (41.2 ± 11.8 vs. 42.9 ± 15.6 min), while the duration of anesthesia was slightly shorter in Cushing's diseasepatients (97.6 ± 18.1 min) than in nonfunctioning pituitary adenomapatients (101.6 ± 20.6 min, p = 0.04). The total perioperative mortality rate was 0.2% (0% in Cushing's disease vs. 0.3% in nonfunctioning pituitary adenoma). Cushing's diseasepatients had surgical and medical complication rates of 3.5% each, not different from those occurring in nonfunctioning pituitary adenoma. The postoperative incidence of diabetes insipidus (10.6%) and isolated hyponatremia (10.6%) in Cushing's diseasepatients was significantly higher than in nonfunctioning pituitary adenomapatients (4.4 and 4.1%; p = 0.02 and p = 0.01, respectively). CONCLUSIONS: In a large series of unselected and consecutive patients with Cushing's disease, transsphenoidal surgery performed by one dedicated experienced neurosurgeon had a reasonably low risk of complications. In particular, despite the higher burden of comorbidities typically associated with hypercortisolism, medical complications are rare and no more frequent than in patients with nonfunctioning pituitary adenoma.
Entities:
Keywords:
Anesthesia; Cushing’s disease; Intraoperative monitoring; Pituitary neoplasm; Pituitary surgery
Authors: Jay Jagannathan; Rene Smith; Hetty L DeVroom; Alexander O Vortmeyer; Constantine A Stratakis; Lynnette K Nieman; Edward H Oldfield Journal: J Neurosurg Date: 2009-09 Impact factor: 5.115
Authors: Elena Valassi; Alicia Santos; Maria Yaneva; Miklós Tóth; Christian J Strasburger; Philippe Chanson; John A H Wass; Olivier Chabre; Marija Pfeifer; Richard A Feelders; Stylianos Tsagarakis; Peter J Trainer; Holger Franz; Kathrin Zopf; Sabina Zacharieva; Steven W J Lamberts; Antoine Tabarin; Susan M Webb Journal: Eur J Endocrinol Date: 2011-06-29 Impact factor: 6.664
Authors: Ivan Ciric; Jin-Cheng Zhao; Hongyan Du; James W Findling; Mark E Molitch; Roy E Weiss; Samuel Refetoff; William D Kerr; Joel Meyer Journal: Neurosurgery Date: 2012-01 Impact factor: 4.654
Authors: Marco Boscaro; Nicoletta Sonino; Alessandro Scarda; Luisa Barzon; Francesco Fallo; Maria T Sartori; Giovanni M Patrassi; Antonio Girolami Journal: J Clin Endocrinol Metab Date: 2002-08 Impact factor: 5.958
Authors: Jessica K Lambert; Levana Goldberg; Sofia Fayngold; Jane Kostadinov; Kalmon D Post; Eliza B Geer Journal: J Clin Endocrinol Metab Date: 2013-02-07 Impact factor: 5.958
Authors: Lina Raffaella Barzaghi; Carmine Antonio Donofrio; Pietro Panni; Marco Losa; Pietro Mortini Journal: Pituitary Date: 2018-02 Impact factor: 4.107
Authors: Leonie H A Broersen; Nienke R Biermasz; Wouter R van Furth; Friso de Vries; Marco J T Verstegen; Olaf M Dekkers; Alberto M Pereira Journal: Pituitary Date: 2018-10 Impact factor: 4.107
Authors: Lukas Andereggen; Luigi Mariani; Jürgen Beck; Robert H Andres; Jan Gralla; Markus M Luedi; Joachim Weis; Emanuel Christ Journal: Acta Neurochir (Wien) Date: 2021-04-03 Impact factor: 2.816