Results of Transsphenoidal Surgery in 35 Cases of Cushing's Disease

This study aims at analyzing the outcomes of transsphenoidal surgery in 35 patients of Cushing's disease (CD), the highest number of patients seen during 11 years from one center in Iran. Materials and Methods: Retrospective data from case records of all patients were retrieved. The diagnosis of CD was based on clinical presentation, hormone studies, adrenal and pituitary imaging, and thoracic imaging as and when considered appropriate. Age, sex, clinical parameters, laboratory investigations, intra-operative findings, post-operative complications, duration of hospital stay and follow up observations were evaluated using appropriate statistical methods. Results: Of 35 patients, 26 were female and 9 male with a mean age of 28 +/- 10 years. The most frequent presenting symptom had been obesity (57%) which was present for 30 +/- 29 months. Four patients had macroadenoma and the other 31 (86%) had microadenoma. All patients were operated by transsphenoidal route; there were no intra-operative complications. Two patients had temporary CSF rhinorrhea and 9 had temporary diabetes insipidus in the post-operative period without any need for surgical intervention. Eight patients were lost to follow up and the remaining 27 were followed for 22 +/- 23 months (minimum 3 months and maximum 8.5years). Remission was achieved in 32 patients (88%), while the remaining 3 did not benefit from surgery. Recurrence occurred in 3 cases (14%), requiring repetition transsphenoidal surgery with success in two. Conclusion: Transsphenoidal adenomectomy is an effective modality of treatment for patients with Cushing's disease with near zero mortality and acceptable morbidity.