Endoscopic Transsphenoidal Surgery for Acromegaly and Cushing’s Disease: 6-Year Experience

Introduction: We present our institutional experience of performing fully endoscopic transsphenoidal approaches in patients with acromegaly and Cushing’s disease from 2007 to 2012.

Methods: A 6-year retrospective analysis of patients with a known history of acromegaly or Cushing’s disease that underwent transsphenoidal tumor resection at our hospital was performed. Hormone levels before surgery and after treatment, as well as perioperative complications, were analyzed. The adjuvant treatment after the surgery was also taken into consideration in our analysis.

Results: A total of 149 endoscopic transsphenoidal surgeries were performed, and 49 of these cases were included for analysis. Of those, 21 patients had acromegaly and 19 had Cushing’s disease; 52% of all tumors were microadenomas. Disease-free criteria were achieved in 75% of these patients, with 56% of them harboring macroadenomas. Transient diabetes insipidus was the most frequent complication. None of the patients required permanent hormone replacement therapy. Patients with acromegaly had a higher tendency to require postoperative adjuvant medical therapy compared with patients with Cushing’s disease, achieving disease control in 71% of them. In our group, there was no mortality after the surgery.

Conclusions: Surgery is a very important part in the treatment of many patients with functioning pituitary adenomas. Endoscopic endonasal approaches have proved to be safe, which has made their use widespread. In patients with acromegaly or Cushing’s disease that are not responsive to medical treatment alone, surgery must be considered. It is possible that these cases will continue to require therapy even after surgical removal of the tumor, especially in patients with acromegaly, as our study suggests.