Correlating Preoperative, Operative, and Postoperative Factors with Successful Hormonal Remission in Cushing’s Disease following Endoscopic Transsphenoidal Surgery: A Single-Center Retrospective Analysis

Introduction: Cushing’s disease, caused by excessive secretion of adrenocorticotropic hormone (ACTH) by a pituitary adenoma, presents a challenging clinical scenario. Endoscopic transsphenoidal surgery (ETSS) is widely regarded as the gold standard treatment. However, achieving successful posttreatment hormonal remission remains elusive, and factors influencing the outcome remain poorly understood. This study aimed to investigate the correlations between preoperative, operative, and postoperative parameters and their impact on achieving successful hormonal remission in patients with Cushing’s disease following ETSS.

Methods: We conducted a retrospective analysis of medical records from a cohort of patients from a single institution diagnosed with Cushing’s disease who underwent ETSS between 2013 and 2023. Data collection included preoperative hormonal profiles, radiological findings, operative details, and postoperative follow-up data. Univariate logistical regression and correlation assessments were performed to identify associations between various parameters and successful hormonal remission.

Results: Our analysis included 51 patients with Cushing’s disease who underwent ETSS, with an overall remission rate of 86.3% (44/51). We found that prior endoscopic transsphenoidal surgery (p = 0.046, 95% CI: 0.04–0.99, OR: 0.19) and cavernous sinus invasion (p = 0.028, 95% CI: 0.02–0.83, OR: 0.13) were found to be significantly associated with non-remission after treatment. Conversely, hospital Nadir cortisol levels (p = 0.006, 95% CI: 0.73–0.94, OR: 0.85), postoperative hydrocortisone administration (p = 0.050, 95% CI: 1.4–172.88, OR: 8.84), and preoperative central weight gain (p = 0.050, 95% CI: 0.94–35.5, OR: 5.85) were found to be associated positively with remission after treatment. Other pertinent variables including micro/macro-adenoma designation (microadenoma, p = 0.499, 95% CI: 0.35–8.06, OR: 1.69), maximal tumor diameter (p = 0.633, 95% CI: 0.83–1.13, OR: 0.96), tumor consistency (p = 0.818, 95% CI: 0.52–2.42, OR: 1.09), tumor characteristics (e.g., cystic, p = 0.078, 95% CI: 0.01–1.4, OR: 0.15), other preoperative Cushing’s symptoms (hair loss, p = 0.276, 95% CI: 0.53–66.4, OR: 3.38, hirsutism, p = 0.378, 95% CI: 0.44–15.92, OR: 2.16, hypertension, p = 0.347, 95% CI: 0.09–2.18, OR: 0.48, etc.), and intraoperative complications (e.g., CSF leak, 95% CI: 0.08–2.16, p = 0.244, OR: 0.38) did not correlate significantly with Cushing’s patient remission status.

Conclusion: This study aims to outline preoperative, operative, and postoperative factors that may predict successful hormonal remission in patients with Cushing’s disease treated with ETSS. Notably, prior operations of ETSS and invasion of the cavernous sinus may correlate with non-remission. However, low posttreatment hospital cortisol level monitoring may allow for prediction of long-term hormonal remission while higher levels may indicate for continued clinical follow-up. Hydrocortisone administration for adrenal insufficiency may also positively correlate with successful remission. These findings and subsequent analyses may provide valuable insight for clinicians in optimizing patient care and achieving better management for Cushing’s disease patients. Further evaluation of other pre-, intra-, and postoperative variables as well as hospital nadir levels analyses may provide greater insight into prediction of hormonal remission and refinement of clinical management for such patients.

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Artikel online veröffentlicht:
05. Februar 2024