Endonasal endoscopic transsphenoidal pituitary surgery: early experience and outcome in paediatric Cushing's disease. (19th July 2013)

• Record Type: Journal Article
• Authors: Storr, Helen L.; Drake, William M.; Evanson, Jane; Matson, Matthew; Berney, Dan M.; Grossman, Ashley B.; Akker, Scott A.; Monson, John P.; Alusi, Ghassan; Savage, Martin O.; Sabin, Ian
• Is Part Of: Clinical endocrinology. Volume 80:Number 2(2014:Feb.)
• Page Start: 270
• Page End: 276
• Publication Date: 2013-07-19
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.12275
• Languages: English
• ISSNs: 0300-0664

Abstract

<abstract abstract-type="main" id="cen12275-abs-0001"> <title>Summary</title> <sec id="cen12275-sec-0001" sec-type="section"> <title>Background</title> <p>Selective adenomectomy remains the first‐line treatment for Cushing's disease (CD), until recently by microscopic transsphenoidal pituitary surgery. Endonasal transsphenoidal endoscopic surgery (ETES) is emerging as a novel, less invasive treatment for pituitary adenomas and has become the optimal surgical approach.</p> </sec> <sec id="cen12275-sec-0002" sec-type="section"> <title>Objective</title> <p>There are no published series for the treatment of paediatric CD by ETES, and we report our centre's preliminary results.</p> </sec> <sec id="cen12275-sec-0003" sec-type="section"> <title>Design</title> <p>Retrospective analysis.</p> </sec> <sec id="cen12275-sec-0004" sec-type="section"> <title>Patients</title> <p>Six paediatric patients (median age 15·8 years; range 11·7–17·0 years) fulfilled standard diagnostic criteria for CD. Preoperatively, no abnormality was identified on pituitary MR scanning in 3 (50%) patients, one had a macroadenoma. Bilateral petrosal sinus sampling demonstrated central ACTH secretion (IPS/P ACTH ratio ≥3·0, post‐CRH) in 3/6 (50%) patients. The same neurosurgeon and endoscopic nasal surgeon undertook all the operations.</p> </sec> <sec id="cen12275-sec-0005" sec-type="section"> <title>Outcome measures</title> <p>Therapeutic outcome and rate of complications.</p> </sec> <sec id="cen12275-sec-0006" sec-type="section"> <title>Results</title> <p>Clinical recovery and biochemical 'cure' were achieved in 5 (83%) patients, and a corticotroph adenoma was confirmed histologically in all cured cases. One case developed post‐operative CSF leak requiring lumbar drain insertion and patching. At a mean interval of 4·7 years (0·1–10·8 years) post‐operatively, cured patients have shown no recurrence. One patient, with a large diffuse adenoma requiring more extensive surgery, has panhypopituitarism, and another patient has GH and gonadotrophin deficiencies.</p> </sec> <sec id="cen12275-sec-0007" sec-type="section"> <title>Conclusions</title> <p>Our experience shows that ETES for removing corticotroph adenomas in children, in most cases not visualized on MRI, is minimally invasive and gave excellent post‐operative recovery/results. In skilled hands, this technique provides an alternative to conventional transsphenoidal microscopic surgery in managing paediatric CD.</p> </sec> </abstract>