Cushing's Disease, Transsphenoidal Surgical Results of 11 Cases

BACKGROUND—Cushing''s disease is the most common cause of endogenous Cushing''s syndrome (up to 60%) and is usually due to pituitary hyperplasia or basophilic adenoma. Materials AND METHODS—Eleven cases of Cushing''s disease that have been admitted to Shariati Hospital since June 1992 up to September 2000, had been reviewed. These included three male, and eight female patients with an age range between (9 – 34) years with a mean of 21 – 5 years.The most common symptoms were headache, weight gain, and menstrual/libdo disturbances. Obesity, moon face, hypertension, depression were the most common signs in our series.These patients were diagnosed on the basis of high serum and urinary free cortisol, abnormal 2-mg dexamethasone and normal 8-mg dexamethazone suppression test.RESULTS—The neuroimaging investigation revealed normal sella turcica in 7 cases, double floor and enlarged sella turcica in 4.Computerized tomography was the most valuable tool which showed the adenoma in 9 cases, MRI with gadolinium injection were helpful in better delineation of the lesion in the last three cases. All patients were treated surgically via transsphenoidal approach.The mean duration of follow-up was 5 yrs (range, 0.5 – 8 yrs). There were regression of the clinical symptoms in 9 cases (82%), and recurrence of these symptoms in one patient six month after the operation (9%). One patient died because of uncontrolled sepsis two months after operation (9%).CONCLUSION—In conclusion the transsphenoidal approach is a safe and effective procedure for treatment of patients with diagnosis of Cushing''s disease of pituitary origin.