As part of an ongoing series, 100 patients with
Cushing's disease underwent transsphenoidal operations.
Pituitary adenomas were confirmed in 93 patients, and initial remission was achieved in 86 (92%) of them. Hypercortisolemia was not corrected in 7 patients, and in 4 this was due to invasive
adenomas. These patients were subjected to irradiation, medical treatment, or both after operation. Only 7 of the 100 patients had no
pituitary adenoma found at operation, and they obtained no clinical remission even after partial or subtotal
hypophysectomy. Follow-up review, with an emphasis on endocrinological studies, was performed on these patients for a mean period of 38 months. Seventy-eight patients were in long term remission after operation and had restoration of noncorticotropic
hormone secretion as well as pituitary-adrenal function. Recurrence was noted in 8 patients after 19 to 82 months in remission. In all of these patients,
pituitary adenomas were verified by reoperation and no case of corticotrophic cell
hyperplasia was noted. We conclude that late recurrence of
Cushing's disease may occur after
adenoma removal and is due to the regrowth of
adenoma cells left behind in the peritumoral tissue at the first operation. In view of the overall remission rate, transsphenoidal adenomectomy is considered a highly effective treatment for
Cushing's disease.