The history of pituitary surgery for Cushing disease

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  • 1 Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
  • | 2 Department of Neurosurgery, University of Virginia Health System, University of Virginia, Charlottesville, Virginia
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Although he never performed a pituitary operation for the disease, Harvey Cushing was the first to describe and treat patients with Cushing disease (CD). Other surgeons at the time were reluctant to operate on the pituitary due to the normal sella on skull radiographs in CD and the unclear etiology of the disorder. To better define and understand factors influencing the history of pituitary surgery for CD, the authors analyzed historical texts related to CD biology, diagnosis, and treatment. Cushing's monograph on basophilic pituitary adenomas and cortisol excess appeared in 1932. One year later in 1933, Alfred Pattison performed the first successful pituitary operation for CD by implanting radon seeds in the sella. Resection of a pituitary adenoma for CD was attempted 1 month later in 1933 by Howard Naffziger, resulting in only transient improvement that corresponded to the lack of tumor in the resected tissue. Soon thereafter, Susman in 1935 and Costello in 1936 described pituitary basophilic adenomas at autopsy in patients without premorbid endocrinopathy. They concluded that the adrenal gland was the cause of CD, which resulted in a 3-decade abandonment of pituitary surgery for CD. Jules Hardy in 1963 used the operating microscope to perform the first selective removal of an adrenocorticotropic hormone (ACTH)–secreting microadenoma, which established a pituitary cause and defined the modern treatment of CD. Subsequent reports by Hardy, Laws, and Wilson resulted in widespread acceptance of pituitary surgery for CD. Initial reluctance to operate on the pituitary for CD was multifaceted and included general uncertainty surrounding the etiology of Cushing syndrome as well as a lack of early surgical success, both due to the small size of ACTH-secreting adenomas. Selective removal of ACTH-secreting adenomas identified the source of CD and ended the delay in acceptance of pituitary surgery for CD.

Abbreviations used in this paper:

ACTH = adrenocorticotropic hormone; CD = Cushing disease; HPA = hypothalamic-pituitaryadrenal.

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  • 1

    Albright F: Cushing's syndrome: its pathological physiology, its relationship to the adreno-genital syndrome, and its connection with the problem of the reaction of the body to injurious agents. Harvey Lectures 38:123186, 1943

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  • 2

    Arner B, , Luft R, , Olivecrona H, & Sjogren B: Successful treatment of a case of Cushing's syndrome by electrocoagulation of the hypophysis. J Clin Endocrinol Metab 13:11011108, 1953

    • Search Google Scholar
    • Export Citation
  • 3

    Arnold A: Effects of x-irradiation on the hypothalamus: a possible explanation for the therapeutic benefits following x-irradiation of the hypophysial region for pituitary dysfunction. J Clin Endocrinol Metab 14:859868, 1954

    • Search Google Scholar
    • Export Citation
  • 4

    Bauer J: The so-called Cushing's Syndrome, its history, terminology and differential diagnosis. Acta Med Scand 137:411416, 1950

  • 5

    Bigos ST, , Robert F, , Pelletier G, & Hardy J: Cure of Cushing's disease by transsphenoidal removal of a microadenoma from a pituitary gland despite a radiographically normal sella turcica. J Clin Endocrinol Metab 45:12511260, 1977

    • Search Google Scholar
    • Export Citation
  • 6

    Bigos ST, , Somma M, , Rasio E, , Eastman RC, , Lanthier A, & Johnston HH, et al.: Cushing's disease: management by transsphenoidal pituitary microsurgery. J Clin Endocrinol Metab 50:348354, 1980

    • Search Google Scholar
    • Export Citation
  • 7

    Boucot N, , Dohan FC, , Raventos A, & Rose E: Roentgen therapy in Cushing's syndrome without adrenocortical tumor. J Clin Endocrinol Metab 17:832, 1957

    • Search Google Scholar
    • Export Citation
  • 8

    Carney JA: The search for Harvey Cushing's patient, Minnie G., and the cause of her hypercortisolism. Am J Surg Pathol 19:100108, 1995

    • Search Google Scholar
    • Export Citation
  • 9

    Collip JB, , Anderson EM, & Thomson DL: The adrenotropic hormone of the anterior pituitary lobe. Lancet 222:347348, 1933

  • 10

    Costello RT: Subclinical adenoma of the pituitary gland. Am J Pathol 12:205216, 1936

  • 11

    Crooke AC: Basophilism treated unsuccessfully with massive doses of oestrogens and deep x-ray therapy, but cured by radon seeds inserted into the sella turcica. Proc R Soc Med 40:153, 1947

    • Search Google Scholar
    • Export Citation
  • 12

    Cushing H: The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism). Bull Johns Hopkins Hosp 50:137195, 1932

    • Search Google Scholar
    • Export Citation
  • 13

    Cushing H: Further notes on pituitary basophilism. JAMA 99:281284, 1932

  • 14

    Cushing H: The meningiomas (dural endotheliomas): their source, and favoured seats of origin. Brain 45:282316, 1922

  • 15

    Cushing H: The Pituitary Body and Its Disorders: Clinical States Produced by Disorders of the Hypophysis Cerebri Philadelphia, JB Lippincott, 1912

    • Search Google Scholar
    • Export Citation
  • 16

    Ellis F: Radiotherapy in the treatment of pituitary basophilism and eosinophilism. Proc R Soc Med 42:853860, 1949

  • 17

    Erdheim J, & Stumme E: Über die Schwangerschaftsveränderung der Hypophyse. Beitr Pathol Anat 46:1132, 1909

  • 18

    Guiot G, & Thibaut B: [Excision of pituitary adenomas by transsphenoidal route.]. Neurochirurgia (Stuttg) 1:133150, 1959. (French, Russian)

    • Search Google Scholar
    • Export Citation
  • 19

    Guthrie L, & Emery WE: Precocious obesity, premature sexual and physical development, and hirsuties in relation to hypernephroma and other morbid conditions. Transact Clin Soc Lond 40:175202, 1907

    • Search Google Scholar
    • Export Citation
  • 20

    Handelsmann & Horsley V: Preliminary note on experimental investigations on the pituitary body. BMJ 2:11501151, 1911

  • 21

    Hardy J: Transphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 16:185217, 1969

  • 22

    Hardy J: Transsphenoidal hypophysectomy. J Neurosurg 34:582594, 1971

  • 23

    Hardy J, Transsphenoidal surgery of hypersecreting pituitary tumors. Kohler PO, & Ross GT: Diagnosis and Treatment of Pituitary Tumors. International Congress Series No. 303 Amsterdam, Excerpta Medica, 1973. 180

    • Search Google Scholar
    • Export Citation
  • 24

    Jores A: Über Hormonuntersuchungen bei Morbus Cushing. Klin Wochenschr 14:13481352, 1945

  • 25

    Kendall EC: The chemistry and partial synthesis of adrenal steroids. Ann N Y Acad Sci 50:540547, 1949

  • 26

    Kepler EJ: Cushing's disease; a primary disorder of the adrenal cortices?. Ann N Y Acad Sci 50:657678, 1949

  • 27

    Kiehna EN, , Keil M, , Lodish M, , Stratakis C, & Oldfield EH: Pseudotumor cerebri after surgical remission of Cushing's disease. J Clin Endocrinol Metab 95:15281532, 2010

    • Search Google Scholar
    • Export Citation
  • 28

    Krause F, Hirnchurgie. Leyden E, & Klemperer F: Die Deutsche Klinik am Eingange des zwanzigsten Jahrhunderts Berlin, Urban & Schwarzenberg, 1905. VIII:

    • Search Google Scholar
    • Export Citation
  • 29

    Liddle GW: Pathogenesis of glucocorticoid disorders. Am J Med 53:638648, 1972

  • 30

    Liddle GW, & Shute AM: The evolution of Cushing's syndrome as a clinical entity. Adv Intern Med 15:155175, 1969

  • 31

    Lindholm J: Cushing's syndrome: historical aspects. Pituitary 3:97104, 2000

  • 32

    Lisser H: Hypophysectomy in Cushing's disease. J Nerv Ment Dis 99:727733, 1944

  • 33

    Löwenstein C: Die Entwicklung der Hypophysisadenome. Virchows Arch Path Anat 188:4465, 1907

  • 34

    Northfield DW: Radon implantation for acromegaly and Cushing's syndrome. Proc R Soc Med 42:845853, 1949

  • 35

    Pattison ARD, & Swan WGA: Surgical treatment of pituitary basophilism. Lancet 231:12651269, 1938

  • 36

    Roussy G, & Clunet J: Tumeurs du lobe antérieur de l'hypophyse. Essai de classification histologique. Rev Neurol 22:313320, 1911

  • 37

    Salassa RM, , Kearns TP, , Kernohan JW, , Sprague RG, & MacCarty CS: Pituitary tumors in patients with Cushing's syndrome. J Clin Endocrinol Metab 19:15231539, 1959

    • Search Google Scholar
    • Export Citation
  • 38

    Salassa RM, , Laws ER Jr, , Carpenter PC, & Northcutt RC: Transsphenoidal removal of pituitary microadenoma in Cushing's disease. Mayo Clin Proc 53:2428, 1978

    • Search Google Scholar
    • Export Citation
  • 39

    Schloffer H: Erfolgreiche Operation eines Hypophysentumors auf nasalem Wege. Wien Klin Wochenschr 20:621624, 1907

  • 40

    Silber RH, & Porter CC: The determination of 17,21-dihydroxy-20-ketosteroids in urine and plasma. J Biol Chem 210:923932, 1954

  • 41

    Susman W: Adenomata of the pituitary, with special reference to pituitary basophilism of Cushing. Br J Surg 22:539544, 1935

  • 42

    Tyrrell JB, , Brooks RM, , Fitzgerald PA, , Cofoid PB, , Forsham PH, & Wilson CB: Cushing's disease. Selective trans-sphenoidal resection of pituitary microadenomas. N Engl J Med 298:753758, 1978

    • Search Google Scholar
    • Export Citation
  • 43

    Wislocki GB, & King LS: The permeability of the hypophysis and hypothalamus to vital dyes, with a study of the hypophyseal vascular supply. Am J Anat 58:421472, 1936

    • Search Google Scholar
    • Export Citation

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