Delayed cure of Cushing's disease after transsphenoidal surgery of pituitary microadenomas

Report of two cases

Stephen D. McDonald Divisions of Endocrinology and Neurosurgery, United States Air Force Medical Center, Lackland Air Force Base, Texas

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Stanley E. Von Hofe Divisions of Endocrinology and Neurosurgery, United States Air Force Medical Center, Lackland Air Force Base, Texas

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Steven G. Dorfman Divisions of Endocrinology and Neurosurgery, United States Air Force Medical Center, Lackland Air Force Base, Texas

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Richard M. Jordan Divisions of Endocrinology and Neurosurgery, United States Air Force Medical Center, Lackland Air Force Base, Texas

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James R. LaMorgese Divisions of Endocrinology and Neurosurgery, United States Air Force Medical Center, Lackland Air Force Base, Texas

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Robert L. Young Divisions of Endocrinology and Neurosurgery, United States Air Force Medical Center, Lackland Air Force Base, Texas

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✓ Transsphenoidal microdissection has been proposed as a preferred means of treating Cushing's disease. This procedure allows the surgeon to remove a pituitary microadenoma and at the same time to preserve normal tissue. Two cases described here were treated by this method. An interesting and important observation was that neither patient appeared to be cured for 2 to 6 weeks after surgery, as assessed by dexamethasone suppression. Later, normal suppressibility occurred and the course of each patient was compatible with cure. Patients treated by this method should not be automatically retreated because of adrenocorticotropic hormone (ACTH) non-suppressibility in the early postoperative period.

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  • 1.

    Cook DM, , Jordan RM, & Kendall JW, et al: Rapid appearance of transient secondary adrenocorticol insufficiency after alpha-particle radiation therapy for Cushing's disease. J Clin Endocrinol Metab 43:295300, 1976 Cook DM, Jordan RM, Kendall JW, et al: Rapid appearance of transient secondary adrenocorticol insufficiency after alpha-particle radiation therapy for Cushing's disease. J Clin Endocrinol Metab 43:295–300, 1976

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  • 2.

    Ganguly A, , Stanchfield JB, & Roberts TS, et al: Cushing's syndrome in a patient with an empty sella turcica and a microadenoma of the adenohypophysis. Am J Med 60:306309, 1976 Ganguly A, Stanchfield JB, Roberts TS, et al: Cushing's syndrome in a patient with an empty sella turcica and a microadenoma of the adenohypophysis. Am J Med 60:306–309, 1976

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  • 3.

    Hardy J: Transsphenoidal surgery of hypersecreting pituitary tumors, in Kohler PO, & Ross GT (eds): Diagnosis and Treatment of Pituitary Tumors. Amsterdam: Excerpta Medica, International Congress Series No. 303, 1973, pp 179195 Hardy J: Transsphenoidal surgery of hypersecreting pituitary tumors, in Kohler PO, Ross GT (eds): Diagnosis and Treatment of Pituitary Tumors. Amsterdam: Excerpta Medica, International Congress Series No. 303, 1973, pp 179–195

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  • 4.

    Lagerquist LG, , Meikle AW, & West CD, et al: Cushing's disease with cure by resection of a pituitary adenoma. Evidence against primary hypothalamic defect. Am J Med 57:826830, 1974 Lagerquist LG, Meikle AW, West CD, et al: Cushing's disease with cure by resection of a pituitary adenoma. Evidence against primary hypothalamic defect. Am J Med 57:826–830, 1974

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  • 5.

    Schnall AM, , Brodkey J, & Pearson OH: Pituitary function following removal of pituitary microadenomas in Cushing's disease. Presented at the 58th Annual Meeting of the Endocrine Society, San Francisco, 1976, Paper 57 (Program and Abstracts) Schnall AM, Brodkey J, Pearson OH: Pituitary function following removal of pituitary microadenomas in Cushing's disease. Presented at the 58th Annual Meeting of the Endocrine Society, San Francisco, 1976, Paper 57 (Program and Abstracts)

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  • 6.

    Tyrrell JB, , Brooks RM, & Fitzgerald P, et al: Pituitary tumors in Cushing's disease: reversal of hypercortisolism by selective transsphenoidal adenomectomy. Presented at the 59th Annual Meeting of the Endocrine Society, Chicago, 1977, Paper 111 (Program and Abstracts) Tyrrell JB, Brooks RM, Fitzgerald P, et al: Pituitary tumors in Cushing's disease: reversal of hypercortisolism by selective transsphenoidal adenomectomy. Presented at the 59th Annual Meeting of the Endocrine Society, Chicago, 1977, Paper 111 (Program and Abstracts)

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