The repeated transsphenoidal adenomectomy because of relapse and persistent course of Itsenko-Kushing disease

Abstract

Objective. To estimate the outcomes of repeated transsphenoidal adenomectomy (RTA) at patients with relapse and persistent course of Itsenko-Kushing disease and to optimize the limits of surgical intervention at such patients. Material and methods. The analysis of RTA results at 50 patients (42 women and 8 men at the age from 16 till 64 years old) with confirmed Itsenko-Kushing disease was conducted. The mean time of RTA performance was 36 months. All patients underwent endoscopic surgery. Results. The remission after RTA was seen at 28 (56%) patients, among them 20 (69%) suffered from developing adrenocortical insufficiency, the recovery of hormonal state was revealed at 8 (31%). The hypercorticoidism remained at 22 (44%) patient. Follow-up after RTA was 6 months with following examination at 30 patients which revealed remaining hypercorticoidism at 14 (47%) persons, complete remission - at 14 (47%) patients and disease relapse - at 2 (6%) patients. Conclusion. The repeated transsphenoidal adenomectomy is relatively safe and effective treatment method at patients with relapse and residual course of Itsenko-Kushing disease while performed under conditions of specialized department. The clear predictors for persistence development or relapse of ACTH-dependent hypercorticoidism were not revealed. The limits of repeated neurosurgical intervention are necessary to determine on a case by case basis.