PITUITARY-FUNCTION AFTER SELECTIVE ADENOMECTOMY FOR CUSHINGS-DISEASE

This retrospective analysis was undertaken to determine whether select ive adenomectomy for Gushing's disease can achieve acceptable cure rat es while causing minimal pituitary dysfunction. Tumour size, histology and pituitary function were evaluated in 34 consecutive patients (26F :8M, mean age 33.6 years) undergoing transsphenoidal adenomectomy for Gushing's disease from 1975 to 1992. Follow-up averaged 5.8 years. Cur e was defined as resolution of symptoms and signs and normalization of urinary cortisol excretion. Sixty-three per cent of patients achieved cure after selective adenomectomy; repeat adenomectomy cured an addit ional four patients. Twenty-eight per cent required bilateral adrenale ctomy and/or pituitary irradiation. Postoperative pituitary function r emained completely intact in 81%. Secondary hypogonadism occurred in 8 %, hypothyroidism in 15% and permanent diabetes insipidus in 4%. There was recurrence in 26% after a mean of 4.6 years (range 1-7). It is co ncluded that selective adenomectomy can achieve acceptable cure rates with a low prevalence of postoperative hypopituitarism, although an in crease of recurrence may be the result of conservative surgery.