Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing's disease

Object. Transsphenoidal surgery is the usual treatment of choice for adreno corticotropic hormone-secreting pituitary adenomas associated with Gushing' s disease. In this paper the authors investigate the complications of trans sphenoidal surgery in the treatment of a contemporary series of patients wi th Gushing's disease. Methods. Between January 1992 and December 1997, 105 patients with Gushing' s disease underwent transsphenoidal surgery at the University of Virginia H ealth Sciences Center. A retrospective analysis of the complications was co nducted, and the mortality rate was found to be 0.9% and permanent morbidit y was 1.8%. The overall number of complications was 14 (13.3%), which inclu ded seven complications directly related to surgery; one instance of perman ent diabetes insipidus; one syndrome of inappropriate secretion of antidiur etic hormone; and five medical complications (four patients developed deep vein thrombosis and one developed pneumonia). Conclusions. Transsphenoidal surgery for Cushing's disease has a higher com plication rate than that for pituitary adenomas in general. This is primari ly related to a greater number of medical complications, most notably deep vein thrombosis, resulting from the generally debilitated state of most pat ients with Gushing's disease. In view of the high incidence of deep vein th rombosis in these patients, prophylaxis for thromboembolism during the peri operative period is recommended.