TRANSSPHENOIDAL ADENOMECTOMY IN CUSHINGS-DISEASE VIA A LATERAL RHINOTOMY APPROACH

BACKGROUND Cushing's disease may be treated by surgical pituitary aden omectomy. We present a surgical approach to the pituitary gland that i ncreases the possibilities of a selective adenomectomy, and compare ou r results with those of other studies. METHODS A retrospective study o f patients with Cushing's disease undergoing transsphenoidal selective adenomectomy via a lateral rhinotomy at Sahlgrenska University Hospit al from 1984-93 is presented. Thirty-one patients (26 women, five men; mean age: 44 years, range: 13-15 years) with Cushing's disease were f ollowed for a median time of 4.5 years after operation (range: 1-10 ye ars). Preoperative and postoperative urinary and serum cortisol, and c ircadian rhythm of serum cortisol were measured. We also measured seru m TSH, T4, PRL, FSH, LH, and testosterone as well as urine and plasma osmolality. RESULTS Our remission rate was 77% and the recurrence rate 3%. Hormonal insufficiency was rare. Hypothyroidism and hypogonadism were present in 3% of the patients, and diabetes insipidus occurred in 6% of the patients. CONCLUSION Selective adenomectomy with its good o pportunities for cure and improvement should be regarded as the treatm ent of choice for Cushing's disease. Using the lateral rhinotomy appro ach to the sphenoidal cavity results in good accessibility to the sell a turcica and its pituitary adenomas, a low frequency of postoperative pituitary insufficiency, and a high remission rate. (C) 1997 by Elsev ier Science Inc.