Endocrine · 2025
Prediction of remission and recurrence of Cushing's disease following transsphenoidal surgery (TSS): a single center, 20-year, retrospective series.
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Natan Dana Bar, Serebro Merav, Ram Zvi, Grossman Rachel, Zohar Naomi Even, Sofer Yael, Yaish Iris, Greenman Yona, Tordjman Karen
Аннотация
PURPOSE: Cushing's disease (CD) is a rare condition with variable surgical outcomes. This study aimed to assess remission and recurrence rates in CD patients undergoing transsphenoidal surgery (TSS) at a major Israeli referral center, and to identify predictive factors for these outcomes. We hypothesized that microadenomas would have higher remission rates than macroadenomas.
METHODS: This retrospective analysis included 97 CD patients who underwent TSS at Tel Aviv Sourasky Medical Center (2002-2022). Remission was defined by biochemical criteria and clinical improvement. Suspected recurrence was confirmed by pathological dexamethasone suppression and/or elevated urinary free cortisol. Univariate and multivariate analyses identified predictors of remission, while Kaplan-Meier survival analysis and Cox proportional hazard modeling determined factors associated with recurrence.
RESULTS: The overall remission rate was 63.9%, with no significant difference between microadenomas (58.7%) and macroadenomas (73.5%), a finding confirmed in a sensitivity analysis limited to cases with pathologically confirmed adenomas. Multivariate logistic regression showed predictors of remission were adenoma presence in pathology specimens (OR = 31.25, P < 0.001) and first-time surgery status (OR = 9.42, P = 0.002), while younger age was a contributory factor (OR = 0.963, P = 0.05). The relapse rate was 22.6% over a median follow-up of 63 [IQR 35-109.5] months. Glucocorticoid withdrawal syndrome emerged as a novel protective factor against recurrence (P = 0.045).
CONCLUSIONS: This largest analysis of TSS outcomes for CD in Israel challenges established notions about remission predictors, including our initial hypothesis about microadenomas. The identification of glucocorticoid withdrawal syndrome as a predictor of long-term remission provides a potential avenue for post-operative monitoring in the local healthcare context.
METHODS: This retrospective analysis included 97 CD patients who underwent TSS at Tel Aviv Sourasky Medical Center (2002-2022). Remission was defined by biochemical criteria and clinical improvement. Suspected recurrence was confirmed by pathological dexamethasone suppression and/or elevated urinary free cortisol. Univariate and multivariate analyses identified predictors of remission, while Kaplan-Meier survival analysis and Cox proportional hazard modeling determined factors associated with recurrence.
RESULTS: The overall remission rate was 63.9%, with no significant difference between microadenomas (58.7%) and macroadenomas (73.5%), a finding confirmed in a sensitivity analysis limited to cases with pathologically confirmed adenomas. Multivariate logistic regression showed predictors of remission were adenoma presence in pathology specimens (OR = 31.25, P < 0.001) and first-time surgery status (OR = 9.42, P = 0.002), while younger age was a contributory factor (OR = 0.963, P = 0.05). The relapse rate was 22.6% over a median follow-up of 63 [IQR 35-109.5] months. Glucocorticoid withdrawal syndrome emerged as a novel protective factor against recurrence (P = 0.045).
CONCLUSIONS: This largest analysis of TSS outcomes for CD in Israel challenges established notions about remission predictors, including our initial hypothesis about microadenomas. The identification of glucocorticoid withdrawal syndrome as a predictor of long-term remission provides a potential avenue for post-operative monitoring in the local healthcare context.