2026 Poster Presentations
P198: SURGICAL OUTCOMES FOR CUSHING'S DISEASE: A 13 YEAR SINGLE INSTITUTION EXPERIENCE
Michelle S Miller, MD1; Jordan Lo2; Brianna Hines2; Smruti Mahapatra2; Darshan Trivedi, MD3; Nyrene Haque, MD4; Blair Barton, MD5; Joseph Keen, MD6; Marcus Ware, MD, PhD6; 1Tulane Ochsner Neurosurgery; 2Tulane University Medical School; 3Ochsner Medical Center Department of Pathology; 4Ochsner Medical Center Department of Endocrinology; 5Ochsner Medical Center Department of Otolaryngology; 6Ochsner Medical Center Department of Neurosurgery
Introduction: While transsphenoidal surgery remains the first line treatment for Cushing’s disease, highly variable remission and recurrence rates have been reported in the literature. We aim to assess the rates of postoperative remission and recurrence at our institution following transsphenoidal surgery for patients who had pituitary adenomas with endocrinologic evidence of Cushing’s disease. These patients are evaluated in our multidisciplinary clinic involving neurosurgery, endocrinology, otolaryngology, and radiation oncology.
Methods: 300 consecutive adult patients who underwent transnasal transsphenoidal surgery with skull base faculty at our institution from 2012 to 2025 were retrospectively reviewed. 42 patients had surgical pathology consistent with corticotroph adenoma, confirmed by positive ACTH and/or TPIT staining. An additional 4 patients with nonspecific pathology who had clinical presentation and endocrinologic work up consistent with Cushing’s disease – as defined by abnormally elevated 8 AM serum cortisol and ACTH, abnormal low dose dexamethasone suppression test, and/or abnormal salivary and urine cortisol levels – were also included. Patient demographics, operative metrics, pre and postoperative hormonal workup and imaging, as well as all endocrine and neurosurgical evaluations were reviewed.
Results: In our patient cohort, corticotroph adenomas made up 17.6% (42/239) of all pituitary adenomas that were confirmed on final surgical pathology. Of those, 54.8% (23/42) showed endocrinologic evidence of Cushing’s disease preoperatively, all of which stained positive for ACTH. 45.2% (19/42) were nonfunctional, of which 15.7% (3/19) were negative for ACTH but positive for transcription factor TPIT.
On preoperative MRI, 48.1%(13/27) of patients with Cushing’s disease had microadenomas, 29.6% (8/27) had macroadenomas, and 22.2%(6/27) had no mass identifiable. Median preop ACTH was 65 pg/ml [IQR 47.5, 103.5] and serum 8 AM cortisol was 17.8 µg/dl [13.3, 24].
85.2% (23/27) of patients initially experienced remission of hypercortisolemia to normal physiologic levels or lower, with 51.2% (14/27) of those patients reaching documented cortisol nadir of <2 µg/dl. Median postop day 1 8 AM cortisol was 10.8 µg/dl [2.0, 20.8]. 85.2% (23/27) of patients were discharged on oral steroids.
Of patients with at least 3 months of neurosurgery follow up, 77% (17/23) had gross total resection on postop MRI. Median neurosurgical and/or endocrine postop follow up time was 18.3 months [8.6, 40.6]. Within that time frame, 19.2% (5/26) of patients required further treatment. Of the 4 patients who did not experience endocrinologic remission, 3 underwent single fraction stereotactic radiosurgery (SRS) and 1 underwent repeat surgical resection - at median 7.0 months after initial surgery. 1 patient who did have initial remission with postop day 1 cortisol of <1.0 had delayed recurrence 9 years later and underwent repeat surgical resection. On statistical analysis, age, sex, and size of the lesion were not found to be significant predictors of need for further treatment.
Conclusion: Overall, this retrospective case review demonstrates surgical efficacy for transsphenoidal surgery for Cushing’s disease at our institution to be on par with the more favorable success rates described in the literature, with 85.2% (23/27) of patients achieving remission initially postop and only 4.3% (1/23) experiencing delayed recurrence at median 18.3 months of follow-up.
