Daignosis and Treatment Outcome in ACTH-Producing Pituitary Adenomas

Kim, Jong Soo; Jung, Hee Won; Kim, Hyun Jib; Cho, Byung Kyu; Choi, Kil Soo; Han, Dae Hee

Abstract

The records of 31 patients diagnosed as having Cushing's disease surgically treated via transsphenoidal approach at our instituion between March, 1984, and April, 1994, were retrospectively reviewed in order to determine the most ideal method in diagnosing and the treatment outcome of ACTH-producing pituitary adenomas. Preoperative diagnosis was made after evaluating the patients with endocrinological studies including inferior petrosal sinus(IPS) sampling, and high-resolution computerized tomography(CT) and/or high-field magnetic resonance(MR) imaging. The sensitivity of IPS sampling technique used in microadenoma cases was 85.7% and of evaluating with CT and MR imaging, 529% and 61.9%, respectively. Of the 31 cases, 22 were microadenomas, 6 macroadenomas, 1 hyperplasia, and 2 histopathologically identified as being not a tumor. Microsurgical procedures included 19 selective adenomectomy(SA), 7 hemihypophysectomy(HH), 2 partial adenomectomy(PA), and 3 multiple biopsies(BX). The surgical remission rates of SA group and H group were 89.5%(17 out of 22) and 71.4%(5 out of 7), respectively. PA and BX groups showed no remission. Out of 7 patients who underwent radiation therapy after showing no remission postoperatively, 5 demonstrated remission, giving an overall remission rate of 87.1%. It is concluded that IPS sampling and high-field MR imaging(including dynamic MR imaging) procedures are the most ideal methods in evaluating and diagnosing patients with Cushing's disease. Selective adenomectomy via transsphenoidal microsurgery is the most effective treatment modality, but such therapeutic intervention should be used with discretion. The best operative results are obtained in cases in which the margin of the adenoma is clearly visualized grossly, and the frozen bipsy of the resected margin is negative for tumor cells.