Surgical Outcomes for Cushing's Disease: A 13 Year Single Institution Experience

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