Article
Treatment and results in Cushing disease with normal magnetic resonance imaging
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Published: | May 4, 2005 |
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Outline
Text
Objective
Cushing disease without any pituitary adenoma visible on MRI is a challenge for both the neurosurgeon and the biologist; we report our experience concerning a subgroup of six patients operated on for this pathology, extracted from a total of 23 patients admitted from Cushing disease treated in our departement over the last four years period.
Methods
We reviewed retropectively a series of 23 patients who underwent transphenoidal surgery; six patients fullfiled the criteria for the study; normal MRI of the pituitary area, no previoud surgery and aperated by sub labial transphénoidal. The age average of the patients was 35 years, there was female preponderance (5 womens/1man) .All patients had clinically severe disease and underwent a preopérative IPSS.
Results
Intra operatively, an adenoma was found in four cases in whom a selective removal of the tumors was achieved; the two remaining cases underwent an hemihypophysectomy on the side of abnormal IPSS. After on average follow up of 20 months all of patients are in remission.
Conclusions
Cushing disease in patients with a normal MRI can succesfuly treated by surgery, inferior petrosal sinus sampling (IPSS) can be helpful in localizing the adenoma. Complication was especially cerebro spinal fluid fistulas.