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Long-Term Mortality after Transsphenoidal Surgery for Cushing Disease

Brooke Swearingen, MD; Beverly M.K. Biller, MD; Fred G. Barker, II, MD; Laurence Katznelson, MD; Steven Grinspoon, MD; Anne Klibanski, MD; and Nicholas T. Zervas, MD

18 May 1999 | Volume 130 Issue 10 | Pages 821-824

Background: Untreated Cushing disease historically has a high mortality rate, but the long-term survival of patients with Cushing disease after transsphenoidal surgery has not been reported.

Objective: To determine long-term mortality rate in patients who are treated for Cushing disease with current management techniques.

Design: Retrospective case series.

Setting: Tertiary care center.

Patients: 161 patients (32 men and 129 women; mean age, 38 years) who were treated for Cushing disease between 1978 and 1996.

Intervention: Transsphenoidal adenomectomy and as-needed adjunctive therapy.

Measurement: Record review with follow-up interview.

Results: The cure rate for patients with microadenomas who had no previous therapy was 90% (123 of 137). No perioperative deaths occurred (0 of 193 procedures [95% CI, 0.0% to 1.9%]). Follow-up data (mean, 8.7 years) were obtained for 99% of patients (159 of 161). Six patients died. The 5- and 10-year survival rates were 99% (CI, 97% to 100%) and 93% (CI, 88% to 99%), respectively. Survival was similar to that seen in an age- and sex-matched sample that was based on U.S. population data (standardized mortality ratio, 0.98 [CI, 0.44 to 2.2]; P > 0.2).

Conclusion: Survival of patients treated for Cushing disease with current management techniques between 1978 and 1996 was better than the poor survival historically associated with this disorder.

Author and Article Information

From Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

Presented in part at the Annual Meeting of the Congress of Neurological Surgeons, New Orleans, Louisiana, 29 September 1997.

Acknowledgments: The authors thank Cheryl Baressi, Rebecca Lewis, and Christopher Owen for their assistance.

Requests for Reprints: Brooke Swearingen, MD, Neurosurgical Service, Massachusetts General Hospital, Fruit Street, Boston, MA 02114.

Current Author Addresses: Drs. Swearingen, Barker, and Zervas: Neurosurgical Service, Massachusetts General Hospital, Fruit Street, Boston, MA 02114.

Drs. Biller, Katznelson, Grinspoon, and Klibanski: Neuroendocrine Service, Massachusetts General Hospital, Fruit Street, Boston, MA 02114.

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