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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
Abstract
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.
- Cushing syndrome
- Surgical procedures, operative
- Fatal outcome
- Outcome and process assessment (health care)
- Adenoma
Article and Author Information
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Presented in part at the Annual Meeting of the Congress of Neurological Surgeons, New Orleans, Louisiana, 29 September 1997.
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Acknowledgments: The authors thank Cheryl Baressi, Rebecca Lewis, and Christopher Owen for their assistance.
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Requests for Reprints: Brooke Swearingen, MD, Neurosurgical Service, Massachusetts General Hospital, Fruit Street, Boston, MA 02114.
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Current Author Addresses: Drs. Swearingen, Barker, and Zervas: Neurosurgical Service, Massachusetts General Hospital, Fruit Street, Boston, MA 02114.
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Drs. Biller, Katznelson, Grinspoon, and Klibanski: Neuroendocrine Service, Massachusetts General Hospital, Fruit Street, Boston, MA 02114.
- Copyright ©2004 by the American College of Physicians
