{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:34:42Z","timestamp":1787668482475,"version":"build-2736575974"},"reference-count":115,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"name":"Munich Excellence Training Initiative for Physician Scientists\n(Metiphys) program award (to AA) and the Deutsche Forschungsgemeinschaft,\nProjektnummer","award":["314061271 \u2013 TRR 205"],"award-info":[{"award-number":["314061271 \u2013 TRR 205"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Exp Clin Endocrinol Diabetes"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Transsphenoidal surgery remains the primary treatment for Cushing\u2019s\ndisease (CD). However, despite the vast improvements in pituitary surgery,\nsuccessful treatment of CD remains a great challenge. Although selective\ntranssphenoidal removal of the pituitary tumor is a safe and effective\nprocedure, the disease persists in around 22% of CD patients due to\nincomplete tumor resection. The persistence of hypercortisolism after pituitary\nsurgery may also be the consequence of a misdiagnosis, as can occur in case of\nectopic ACTH secretion or pseudo-Cushing. Considering the elevated mortality and\nmorbidity characterizing the disease, a multidisciplinary approach is needed to\nminimize potential pitfalls occurring during the diagnosis, avoid surgical\nfailure and provide the best care in those patients who have undergone\nunsuccessful surgery. In this review, we analyze the factors that could predict\nremission or persistence of CD after pituitary surgery and revise the\ntherapeutic options in case of surgical failure.<\/jats:p>","DOI":"10.1055\/a-1220-6056","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T22:52:41Z","timestamp":1598309561000},"page":"208-215","source":"Crossref","is-referenced-by-count":4,"title":["Persistent Cushing\u2019s Disease after Transsphenoidal Surgery:\nChallenges and Solutions"],"prefix":"10.1055","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2255-1738","authenticated-orcid":false,"given":"Adriana","family":"Albani","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik IV, Klinikum der Universit\u00e4t\nM\u00fcnchen, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, Munich,\nGermany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marily","family":"Theodoropoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,8,24]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1016\/S0140-6736(06)68699-6","article-title":"Cushing\u2019s syndrome","volume":"367","author":"J Newell-Price","year":"2006","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1530\/EJE-11-0272","article-title":"The European Registry on Cushing\u2019s syndrome: 2-year experience. 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Metab"},{"key":"ref6","first-page":"117","article-title":"Incidence and late prognosis of cushing\u2019s syndrome: A population-based\nstudy","volume":"86","author":"J Lindholm","year":"2001","journal-title":"J Clin Endocrinol Metab"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"6348","DOI":"10.1210\/jc.2003-032180","article-title":"Transsphenoidal microsurgery for Cushing\u2019s disease: Initial outcome and\nlong-term results","volume":"89","author":"G D Hammer","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1210\/jc.2011-2957","article-title":"Outcome of Cushing\u2019s disease following transsphenoidal surgery in a\nsingle center over 20 years","volume":"97","author":"Z K Hassan-Smith","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1093\/neurosurgery\/16.CN_suppl_1.185","article-title":"Transphenoidal microsurgery of the normal and pathological pituitary","volume":"16","author":"J Hardy","year":"1969","journal-title":"Clin Neurosurg"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1055\/s-2002-36197","article-title":"Endoscopic endonasal transsphenoidal approach: Outcome analysis of 100\nconsecutive procedures","volume":"45","author":"P Cappabianca","year":"2002","journal-title":"Minim Invasive Neurosurg"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1530\/EJE-13-0325","article-title":"Endoscopic transsphenoidal pituitary surgery: A good and safe primary treatment\noption for Cushing\u2019s disease, even in case of macroadenomas or invasive\nadenomas","volume":"169","author":"M A Wagenmakers","year":"2013","journal-title":"Eur J Endocrinol"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"2454","DOI":"10.1210\/jc.2007-2734","article-title":"Treatment of adrenocorticotropin-dependent Cushing\u2019s syndrome: A\nconsensus statement","volume":"93","author":"B M Biller","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1210\/jc.2005-1204","article-title":"Clinical review: Early morning cortisol levels as a predictor of remission after\ntranssphenoidal surgery for Cushing\u2019s disease","volume":"91","author":"F Esposito","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1210\/jc.2012-2893","article-title":"Predictors of mortality and long-term outcomes in treated Cushing\u2019s\ndisease: A study of 346 patients","volume":"98","author":"J K Lambert","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1530\/EJE-13-0634","article-title":"Long-term remission and recurrence rates after first and second transsphenoidal\nsurgery for Cushing\u2019s disease: Care reality in the 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factors in a single-centre study","volume":"168","author":"K I Alexandraki","year":"2013","journal-title":"Eur J Endocrinol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"5858","DOI":"10.1210\/jc.2003-030751","article-title":"Long-term predictive value of postsurgical cortisol concentrations for cure and\nrisk of recurrence in Cushing\u2019s disease","volume":"88","author":"A M Pereira","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"4728","DOI":"10.1210\/jc.2008-1171","article-title":"Midnight salivary cortisol determination for assessing the outcome of\ntranssphenoidal surgery in Cushing\u2019s disease","volume":"93","author":"C A Carrasco","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"3770","DOI":"10.1210\/jc.2015-2107","article-title":"Accuracy of late-night salivary cortisol in evaluating postoperative remission\nand recurrence in 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disease patient with\npersistent\/recurrent hypercortisolism after pituitary surgery","volume":"98","author":"X Bertagna","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.3171\/jns.2002.97.6.1343","article-title":"Basis of persistent and recurrent Cushing disease: An analysis of findings at\nrepeated pituitary surgery","volume":"97","author":"R D Dickerman","year":"2002","journal-title":"J Neurosurg"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1590\/S0004-27302007000800022","article-title":"Prospective evaluation of transsphenoidal pituitary surgery in 108 patients with\nCushing\u2019s disease","volume":"51","author":"G Rollin","year":"2007","journal-title":"Arq Bras Endocrinol Metabol"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3171\/JNS\/2008\/108\/01\/0009","article-title":"Long-term results after microsurgery for Cushing disease: Experience 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