{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T09:24:43Z","timestamp":1762161883249,"version":"3.38.0"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We aimed to characterize the clinical features and remission rates of patients\n                    with Cushing\u2019s Disease (CD) without magnetic resonance imaging (MRI) detectable\n                    pituitary adenoma compared to CD patients with MRI-detectable pituitary\n                    adenoma.All patients with adrenocorticotropic hormone (ACTH)-dependent Cushing\u2019s\n                    syndrome (CS) without MRI-detectable pituitary adenoma underwent high-dose\n                    dexamethasone suppression test, corticotropin-releasing hormone stimulation\n                    test, and\/or bilateral inferior petrosal sinus sampling (BIPSS). The diagnosis\n                    of CD in patients without MRI-detectable adenoma was confirmed when the results\n                    of dynamic testing and sampling concordantly indicated ACTH-producing\n                    adenoma.These patients were included in MRI-undetectable group. Patients with\n                    ACTH-dependent CS had pituitary adenoma\u22656 mm and those with pituitary\n                    adenoma&lt;6 mm but BIPSS findings indicative of CD were included in\n                    MRI-detectable adenoma group. The study included 60 patients without\n                    MRI-detectable adenoma and 74 patients with MRI-detectable adenoma. At\n                    presentation, patients without MRI-detectable adenoma were older [47 years\n                    (30.25\u201358) vs. 40.5 years (29\u201349), p=0.036]. Hypertension (65% vs. 47.3%),\n                    diabetes mellitus (58.3% vs. 39.2%), and cardiovascular disease (13.3% vs. 2.7%)\n                    were more common in patients without MRI-detectable adenoma (p=0.040, p=0.027,\n                    p=0.020; respectively). The transsphenoidal surgery as initial treatment was\n                    higher in the patients with MRI-detectable adenoma group (97.3% vs. 80%,\n                    p=0.001). Third-month remission (60.4% vs. 63.8%, p=0.700) after surgery, and\n                    remission rates in the last visit (65.3% vs. 79.7%, p=0.077) were similar\n                    between the two groups. Inconclusion, the absence of an MRI-detectable adenoma\n                    underscores the necessity for comprehensive management.<\/jats:p>","DOI":"10.1055\/a-2527-2029","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T00:03:51Z","timestamp":1741305831000},"page":"163-169","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Features and Remission Rates in Cushing\u2019s Disease: A\n                    Comparison of MRI-Detectable and MRI-Undetectable Pituitary\n                    Adenomas"],"prefix":"10.1055","volume":"57","author":[{"given":"Serhat","family":"Uysal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of\n                    Endocrinology and Metabolism, Faculty of Medicine, Istanbul\n                    University-Cerrahpasa, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cem","family":"Sulu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of\n                    Endocrinology and Metabolism, Faculty of Medicine, Istanbul\n                    University-Cerrahpasa, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilkin","family":"Muradov","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of\n                    Endocrinology and Metabolism, Faculty of Medicine, Istanbul\n                    University-Cerrahpasa, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serdar","family":"Sahin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of\n                    Endocrinology and Metabolism, Faculty of Medicine, Istanbul\n                    University-Cerrahpasa, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nurdan","family":"Gul","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of\n                    Endocrinology and Metabolism, Faculty of Medicine, Istanbul University,\n                    Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ozlem","family":"Soyluk Selcukbiricik","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of\n                    Endocrinology and Metabolism, Faculty of Medicine, Istanbul University,\n                    Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayse","family":"Kubat Uzum","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of\n                    Endocrinology and Metabolism, Faculty of Medicine, Istanbul University,\n                    Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gokcen","family":"Unal Kocabas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of\n                    Endocrinology and Metabolism, Faculty of Medicine, Ege University, Izmir,\n                    Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Banu","family":"Sarer Yurekli","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of\n                    Endocrinology and Metabolism, Faculty of Medicine, Ege University, Izmir,\n                    Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aysa","family":"Hacioglu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of\n                    Endocrinology and Metabolism, Faculty of Medicine, Erciyes University, Kayseri,\n                    Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zuleyha","family":"Karaca","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of\n                    Endocrinology and Metabolism, Faculty of Medicine, Erciyes University, Kayseri,\n                    Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet","family":"Barburoglu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Istanbul\n                    University, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bora","family":"Korkmazer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Istanbul\n                    University-Cerrahpasa, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osman","family":"Kizilkilic","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Istanbul\n                    University-Cerrahpasa, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pinar","family":"Kadioglu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of\n                    Endocrinology and Metabolism, Faculty of Medicine, Istanbul\n                    University-Cerrahpasa, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,3,6]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"261","DOI":"10.3171\/2011.8.JNS102005","article-title":"The history of pituitary surgery for Cushing disease: historical vignette","volume":"116","author":"G U Mehta","year":"2012","journal-title":"J Neurosurg"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"M33","DOI":"10.1530\/EJE-15-0464","article-title":"Cushing\u2019s syndrome: update on signs, symptoms and biochemical screening","volume":"173","author":"L K Nieman","year":"2015","journal-title":"Eur J Endocrinol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1210\/jc.2008-0125","article-title":"The diagnosis of Cushing\u2019s syndrome: an endocrine society clinical practice\n                    guideline","volume":"93","author":"L K Nieman","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"104091","DOI":"10.1016\/j.lpm.2021.104091","article-title":"Cushing\u2019s disease","volume":"50","author":"A Ferriere","year":"2021","journal-title":"Presse M\u00e9d"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/cen.12345","article-title":"Efficacy of medical treatment in C ushing\u2019s disease: a systematic review","volume":"80","author":"M R Gadelha","year":"2014","journal-title":"Clin Endocrinol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"821","DOI":"10.7326\/0003-4819-130-10-199905180-00015","article-title":"Long-term mortality after transsphenoidal surgery for Cushing disease","volume":"130","author":"B Swearingen","year":"1999","journal-title":"Ann Inter Med"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"5134","DOI":"10.1210\/jc.2004-1778","article-title":"Detection of adrenocorticotropin-secreting pituitary adenomas by magnetic\n                    resonance imaging in children and adolescents with cushing disease","volume":"90","author":"D Batista","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.3171\/2017.3.JNS163122","article-title":"Comparison of MRI techniques for detecting microadenomas in Cushing\u2019s\n                    disease","volume":"128","author":"Y Grober","year":"2018","journal-title":"J Neurosurg"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"404","DOI":"10.3171\/2016.1.JNS152119","article-title":"Cushing\u2019s disease: pathobiology, diagnosis, and management","volume":"126","author":"R R Lonser","year":"2017","journal-title":"Journal of neurosurgery"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.wneu.2022.03.076","article-title":"MRI\u2013Negative Cushing\u2019s disease: a review on therapeutic management","volume":"162","author":"M Sabahi","year":"2022","journal-title":"World Neurosurg"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/foc.2007.23.3.4","article-title":"Evaluation and management of Cushing syndrome in cases of negative sellar\n                    magnetic resonance imaging","volume":"23","author":"J Jagannathan","year":"2007","journal-title":"Neurosurg Focus"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1111\/j.1365-2265.2007.03082.x","article-title":"Bilateral laparoscopic adrenalectomy for corticotrophin\u2013dependent Cushing\u2019s\n                    syndrome: a review of the Mayo Clinic experience","volume":"68","author":"J T Chow","year":"2008","journal-title":"Clin Endocrinol"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1210\/jc.2012-3200","article-title":"Approach to the Cushing\u2019s disease patient with persistent\/recurrent\n                    hypercortisolism after pituitary surgery","volume":"98","author":"X Bertagna","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/S2213-8587(21)00235-7","article-title":"Consensus on diagnosis and management of Cushing\u2019s disease: a guideline\n                    update","volume":"9","author":"M Fleseriu","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/S0140-6736(14)61375-1","article-title":"Cushing\u2019s syndrome","volume":"386","author":"A Lacroix","year":"2015","journal-title":"Lancet"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.beem.2009.06.001","article-title":"Cushing\u2019s disease","volume":"23","author":"X Bertagna","year":"2009","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.ecl.2018.01.005","article-title":"The ectopic adrenocorticotropic hormone syndrome: rarely easy, always\n                    challenging","volume":"47","author":"A R Hayes","year":"2018","journal-title":"Endocrinol Metab Clin"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1056\/NEJM199109263251301","article-title":"Petrosal sinus sampling with and without corticotropin-releasing hormone for the\n                    differential diagnosis of Cushing\u2019s syndrome","volume":"325","author":"E H Oldfield","year":"1991","journal-title":"N Eng J Med"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"e22081","DOI":"10.1002\/jcla.22081","article-title":"Preanalytical stability of adrenocorticotropic hormone depends on both time to\n                    centrifugation and temperature","volume":"31","author":"Z Q Wu","year":"2017","journal-title":"J Clin Lab Anal"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s12022-022-09703-7","article-title":"Overview of the 2022 WHO classification of pituitary tumors","volume":"33","author":"S L Asa","year":"2022","journal-title":"Endocr Pathol"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s11102-019-00951-1","article-title":"The incidence of Cushing\u2019s disease: a nationwide Swedish study","volume":"22","author":"O Ragnarsson","year":"2019","journal-title":"Pituitary"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"e13114","DOI":"10.1111\/jne.13114","article-title":"Clinical presentation and etiology of Cushing\u2019s syndrome: Data from ERCUSYN","volume":"34","author":"E Valassi","year":"2022","journal-title":"J Neuroendocrinol"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1111\/cen.14560","article-title":"Paediatric patients with Cushing disease and negative pituitary MRI have a\n                    higher risk of nonremission after transsphenoidal surgery","volume":"95","author":"C Tatsi","year":"2021","journal-title":"Clin Endocrinol"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1111\/j.1365-2265.2011.04279.x","article-title":"Diagnosis and therapy for Cushing\u2019s disease with negative dynamic MRI finding: a\n                    single-centre experience","volume":"76","author":"Y Sun","year":"2012","journal-title":"Clin Endocrinol"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s12902-022-01069-5","article-title":"MRI-negative Cushing\u2019s disease: management strategy and outcomes in 15 cases\n                    utilizing a pure endoscopic endonasal approach","volume":"22","author":"G Sharifi","year":"2022","journal-title":"BMC Endocr Disord"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.3390\/jcm11061558","article-title":"Clinical study and systematic review of pituitary microadenomas vs.\n                    macroadenomas in Cushing\u2019s disease: does size matter?","volume":"11","author":"A Akirov","year":"2022","journal-title":"J Clin Med"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1007\/s40618-016-0504-y","article-title":"Negative correlation between tumour size and cortisol\/ACTH ratios in patients\n                    with Cushing\u2019s disease harbouring microadenomas or macroadenomas","volume":"39","author":"M Machado","year":"2016","journal-title":"J Endocrinol Investig"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"4963","DOI":"10.1210\/jc.2005-0070","article-title":"Clinical and biochemical characteristics of adrenocorticotropin-secreting\n                    macroadenomas","volume":"90","author":"Y S Woo","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"key":"ref29","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":"ref30","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1007\/s11102-015-0645-6","article-title":"Comorbidities in Cushing\u2019s disease","volume":"18","author":"S Sharma","year":"2015","journal-title":"Pituitary"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"46","DOI":"10.3346\/jkms.2009.24.1.46","article-title":"Comparisons between macroadenomas and microadenomas in Cushing\u2019s disease:\n                    characteristics of hormone secretion and clinical outcomes","volume":"24","author":"Y-C Hwang","year":"2009","journal-title":"J Korean Med Sci"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1007\/s11102-011-0362-8","article-title":"ACTH-secreting pituitary adenomas: size does not correlate with hormonal\n                    activity","volume":"15","author":"N Mathioudakis","year":"2012","journal-title":"Pituitary"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1530\/EC-17-0175","article-title":"Duration of post-operative hypocortisolism predicts sustained remission after\n                    pituitary surgery for Cushing\u2019s disease","volume":"6","author":"P Bansal","year":"2017","journal-title":"Endocr Connect"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"3383","DOI":"10.1210\/jc.2007-0208","article-title":"Outcomes and management of patients with Cushing\u2019s disease without pathological\n                    confirmation of tumor resection after transsphenoidal surgery","volume":"92","author":"N Pouratian","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1007\/s00701-017-3140-1","article-title":"Efficacy of endoscopic endonasal transsphenoidal surgery for Cushing\u2019s disease\n                    in 230 patients with positive and negative MRI","volume":"159","author":"H Cebula","year":"2017","journal-title":"Acta Neurochirurg"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"4101","DOI":"10.1210\/jc.2019-00333","article-title":"Why we should still treat by neurosurgery patients with Cushing disease and a\n                    normal or inconclusive pituitary MRI","volume":"104","author":"J Cristante","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"key":"ref37","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 with 426\n                    primary operations over 35 years","volume":"108","author":"B M Hofmann","year":"2008","journal-title":"J Neurosurg"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1227\/NEU.0b013e31827b966a","article-title":"Endoscopic transsphenoidal surgery for cushing disease: techniques, outcomes,\n                    and predictors of remission","volume":"72","author":"R M Starke","year":"2013","journal-title":"Neurosurgery"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"531","DOI":"10.3171\/2008.8.JNS08339","article-title":"Outcome of using the histological pseudocapsule as a surgical capsule in Cushing\n                    disease","volume":"111","author":"J Jagannathan","year":"2009","journal-title":"J Neurosurg"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"751","DOI":"10.3171\/JNS\/2008\/109\/10\/0751","article-title":"Management of Cushing\u2019s disease: outcome in patients with microadenoma detected\n                    on pituitary magnetic resonance imaging","volume":"109","author":"D M Prevedello","year":"2008","journal-title":"J Neurosurg"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2527-2029.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T00:04:38Z","timestamp":1741305878000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2527-2029"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":40,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2025,3,6]]},"published-print":{"date-parts":[[2025,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2527-2029","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}