{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:15:21Z","timestamp":1790741721328,"version":"4.1.0"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2009,9]]},"abstract":"\nObject<\/jats:title>\nMany patients with Cushing disease still have active or recurrent disease after pituitary surgery. The histological pseudocapsule of a pituitary adenoma is a layer of compressed normal anterior lobe that surrounds the adenoma and can be used during surgery to identify and guide removal of the tumor. In this study the authors examined the results of using the pseudocapsule as a surgical capsule in the resection of adenomas in patients with Cushing disease.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nThe authors reviewed a prospective database of data obtained in patients with Cushing disease who underwent surgery. The analysis included all cases in which a lesion was identified during surgery and in which the lesion was believed to be confined to the pituitary gland in patients with Cushing disease between January 1990 and March 2007. Since the objective was to determine the success of using the pseudocapsule as a surgical capsule, patients with invasive tumors and patients in whom no lesion was identified during surgery\u2014challenging cases for surgical success\u2014were excluded from analysis.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nIn 261 patients an encapsulated adenoma was identified at surgery. Tumor was visible on MR imaging in 135 patients (52%); in 126 patients (48%) MR imaging detected no tumor. The range of tumor size overlapped considerably in the groups with positive and negative MR imaging results, indicating that in addition to size other features of the adenoma influence the results of MR imaging. In 252 patients hypercortisolism resolved after the first operation, whereas in 9 patients (3 with positive MR imaging and 6 with negative MR imaging) early reoperation was required. Hypercortisolism resolved in all 261 patients (256 with hypocortisolism and 5 with eucortisolism) before hospital discharge. Forty-six patients (18%) had postoperative electrolyte abnormalities (30 with hyponatremia and 16 with diabetes insipidus), but only 2 patients required treatment at discharge. The mean clinical follow-up duration was 84 months (range 12\u2013215 months). Six patients (2%) had recurrence of hypercortisolism, all of whom were treated successfully with reoperation.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nBecause of their small size, adenomas can be challenging to identify in patients with Cushing disease. Use of the histological pseudocapsule of an adenoma allows accurate identification of the tumor and helps guide its complete excision. With this approach the overall remission rate is high and the rate of complications is low.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2008.8.jns08339","type":"journal-article","created":{"date-parts":[[2009,3,6]],"date-time":"2009-03-06T16:38:59Z","timestamp":1236357539000},"page":"531-539","source":"Crossref","is-referenced-by-count":137,"title":["Outcome of using the histological pseudocapsule as a surgical capsule in Cushing disease"],"prefix":"10.3171","volume":"111","author":[{"given":"Jay","family":"Jagannathan","sequence":"first","affiliation":[{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke; Branches of"},{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Smith","sequence":"additional","affiliation":[{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke; Branches of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hetty L.","family":"DeVroom","sequence":"additional","affiliation":[{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke; Branches of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander O.","family":"Vortmeyer","sequence":"additional","affiliation":[{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke; Branches of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantine A.","family":"Stratakis","sequence":"additional","affiliation":[{"name":"Developmental Endocrinology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynnette K.","family":"Nieman","sequence":"additional","affiliation":[{"name":"Reproductive Biology and Medicine, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward H.","family":"Oldfield","sequence":"additional","affiliation":[{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke; Branches of"},{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1110531","series-title":"Clin Endocrinol (Oxf)","first-page":"549","article-title":"Long-term remission rates after pituitary surgery for Cushing's disease: the need for long-term surveillance","volume":"63","author":"Atkinson","year":"2005"},{"key":"b2-1110531","series-title":"J Clin Endocrinol Metab","first-page":"5134","article-title":"Detection of adrenocorticotropin-secreting pituitary adenomas by magnetic resonance imaging in children and adolescents with cushing disease","volume":"90","author":"Batista","year":"2005"},{"key":"b3-1110531","series-title":"J Clin Endocrinol Metab","first-page":"63","article-title":"Outcomes of therapy for Cushing's disease due to adrenocorticotropin-secreting pituitary macroadenomas","volume":"83","author":"Blevins","year":"1998"},{"key":"b4-1110531","series-title":"Clin Endocrinol (Oxf)","first-page":"617","article-title":"Transsphenoidal pituitary surgery in Cushing's disease: can we predict outcome?","volume":"54","author":"Chee","year":"2001"},{"key":"b5-1110531","series-title":"Neurol Clin","first-page":"751","article-title":"Pituitary tumors","volume":"3","author":"Ciric","year":"1985"},{"key":"b6-1110531","series-title":"J Neurosurg","first-page":"570","article-title":"Cushing's first case of transsphenoidal surgery: the launch of the pituitary surgery era","volume":"103","author":"Cohen-Gadol","year":"2005"},{"key":"b7-1110531","series-title":"Am J Pathol","first-page":"205","article-title":"Subclinical adenoma of the pituitary gland","volume":"12","author":"Costello","year":"1936"},{"key":"b8-1110531","series-title":"Neurol Res","first-page":"51","article-title":"Approaches to the sellar and parasellar region: anatomic comparison of endonasal-transsphenoidal, sublabial-transsphenoidal, and transethmoidal approaches","volume":"23","author":"Das","year":"2001"},{"key":"b9-1110531","series-title":"J Magn Reson Imaging","first-page":"509","article-title":"Dynamic contrast-enhanced MR imaging of the pituitary gland with fast spin-echo technique","volume":"4","author":"Davis","year":"1994"},{"key":"b10-1110531","series-title":"J Neurosurg","first-page":"1343","article-title":"Basis of persistent and recurrent Cushing disease: an analysis of findings at repeated pituitary surgery","volume":"97","author":"Dickerman","year":"2002"},{"key":"b11-1110531","series-title":"Nucl Med Rev Cent East Eur","first-page":"137","article-title":"The case of Cushing's disease imaging by SPECT examination without manifestation of pituitary adenoma in MRI examination","volume":"8","author":"Gierach","year":"2005"},{"key":"b12-1110531","series-title":"J Clin Endocrinol Metab","first-page":"6348","article-title":"Transsphenoidal microsurgery for Cushing's disease: initial outcome and long-term results","volume":"89","author":"Hammer","year":"2004"},{"key":"b13-1110531","series-title":"J Neurosurg","first-page":"582","article-title":"Transsphenoidal hypophysectomy","volume":"34","author":"Hardy","year":"1971"},{"key":"b14-1110531","series-title":"Surg Neurol","first-page":"160","article-title":"Transsphenoidal surgery","volume":"5","author":"Hardy","year":"1976"},{"key":"b15-1110531","series-title":"Adv Neurol","first-page":"261","article-title":"Transsphenoidal neurosurgery of intracranial neoplasm","volume":"15","author":"Hardy","year":"1976"},{"key":"b16-1110531","series-title":"J Neurosurg","first-page":"9","article-title":"Long-term results after microsurgery for Cushing disease: experience with 426 primary operations over 35 years","volume":"108","author":"Hofmann","year":"2008"},{"key":"b17-1110531","series-title":"J Clin Endocrinol Metab","first-page":"440","article-title":"Diagnosis and management of Cushing's syndrome: results of an Italian multicentre study. 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