{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T07:58:52Z","timestamp":1792828732895,"version":"4.5.0"},"reference-count":17,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1989,10]]},"abstract":"<jats:p content-type=\"fine-print\">\u2713 Transsphenoidal resection of adrenocorticotrophic hormone (ACTH)-producing pituitary adenomas has the potential of curing most patients with Cushing's disease. However, transsphenoidal exploration of the pituitary is not always curative, and patients who have remission of hypercortisolism following surgery occasionally develop a recurrence. Whether repeat pituitary surgery should be performed for recurrent or persistent Cushing's disease has not been evaluated previously. To determine the efficacy of transsphenoidal surgery in recurrent or persistent Cushing's disease, we performed transsphenoidal surgery in 31 patients (22 women and nine men) who had previously undergone a transsphenoidal operation and two female patients who had had previous pituitary irradiation only.<\/jats:p>\n<jats:p content-type=\"fine-print\">In 24 (73%) of the 33 patients, remission of hypercortisolism was achieved by surgery. Although preoperative computerized tomography (CT) scanning identified an adenoma in only three of the 33 patients, in 20 patients a discrete adenoma was identified at pituitary exploration. The incidence of remission of hypercortisolism was greatest if an adenoma was identified at surgery and the patient received selective adenomectomy (19, or 95% of 20 patients), if there was evidence at surgery or by preoperative CT scanning that the previous surgical exposure of the pituitary was incomplete (seven, or 78% of nine patients), if an adenoma was seen on preoperative CT scanning (three of three patients), or if the patient had had prior pituitary irradiation without surgery (two of two patients). In contrast, only five (42%) of 12 patients who received subtotal or total hypophysectomy had remission of hypercortisolism. Surgically induced hypopituitarism occurred in six (50%) of these 12 patients, but in only one (5%) of the 20 patients who underwent selective adenomectomy. Three (13%) of the 24 patients who were in remission from hypercortisolism following repeat surgery developed recurrent hypercortisolism 10 to 47 months postoperatively.<\/jats:p>\n<jats:p content-type=\"fine-print\">Repeat transsphenoidal exploration of the pituitary and treatment limited to selective adenomectomy should be considered in patients with hypercortisolism despite previous pituitary treatment. If an adenoma is identified during surgery, the chance of remission of Cushing's disease is high and the risk of hypopituitarism is low; however, if no adenoma can be found and partial or complete hypophysectomy is performed, remission of hypercortisolism is less likely and the risk of hypopituitarism is about 50%.<\/jats:p>","DOI":"10.3171\/jns.1989.71.4.0520","type":"journal-article","created":{"date-parts":[[2009,5,8]],"date-time":"2009-05-08T16:23:22Z","timestamp":1241799802000},"page":"520-527","source":"Crossref","is-referenced-by-count":164,"title":["Repeat transsphenoidal surgery for Cushing's disease"],"prefix":"10.3171","volume":"71","author":[{"given":"Robert B.","family":"Friedman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward H.","family":"Oldfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynnette K.","family":"Nieman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George P.","family":"Chrousos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L.","family":"Doppman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon B.","family":"Cutler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Lynn","family":"Loriaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"195","DOI":"10.3171\/jns.1983.59.2.0195","article-title":"Transsphenoidal microsurgical management of Cushing's disease. Report of 100 cases.","volume":"59","author":"Boggan","year":"1983"},{"key":"b2","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1056\/NEJM198301133080216","article-title":"A survey of results with transsphenoidal surgery in Cushing's disease.","volume":"308","author":"Burch","year":"1983"},{"key":"b3","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1056\/NEJM198403083101004","article-title":"The corticotropin-releasing factor stimulation test: an aid in the evaluation of patients with Cushing's syndrome.","volume":"310","author":"Chrousos","year":"1984"},{"key":"b4","series-title":"Metabolism","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1016\/0026-0495(79)90097-0","article-title":"Cushing's syndrome: a review of diagnostic tests.","volume":"28","author":"Crapo","year":"1979"},{"key":"b5","series-title":"J Clin Metab","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1210\/jcem-48-6-931","article-title":"Conventional supervoltage irradiation is an effective treatment for acromegaly.","volume":"48","author":"Eastman","year":"1979"},{"key":"b6","series-title":"Can J Neurol Sci","first-page":"375","article-title":"Cushing's disease: 50 years later.","volume":"4","author":"Hardy","year":"1982"},{"key":"b7","series-title":"Clin Neurosurg","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1093\/neurosurgery\/16.CN_suppl_1.185","article-title":"Transsphenoidal microsurgery of the normal and pathological pituitary.","volume":"16","author":"Hardy","year":"1969"},{"key":"b8","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"823","DOI":"10.3171\/jns.1985.63.6.0823","article-title":"Transsphenoidal surgery following unsuccessful prior therapy. An assessment of benefits and risks in 158 patients.","volume":"63","author":"Laws","year":"1985"},{"key":"b9","series-title":"J Clin Endocrinol Metab","first-page":"426","article-title":"Tests and pituitary-adrenal suppressibility in the diagnosis of Cushing's syndrome.","volume":"21","author":"Liddle","year":"1961"},{"key":"b10","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1056\/NEJM195807242590403","article-title":"ACTH-producing tumor of the pituitary gland.","volume":"259","author":"Nelson","year":"1958"},{"key":"b11","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"560","DOI":"10.7326\/0003-4819-52-3-560","article-title":"ACTH-producing pituitary tumors following adrenalectomy for Cushing's syndrome.","volume":"52","author":"Nelson","year":"1960"},{"key":"b12","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"862","DOI":"10.7326\/0003-4819-105-6-862","article-title":"The ovine corticotropin-releasing hormone stimulation test and the dexamethasone suppression test in the differential diagnosis of Cushing's syndrome.","volume":"105","author":"Nieman","year":"1986"},{"key":"b13","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1056\/NEJM198501103120207","article-title":"Preoperative lateralization of ACTH-secreting microadenomas by bilateral and simultaneous inferior petrosal sinus sampling.","volume":"312","author":"Oldfield","year":"1985"},{"key":"b14","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1056\/NEJM197107292850501","article-title":"Results of treatment in 108 patients with Cushing's syndrome.","volume":"285","author":"Orth","year":"1971"},{"key":"b15","series-title":"Mayo Clin Proc","first-page":"24","article-title":"Transsphenoidal removal of pituitary microadenoma in Cushing's disease.","volume":"53","author":"Salassa","year":"1978"},{"key":"b16","series-title":"Radiology","first-page":"775","article-title":"Pituitary CT scanning in Cushing's syndrome.","volume":"162","author":"Saris","year":"1986"},{"key":"b17","series-title":"Clinical Management of Pituitary Disorders.","first-page":"229","article-title":"Neurosurgical aspects of Cushing's disease and Nelson's syndrome","author":"Wilson","year":"1979"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/71\/4\/article-p520.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/71\/4\/article-p520.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/71\/4\/article-p520.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T21:29:27Z","timestamp":1679866167000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/71\/4\/article-p520.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1989,10]]},"references-count":17,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/jns.1989.71.4.0520","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[1989,10]]}}}