{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T20:31:55Z","timestamp":1772915515470,"version":"3.50.1"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1990,3]]},"abstract":"<jats:p content-type=\"fine-print\">\u2713 From 1977 to 1988, 56 patients with a preoperative diagnosis of Cushing\u03b1s disease were treated by transsphenoidal microsurgical exploration of the pituitary gland. In 42 patients, a discrete tumor was found and a selective adenomectomy was performed. Total hypophysectomy was performed in nine patients. In an attempt to preserve pituitary function, a technique of subtotal hypophysectomy was utilized in the remaining five patients. Regular and adequate follow-up results were obtained in 53 patients. A sustained remission was obtained in 45 of these 53 patients for a remission rate of 84.9%. Eight patients were classified as therapeutic failures. The causes for failure included: 1) invasive tumor; 2) hyperplasia mistaken for an adenoma; 3) a presumed ectopic source of adrenocorticotropic hormone; 4) misdiagnosis; 5) atypical tumor; and 6) recurrence of disease after remission. In cases of therapeutic failure, the original diagnosis of Cushing's disease must be reevaluated and treatment continued until sustained remission is achieved. Necessary measures to help avoid surgical failures and an approach for further diagnostic and therapeutic maneuvers in these cases are discussed.<\/jats:p>","DOI":"10.3171\/jns.1990.72.3.0363","type":"journal-article","created":{"date-parts":[[2009,5,13]],"date-time":"2009-05-13T18:20:02Z","timestamp":1242238802000},"page":"363-369","source":"Crossref","is-referenced-by-count":91,"title":["Cushing's disease: results of transsphenoidal microsurgery with emphasis on surgical failures"],"prefix":"10.3171","volume":"72","author":[{"given":"George T.","family":"Tindall","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl J.","family":"Herring","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard V.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Adams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nelson B.","family":"Watts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Endocrinol Metab Clin","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1016\/S0889-8529(18)30470-5","article-title":"Cushing's disease.","volume":"16","author":"Aron","year":"1987"},{"key":"b2","series-title":"Cleve Clin J Med","doi-asserted-by":"publisher","first-page":"357","DOI":"10.3949\/ccjm.55.4.357","article-title":"Results of transsphenoidal surgery for Cushing's disease. 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A review.","volume":"145","author":"Burch","year":"1985"},{"key":"b5","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"204","DOI":"10.3171\/jns.1987.66.2.0204","article-title":"Surgical treatment of Cushing's disease.","volume":"66","author":"Chandler","year":"1987"},{"key":"b6","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1148\/radiology.163.2.3562821","article-title":"Pituitary adenomas in patients with Cushing disease: initial experience with Gd-DTPA-enhanced MR imaging.","volume":"163","author":"Dwyer","year":"1987"},{"key":"b7","series-title":"Acta Neurochir","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/BF01401978","article-title":"Transsphenoidal surgery of parasellar pituitary adenomas.","volume":"92","author":"Fahlbusch","year":"1988"},{"key":"b8","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"647","DOI":"10.7326\/0003-4819-94-5-647","article-title":"Selective venous sampling for ACTH in Cushing's syndrome. Differentiation between Cushing's disease and the ectopic ACTH syndrome.","volume":"94","author":"Findling","year":"1981"},{"key":"b9","series-title":"Am J Clin Pathol","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1093\/ajcp\/90.3.345","article-title":"Appropriate laboratory testing in the screening and work-up of Cushing's syndrome.","volume":"90","author":"Fuhrman","year":"1988"},{"key":"b10","series-title":"Endocrinol Metab Clin","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1016\/S0889-8529(18)30468-7","article-title":"Radiotherapy of pituitary tumors.","volume":"16","author":"Halberg","year":"1987"},{"key":"b11","series-title":"Can J Neurol Sci","first-page":"375","article-title":"Cushing's disease: 50 years later. Presidential address: XVII Canadian Congress of Neurological Sciences.","volume":"9","author":"Hardy","year":"1982"},{"key":"b12","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":"b13","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"487","DOI":"10.7326\/0003-4819-109-6-487","article-title":"Transsphenoidal microsurgery for Cushing disease. A report of 216 cases.","volume":"109","author":"Mampalam","year":"1988"},{"key":"b14","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"445","DOI":"10.7326\/0003-4819-109-6-445","article-title":"Therapy of Cushing disease: a consensus for pituitary microsurgery.","volume":"109","author":"Melby","year":"1988"},{"key":"b15","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1227\/00006123-198708000-00015","article-title":"Long term results of transsphenoidal adenomectomy in patients with Cushing's disease.","volume":"21","author":"Nakane","year":"1987"},{"key":"b16","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":"b17","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1056\/NEJM198501103120207","article-title":"Preoperative lateralization of ACTH-secreting pituitary microadenomas by bila teral and simultaneous inferior petrosal venous sinus sampling.","volume":"312","author":"Oldfield","year":"1985"},{"key":"b18","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":"b19","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1210\/jcem-61-4-718","article-title":"Prolonged treatment of Cushing's disease by ketoconazole.","volume":"61","author":"Sonino","year":"1985"},{"key":"b20","series-title":"Acta Endocrinol","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1530\/acta.0.1130005","article-title":"Transsphenoidal microsurgery for Cushing's disease.","volume":"113","author":"Tagliaferri","year":"1986"},{"key":"b21","series-title":"Medicine for the Practicing Physician","first-page":"454","article-title":"Cushing's syndrome","author":"Watts","year":"1988"},{"key":"b22","series-title":"Lab Med","first-page":"44","article-title":"Testing for Cushing's syndrome.","volume":"6","author":"Watts","year":"1975"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/72\/3\/article-p363.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/72\/3\/article-p363.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/72\/3\/article-p363.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T22:17:20Z","timestamp":1679869040000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/72\/3\/article-p363.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1990,3]]},"references-count":22,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/jns.1990.72.3.0363","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[1990,3]]}}}