Surgery brings Cushing’s remission to 60% of patients over 20 years: Study
Most in UK had no complications, but researchers note risks are unavoidable
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Surgery is usually successful for bringing Cushing’s disease into remission, and most patients do not experience any problems — but nonetheless, serious and even fatal complications are possible, and surgery isn’t effective for all individuals with the disease.
Those are the findings of a new study from the U.K. that investigated surgical outcomes over a 20-year period among more than 100 people in the country with Cushing’s disease.
“Surgery is an effective first-line treatment for patients with [Cushing’s disease],” the researchers concluded, noting, however, that “a significant minority will relapse.”
According to the team, more research is needed to determine in advance whether a patient is likely to benefit from surgery — typically the first treatment for people diagnosed with Cushing’s disease. Such determinations could lead to better care for individuals with the cortisol-related condition, the researchers noted.
Their retrospective study, “Disease Remission and Surgical Outcomes of Endoscopic Transsphenoidal Surgery for Cushing Disease: A Single Center Experience,” was published in the journal World Neurosurgery.
Cushing’s disease is caused by a tumor in the pituitary gland, a small structure located in the brain. The pituitary tumor secretes high levels of a signaling molecule that prompts the adrenal glands, located above the kidneys, to make too much of the stress hormone cortisol. Excessive cortisol levels ultimately drive most symptoms of Cushing’s disease.
Surgery to remove tumor is typically first Cushing’s treatment
The main first-line treatment for Cushing’s disease is a surgical procedure to remove the disease-driving pituitary tumor. Here, the scientists reported on outcomes for 125 Cushing’s disease patients who underwent surgery at King’s College Hospital between 2004 and 2025.
“In one of the largest modern series in the literature, we reviewed the treatment pathway and long-term outcomes of consecutive patients treated for [Cushing’s disease] at a single regional treatment center over a 20-year period,” the scientists wrote.
Among the patients, the median age was 48, and about three-quarters were female. There were 41 individuals with a macroadenoma, or a tumor larger than 1 cm (.39 inches), and 57 with a microadenoma, which is a tumor smaller than 1 cm. The remaining 26 patients had no tumor visible with MRI; this usually means the tumor is too small to be seen on the imaging scan.
Most patients (about 70%) underwent one surgical procedure, though some had two or more, the researchers noted.
More than two-thirds of patients had no surgical complications
Complications related to surgery were reported in nearly a third (32%) of patients. Put another way, most patients (68%) had none. The researchers noted that complications were markedly more common among patients who underwent more than one surgical procedure. The most common were diabetes insipidus, a hormonal issue that causes excessive urination and extreme thirst, and leaks of the fluid that surrounds the brain.
There were also three patients who died due to surgical complications: One had a heart attack, and two had severe bleeding during surgery. The researchers noted that, after these three deaths were reported, their center changed some of its procedures for doing Cushing’s surgery in high-risk cases. Since those changes were implemented, there have been no further deaths, according to the team.
Disease remission — defined as very low cortisol levels at three months after surgery — was achieved in about 60% of the patients, though this varied markedly by tumor size. Remission was achieved in more than 70% of patients with microadenomas or tumors too small to be detected on MRI. By contrast, remission was achieved in fewer than half of those individuals with larger macroadenomas.
This study did confirm that patients who achieved remission at [three] months were more likely to be in remission at the last follow-up.
Statistical analyses also showed that male patients were more likely to achieve remission than female patients.
“We observed a statistically and clinically significant association between patient sex and tumor type on remission — a finding not previously reported,” the researchers wrote.
The team noted that “the underlying reasons for this result are unclear,” highlighting a need for future research to investigate these differences.
A better understanding of who is or isn’t most likely to benefit from surgery could help guide more personalized care for people with Cushing’s disease, the scientists said.
Overall, according to the researchers, “this study did confirm that patients who achieved remission at [three] months were more likely to be in remission at the last follow-up.”
