Endoscopic Endonasal Surgery is Safe, Effective for Treating Cushing’s Patients, Study Concludes

Clinical outcomes of Cushing’s disease patients who undergo endoscopic endonasal surgery to remove a pituitary adenoma are similar to those seen in patients who underwent previously used microscope-assisted techniques.

According to a new study, that means despite the need for specialized training and equipment, using an endoscopic endonasal approach is an appropriate and safe surgical technique for removing a pituitary adenoma.

Led by Brazilian researchers, the study, “Long Term Follow-up after Endoscopic Endonasal Approach for the Treatment of Cushing’s Disease,” was published in the Journal of Neurological Surgery.

Cushing’s disease is caused by a benign tumor in the pituitary gland, often called a pituitary adenoma, that secretes high levels of adrenocorticotropic hormone (ACTH). ACTH, in turn, leads to the increased production and secretion of cortisol, which causes the clinical features that are classically seen in patients with Cushing’s, such as obesity, diabetes, and hypertension (high blood pressure).

Psychiatric changes, such as depression, anxiety, psychosis, thoughts of suicide, and paranoia, also are often observed.

If left untreated, Cushing’s disease is associated with a high morbidity rate and mortality rate, which is 1.9 to 4.8 times higher than reported in the general population.

Currently, surgery to remove the tumor (selective adenomectomy) is the standard treatment for Cushing’s disease, and it has been shown to be a viable and relatively successful treatment strategy.

New, less-invasive surgical strategies, such as the endoscopic endonasal approach (EEA), have been proposed for treating these patients.

This technique involves removing tumors in the pituitary gland through the nose, and it has been used widely and with excellent results to treat several types of health problems. However, for some endocrinologists and neurosurgeons, there still are unanswered questions regarding the effectiveness and safety of this technique.

So, researchers conducted a study to evaluate outcomes of patients who underwent EEA as a treatment for Cushing’s disease in a large speciality hospital in São Paulo, Brazil.

They retrospectively reviewed the medical records of 16 patients (14 females and two males, mean age 33.7 years) who underwent EEA as first treatment for Cushing’s disease, and had been followed after surgery for a minimum of 18 months.

Using magnetic resonance imaging (MRI), researchers were able to identify a pituitary adenoma in 93.8% of the patients.

After surgery, and upon mean follow-up of 52.0 months, no new neurological problems or deficits were reported, indicating this treatment approach is  generally safe.

Collectively, 87.5% and 68.75% of patients achieved early remission and sustained remission, respectively, after a single EEA surgery. Also, 68.75% of patients experienced weight reduction, 60% saw improved blood pressure, and 55.5% logged lower serum glucose levels after remission.

“Despite the need for specialized training, equipment, and team building by ENT (Ear, Nose and Throat) and neurosurgery, the transition from microscope assisted pituitary surgery to endoscopic endonasal approach is possible and safe,” researchers wrote.

“The clinical outcomes, even in the early years, are similar to the previous microscope assisted treatment,” they stated. “Over time, with greater experience and knowledge, there is a tendency for improvement,” they concluded.