Therapeutic options after surgical failure in Cushing's disease: A critical review

Rubinstein, German; Osswald, Andrea; Zopp, Stephanie; Ritzel, Katrin; Theodoropoulou, Marily; Beuschlein, Felix; Reincke, Martin

doi:10.1016/j.beem.2019.04.004

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Rubinstein, G., Osswald, A., Zopp, S., Ritzel, K., Theodoropoulou, M., Beuschlein, F., & Reincke, M. (2019). Therapeutic options after surgical failure in Cushing’s disease: A critical review. Best Practice & Research : Clinical Endocrinology & Metabolism, 33(2), 101270. https://doi.org/10.1016/j.beem.2019.04.004

Abstract

Cushing's disease (CD) is the most common etiology of Cushing's syndrome (CD) due to corticotroph pituitary adenoma, which are in most cases small (80-90% microadenomas) and in about 40% cannot be visualized on imaging of the sella. First-line treatment for CD is transsphenoidal surgery (TSS) with the aim of complete adenoma removal and preservation of pituitary gland function. As complete adenoma resection is not always possible, surgical failure is a common problem. This can be the case either due to persistent hypercortisolism afte