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Cukiert A, Pimentel F, Andrioli M, Goldman J, Nery M, Salgado LR, Knoepfelmacher M, Liberman B.
Serviços de Neurocirurgia e Endocrinologia do Hospital Brigadeiro, São Paulo SP
Remission of hypercortisolism is obtained in 60-70 % of patients with Cushing’s disease submitted to surgery. On the other hand, 15-20 % of them will reccur during long-term follow-up. We report on 4 patients previously operated in other services at least 2 years ago who were reoperated. In all patients, MRI suggested tumor recurrence and lack of cavernous sinus invasion. Three of them remitted after primary surgery but recurred. One did not remit after primary surgery. All were reoperated through the transesphenoidal route (same approach as in primary surgery). Three are now in remission (including the one who did not achieved remission after primary surgery). No tumor was found in the patient who was not cured by surgery. In 2 patients, ACTH-secreting tumors were found. In one patient cured by surgery no tumor was found. Clinical remission of hypercortisolism can be achieved after transesphenoidal reoperations. The presence of MRI defined lesions and lack of cavernous sinus invasion are clear markers of a better prognosis.