Surgical treatment of Cushing’s disease

Abstract

Cushing’s disease, as noted in this book, has very serious consequences for those affected. Accurate endocrine diagnosis is crucial as often the adenomas causing the ACTH excess are not large enough to be visualized on imaging studies. While a pituitary adenoma is causative in over 85 % of patients, this often needs confi rmation with petrosal sinus sampling and measurements of circulating ACTH. Surgery with the intent of complete removal of the adenoma is usually the fi rst-line of treatment. This is almost always done via a transsphenoidal approach with either microscopic or endoscopic techniques. In this chapter, we will discuss the imaging and surgical techniques for these microadenomas, as well as the more common reasons for failure of accurate diagnosis and treatment.