Transsphenoidal microadenomectomy in cases of Cushing's disease.

Hypothalamo-pituitary functions in 60 cases of Cushing's disease have been followed up after transsphenoidal selective adenomectomy. The adenoma was found and selectively removed in 56 cases. Remarkable clinical improvement followed within several months after selective adenomectomy in the successful cases, paralleled with endocrine results. Long follow-up studies demonstrated a recovery of the ACTH-cortisol system with restarting of the circadian rhythm and normal suppressibility to low-dose dexamethasone. The functions of the other anterior pituitary hormones such as GH, TSH, and gonadotropins also returned to normal after selective adenomectomy in the majority of the clinically cured cases. These results strongly suggest that transsphenoidal pituitary exploration should be accepted as an initial treatment of Cushing's disease because of its high clinical remission rate in association with fair chance of radical cure and return to normal endocrine function.