Natan Dana Bar, Serebro Merav, Ram Zvi, Grossman Rachel, Zohar Naomi Even, Sofer Yael, Yaish Iris, Greenman Yona, Tordjman Karen
Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Endocrine. 2025 Jun 18. doi: 10.1007/s12020-025-04304-w.
Cushing's disease (CD) is a rare condition with variable surgical outcomes. This study aimed to assess remission and recurrence rates in CD patients undergoing transsphenoidal surgery (TSS) at a major Israeli referral center, and to identify predictive factors for these outcomes. We hypothesized that microadenomas would have higher remission rates than macroadenomas.
This retrospective analysis included 97 CD patients who underwent TSS at Tel Aviv Sourasky Medical Center (2002-2022). Remission was defined by biochemical criteria and clinical improvement. Suspected recurrence was confirmed by pathological dexamethasone suppression and/or elevated urinary free cortisol. Univariate and multivariate analyses identified predictors of remission, while Kaplan-Meier survival analysis and Cox proportional hazard modeling determined factors associated with recurrence.
The overall remission rate was 63.9%, with no significant difference between microadenomas (58.7%) and macroadenomas (73.5%), a finding confirmed in a sensitivity analysis limited to cases with pathologically confirmed adenomas. Multivariate logistic regression showed predictors of remission were adenoma presence in pathology specimens (OR = 31.25, P < 0.001) and first-time surgery status (OR = 9.42, P = 0.002), while younger age was a contributory factor (OR = 0.963, P = 0.05). The relapse rate was 22.6% over a median follow-up of 63 [IQR 35-109.5] months. Glucocorticoid withdrawal syndrome emerged as a novel protective factor against recurrence (P = 0.045).
This largest analysis of TSS outcomes for CD in Israel challenges established notions about remission predictors, including our initial hypothesis about microadenomas. The identification of glucocorticoid withdrawal syndrome as a predictor of long-term remission provides a potential avenue for post-operative monitoring in the local healthcare context.
库欣病（CD）是一种罕见疾病，手术结果各异。本研究旨在评估在以色列一家主要转诊中心接受经蝶窦手术（TSS）的CD患者的缓解率和复发率，并确定这些结果的预测因素。我们假设微腺瘤的缓解率会高于大腺瘤。
这项回顾性分析纳入了97例在特拉维夫索罗卡医疗中心接受TSS的CD患者（2002 - 2022年）。缓解通过生化标准和临床改善来定义。疑似复发通过病理地塞米松抑制试验和/或尿游离皮质醇升高来确认。单因素和多因素分析确定缓解的预测因素，而Kaplan-Meier生存分析和Cox比例风险模型确定与复发相关的因素。
总体缓解率为63.9%，微腺瘤（58.7%）和大腺瘤（73.5%）之间无显著差异，这一发现在限于病理确诊腺瘤病例的敏感性分析中得到证实。多因素逻辑回归显示，缓解的预测因素是病理标本中存在腺瘤（OR = 31.25，P < 0.001）和首次手术状态（OR = 9.42，P = 0.002），而年龄较小是一个促成因素（OR = 0.963，P = 0.05）。在中位随访63 [IQR 35 - 109.5]个月期间，复发率为22.6%。糖皮质激素戒断综合征成为预防复发的一个新的保护因素（P = 0.045）。
这项对以色列CD患者TSS结果的最大规模分析挑战了关于缓解预测因素的既定观念，包括我们最初关于微腺瘤的假设。将糖皮质激素戒断综合征确定为长期缓解的预测因素为当地医疗环境中的术后监测提供了一条潜在途径。
