Factors influencing the immediate and late outcome of XXXX treated by transsphenoidal surgery: a retrospective study by the European @entity699 Survey Group.

@entity1 @entity5 @entity699 @entity509 @entity134 @entity977 @entity701 @entity6192
@entity699 attributable to hypersecretion of ACTH by a @entity977 is an uncommon and progressively lethal disease. Because of its rarity, it has been difficult to collect a large series of @entity1 in order to identify the prognostic factors influencing the outcome after transsphenoidal surgery. We conducted a multicenter, retrospective analysis of the early and late results of surgical treatment of @entity699 . Files of @entity1 with @entity699 who underwent transsphenoidal surgery between 1975 and 1990 were collected from 25 institutions throughout Europe. Data from 668 of 716 @entity1 were suitable for statistical analyses. Surgical mortality was 1.9%, and major morbidity occurred in 97 @entity1 (14.5%). Clinical and biochemical remission of @entity699 after surgery occurred in 510 cases (76.3%). Identification of the @entity5 by neuroradiological imaging or at operation with histopathological corroboration was associated with remission of @entity699 . Recurrence of the disease occurred in 65 (12.7%) of 510 @entity1 in remission after surgery at a mean time of 39.3 months (range 6-104 months). The distribution of the recurrences did not show any apparent plateau or cluster throughout the follow-up period. Low postoperative @entity134 levels, absence of @entity701 response to @entity6192 , and the need for long-term glucocorticoid substitution therapy were all associated with a high probability of long-term remission. Our study demonstrates that transsphenoidal surgery is a safe and effective treatment for @entity1 with @entity699 . However, after successful surgery there is a steady increase in the percentage of recurrences, which continues with time. @entity1 who after operation had @entity509 and needed long-term glucocorticoid substitution therapy had the lowest risk of relapse.
