Clinical characteristics and surgical treatment of pituitary adrenocorticotropin-secreting macroadenomas: experience from a single-centre study

Cushing’s disease due to adrenocorticotropin (ACTH)-secreting macroadenomas is rare. The aim of this study was to evaluate the clinical characteristics and biochemical assessment of patients with corticotroph macroadenomas,and the early and late outcomes of transsphenoidal surgery as the first surgical approach during a long-term follow-up. We performed a retrospective review of 20 patients with Cushing’s disease due to macroadenomas and 126 patients with ACTH-secreting microadenomas. We found that macroadenomas patients presented with higher ACTH levels than those of microadenomas. The percentage of patients having >50% suppression (of ...?) was significantly different between the patients with macroadenoma and microadenomas. The mean of cortisol and ACTH levels evaluated at the first day after operation was significantly reduced. Immediate remission was achieved in 90 of 126 (71.4%) microadenoma patients, and delayed remisson (within a month after operation) was achieved in 109 of 126 (86.5%). UFC levels before operation was significantly higher in non-remission patients than that of remission group. For imaging, the tumour size was significantly larger in non-remission patients than in remission ones. In a word, patients with ACTH-secreting pituitary macroadenomas show higher baseline ACTH levels but increased glucocorticoid suppressibility compared with patients with microadenomas, Increased tumor size or UFC level are unfavorable factors to indicate remission after transsphenoidal surgery. Moreover, TSS plays an important role in achieving long-term remission not only for intrasellar microadenomas but also for extrasellar macroadenomas.