CLINICAL STUDY Factors influencing cure by transsphenoidal selective adenomectomy in paediatric Cushing’s disease

Objective: Early diagnosis and effective treatment of paediatric Cushing’s disease (CD) is necessary to minimise associated morbidity. Accepted first-line treatment is selective transsphenoidal microadeno-mectomy (TSS), which can be technically difficult, and cure rates vary considerably between centres. In our paediatric CD patient group we have assessed the possible factors which may influence cure by TSS. Subjects and methods: From 1983–2004, 27 paediatric patients (16 males, 11 females; mean age^S.D., 13.1^3.2 yr; range, 6.4–17.8 yr) with CD were managed in our centre and underwent TSS. Sixteen patients (59%), seven males and nine females (mean age^S.D., 14.2^2.5 yr; range, 8.2 –17.8 yr), were cured (post-operative serum cortisol,50 nM). Eleven patients, nine males and two females (mean age^S.D., 11.5^3.6 yr; range, 6.4–17.8 yr) had post-operative cortisol levels above 50 nM (2–20 days), with mean serum cortisol levels at 09:00 h of 537 nM (range 269–900 nM) indicating a lack of cure. These 11 patients received external beam pituitary radio-therapy (RT). One patient with a pituitary macroadenoma had a post-operative cortisol level of,50 nM but 0.8 yr later showed an elevated cortisol and residual disease. Results: The patients cured by TSS alone were significantly older than those not cured (P 0.038