MRI-Negative Cushing's Disease: A Review on Therapeutic Management

Mohammadmahdi Sabahi; Taha Shahbazi; Seyed Farzad Maroufi; Kevin Vidal; Pablo F Recinos; Varun R Kshettry; Florian Roser; Badih Adada; Hamid Borghei-Razavi

doi:10.1016/j.wneu.2022.03.076

MRI-Negative Cushing's Disease: A Review on Therapeutic Management

World Neurosurg. 2022 Jun:162:126-137.e1. doi: 10.1016/j.wneu.2022.03.076. Epub 2022 Mar 22.

Authors

Mohammadmahdi Sabahi¹, Taha Shahbazi¹, Seyed Farzad Maroufi², Kevin Vidal³, Pablo F Recinos⁴, Varun R Kshettry⁴, Florian Roser⁵, Badih Adada³, Hamid Borghei-Razavi⁶

Affiliations

¹ Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
² Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
³ Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, Florida, USA.
⁴ Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA.
⁵ Department of Neurosurgery, Cleveland Clinic, Abu Dhabi, UAE.
⁶ Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, Florida, USA. Electronic address: borgheh2@ccf.org.

PMID: 35338018
DOI: 10.1016/j.wneu.2022.03.076

Abstract

Objectives: In this systematic review and meta-analysis, we review the literature regarding patients with Cushing's disease (CD) with negative or inconclusive magnetic resonance imaging (MRI).

Methods: A quantitative systematic review was performed. Article selection was performed by searching MEDLINE (using PubMed), EMBASE, and Cochrane electronic bibliographic databases.

Results: 28 articles described surgical management of inconclusive MRI or MRI-negative CD. A total of 858 patients underwent surgery for their Cushing adenoma. Different types of surgery, including endoscopic endonasal transsphenoidal surgery (EETS) (190 cases) and microscopic endonasal transsphenoidal surgery (METS) (488 cases), were performed on patients with MRI-negative CD. 7 studies, which included 164 patients, did not describe any surgery. EETS and METS are conducted to achieve selective adenomectomy (231 cases), partial adenomectomy (80 cases), total adenomectomy (13 cases), hemihypophysectomy (15 cases), or enlarged adenomectomy (48 cases). Based on available data on these studies, the remission rate, persistence rate, and recurrence rate after different types of surgeries on patients with MRI-negative CD were 72.97%, 27.03%, and 12.05%, respectively. There was no statistically significant difference between EETS and METS in the subanalysis regarding recurrence rate, remission rate, and persistence rate. However, the recurrence rate in the METS group is almost 3 times higher than in the EETS group.

Conclusions: Surgery has a good prognosis in patients with MRI-negative CD in terms of remission, and EETS has a lower rate of disease recurrence than METS; therefore, EETS seems to be the potential recommended treatment technique, while to confirm the therapeutic method of choice, further investigations should be done.

Keywords: Endocrine surgical procedures; Magnetic resonance imaging; Meta-analysis; Pituitary ACTH hypersecretion; Systematic review.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Adenoma* / diagnostic imaging
Adenoma* / surgery
Humans
Magnetic Resonance Imaging
Neoplasm Recurrence, Local
Pituitary ACTH Hypersecretion* / diagnostic imaging
Pituitary ACTH Hypersecretion* / surgery
Pituitary Neoplasms* / surgery
Retrospective Studies
Treatment Outcome