Predictive Factors for Recurrence Following Endoscopic Treatment of Cushing's Disease
Bibliographic record
Abstract
Background: While the endoscopic transsphenoidal approach (ETA) has become routine for treating lesions arising from the pituitary gland, there remain relatively little data describing outcomes for this technique in managing Cushing’s disease (CD). The purpose of this study is to describe our institution’s experience and outcomes for endoscopic resection of ACTH-secreting tumors and identify predictors of recurrence. We also perform a literature review to correlate factors identified by other groups. Methods: The medical record, including biochemical data and imaging findings, was reviewed for patients who underwent ETA for Cushing’s disease. The English-language literature was reviewed for published series of CD patients treated with a pure endoscopic approach from which basic outcome data could be extracted. Results: During a nine-year interval, 39 patients were identified who underwent ETA for Cushing’s disease. Twenty-five (64.1%) were primary procedures, while the remainder had undergone prior surgery. An overall remission rate of 71% was achieved. No postoperative CSF leak or new anterior pituitary dysfunction was observed. MRI findings of either microadenoma or no detectable imaging abnormality, and involvement of the cavernous sinus, were associated with a higher recurrence rate ( p < 0.05) during a mean follow-up of 44.8 months. Other clinical and pathologic factors were not significantly predictive of recurrence. Fewer than 500 patients have been included in seven prior series of CD treated with a pure endoscopic approach. While some series have found that larger tumors are significantly associated with a higher remission rate, others have reported that microadenomas or equivocal/negative MRI are more likely to result in remission; others have not identified any predictive factors for disease remission. Conclusion: ETA is a safe and effective method for treating Cushing’s disease. However, the current literature remains unclear regarding factors that are associated with disease remission and recurrence. Due to the relative rarity of this condition, more data are needed with long-term follow-up from multiple centers to better elucidate its significant clinical factors.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".