The surgical management of Cushing disease: a case series from a Canadian tertiary center
Bibliographic record
Abstract
OBJECTIVE: To evaluate remission, recurrence, and complication rates following endoscopic transsphenoidal surgery (ETSS) for Cushing disease (CD) at a Canadian tertiary center, and assess concordance of preoperative cerebral MRI and inferior petrosal sinus sampling (IPSS) with intraoperative adenoma laterality. METHODS: We retrospectively reviewed 92 patients with confirmed CD who underwent ETSS by a single neurosurgeon between August 2007 and May 2025. Outcomes included biochemical remission, recurrence, and complications. We assessed the concordance of preoperative MRI and IPSS with intraoperative tumor localization. RESULTS: The cohort included 92 patients (mean age 46.6 ± 15.0 years; 77% female) with a median follow-up of 18.3 months (IQR 6.4-44.9). Preoperative MRI identified a microadenoma in 63 cases, macroadenoma in 17, and was negative in 12. Remission was achieved in 76.7% (86.4% early ≤6 months), with 7.9% experiencing recurrence after a median of 13.2 months. Complications included arginine vasopressin deficiency (AVPD) in 43.5% of the cohort (persistent >6 months in 10.2%), hypothyroidism in 14.1%, syndrome of inappropriate antidiuretic hormone secretion (SIADH) in 5.4%, and cerebrospinal fluid (CSF) leak in 3.3%. Intraoperatively, 78.8% of microadenomas were in the posterior adenohypophysis, and 27.4% exhibited multifocal distribution. Concordance of adenoma laterality was 56.5% for MRI and 41.7% for IPSS, with no statistically significant difference. CONCLUSION: ETSS achieved high remission with low morbidity in CD. Frequent posterior and multifocal adenomas in the adenohypophysis support systematic pituitary exploration. Localization remains challenging, with limited concordance using MRI and IPSS, highlighting the need for cautious interpretation in surgical planning.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 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".