Pituitary surgery and postoperative management in Cushing's disease

Transsphenoidal pituitary surgery is the therapy for most Cushing's disease patients. This article describes the surgical technique, efficacy, perioperative management, and complications associated with this procedure. Numerous biochemical tests of cortisol status have been studied for the evaluation of the postoperative patient. Factors that predict postoperative remission and future relapse of Cushing's disease are addressed. Secondary interventions for persistent or recurrent disease include repeat transsphenoidal resection, pituitary radiation, medical therapy, and bilateral adrenalectomy.