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This article, published in the Journal of Neurological Surgery, examines the impact of frailty on surgical outcomes in patients with Cushing's disease (CD). The study analyzed data from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) and found that mild frailty independently predicted outcomes after transsphenoidal surgery for CD. Mildly frail patients had longer hospital stays and were more likely to be discharged to skilled nursing facilities. The study suggests that assessing frailty could be useful for preoperative risk stratification and prognostication in CD patients. [Extracted from the article]

This article discusses the establishment of a national pituitary surgical research platform called RAPID, which aims to improve patient care and surgical outcomes for pituitary disorders. The initial focus of the collaboration is on Cushing's disease. The study provides an overview of the patient cohort, surgical outcomes, and lays the foundation for future research. The data collected from nine academic pituitary centers shows that 528 patients with Cushing's disease were treated by 26 neurosurgeons from 2003 to 2023. The report highlights insights into surgical outcomes and disease recurrence rates across different surgeons and environments. The collaboration is expected to advance the standard of care for patients with pituitary disorders. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, examines the outcomes of patients with Crooke cell adenomas (CCA) compared to those with corticotroph adenomas (sCTA), both of which are types of pituitary corticotroph adenomas found in patients with Cushing's disease. The study, which included 2,826 patients from 12 international centers, found that CCA patients had poorer endocrinologic outcomes compared to sCTA patients, despite having better local control rates and fewer residual tumors. The authors suggest that further research is needed to better understand CCA and develop more targeted treatment approaches. [Extracted from the article]

This article discusses the issue of unplanned hospital readmissions following trans-sphenoidal surgery for Cushing's disease. The study analyzed data from a multi-institutional database of patients who underwent this surgery between 2003 and 2023. The results showed that 10.3% of patients experienced unplanned readmissions, with the most common reasons being hyponatremia, CSF leak evaluation, headache/nausea, and epistaxis. The study also found that an increased number of chronic medical conditions and the need for a return to surgery were associated with a higher chance of unplanned readmission. The authors suggest strategies to mitigate these readmissions, such as fluid restriction and optimizing chronic medical conditions. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the factors that contribute to the recurrence of Cushing's disease (CD) after transsphenoidal surgery. The study analyzed data from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) database, which included 383 CD patients. The results showed that patients who experienced recurrence had a longer postoperative hospital stay, larger tumor volumes, and a higher rate of failed prior treatment. Younger age and the absence of cavernous sinus invasion were identified as potential protective factors against recurrence. The findings suggest that early detection and treatment of tumors may improve outcomes for CD patients. [Extracted from the article]

Crooke cell adenomas (CCAs) are a rare, aggressive subset of secretory pituitary corticotroph adenomas (sCTAs) found in 5%–10% of patients with Cushing disease. Multiple studies support worse outcomes in CCAs but are limited by small sample size and single-institution databases. We compared outcomes in CCA and sCTA using a multicenter, international retrospective database of high-volume skull base centers. Patients surgically treated for pituitary adenoma from January 2017 through December 2020 were included. Among 2826 patients from 12 international centers, 20 patients with CCA and 480 patients with sCTA were identified. No difference in baseline demographics, tumor characteristics, or postoperative complications was seen. Microsurgical approaches (60% CCA vs. 62.3% sCTA) were most common. Gross total resection was higher in CCA patients (100% vs. 83%, P = 0.05). Among patients with gross total resection according to intraoperative findings, fewer CCA patients had postoperative hormone normalization of pituitary function (50% vs. 77.8%, P < 0.01) and remission of hypersecretion by 3–6 months (75% vs. 84.3%, P < 0.01). This was the case despite CCA having better local control rates (100% vs. 96%, P < 0.01) and fewer patients with remnant on magnetic resonance imaging (0% vs. 7.2%, P < 0.01). A systematic literature review of 35 studies reporting on various treatment strategies reiterated the high rate of residual tumor, persistent hypercortisolism, and tumor-related mortality in CCA patients. This modern, multicenter series of patients with CCA reflects their poor prognosis and reduced postsurgical hormonal normalization. Further work is necessary to better understand the pathophysiology of CCA to devise more targeted treatment approaches. [ABSTRACT FROM AUTHOR]