Outcomes after repeat transsphenoidal surgery for recurrent Cushing's disease. Comment.

This study, coming from one of the most renewed pituitary centers and from the most experienced “pituitary neurosurgeon,” reviews the outcomes of patients undergoing reoperation for recurrent CD. It is known that remission rates range from 64 to 93%, with the highest rates of 86 to 98% in patients with magnetic resonance imaging-defined noninvasive microadenomas treated with primary transsphenoidal tumor removal (1). On the other hand, repeat transsphenoidal surgery usually represents a challenging task in CD, especially if the surgical route is via a submucosal transseptal approach. Nevertheless, as demonstrated by this study, reoperation may help a relatively important percentage of patients and still cure them, especially if we consider that no definitive medical treatment exists for CD and the alternative to repeat surgery is radiotherapy and/or bilateral adrenalectomy. I agree with the authors when they state that in experienced hands reoperation does not yield a higher complication rate than that for the initial surgery. The surgeon, the endocrinologist, and the patient should all be aware of this fact before considering the alternative of radiotherapy, adrenalectomy, or both.