The role of neurosurgical treatment in prediction of the recurrence of Cushing disease

Cushing's disease (CD) is a rare disease with a clinical picture of hypercortisolism, caused by the presence of pituitary tumor and characterized by hypersecretion of adrenocorticotropic hormone (ACTH) and an increase in cortisol production by the adrenal gland. Surgical treatment is the first line of therapy. Preoperative identification is required to achieve complete tumor resection and to achieve clinical remission. The volume and type of surgical intervention depends on the characteristics of the tumor.The results of the operation are assessed by radicality, postoperative complications and biochemical parameters. But one third of patients does not achieve remission after surgery. The reason for the lack of effect after surgery may be anatomical and morphological features of the tumor, and the experience of the surgeon and the surgical technique used. Knowledge of the features of surgical tactics and the intraoperative picture makes it possible to assess the prognosis of the risk of recurrence. Assessment of radicality can be carried out both immediately after the operation and in the delayed period.Calculation of the risk of recurrence of the СD at the preoperative and postoperative periods allows you to optimize and personalize the algorithm for monitoring and early diagnosis of CD recurrence and for the next stage of treatment.