Prevalence of Signs and Symptoms of Pseudotumor Cerebri Syndrome Before and After Transsphenoidal Surgery for Cushing’s Disease – A Prospective Consecutive Case Series

Abstract

Introduction Pseudotumor cerebri syndrome (PTCS) has anecdotally been described after successful treatment of Cushing’s disease (CD), but the prevalence following transsphenoidal surgery has not been determined so far in a prospective study. Patients and Methods 41 consecutive adult CD patients were prospectively screened for signs and symptoms of PTCS, headache-related impairment, and ophthalmological features associated with intracranial pressure elevation before surgery and at follow-up (mean 4 months). Results Biochemical remission was achieved in 36 of 41 (87.8%) patients after surgery. The most frequent preoperative complaints were visual acuity impairment (19 cases; 46.3%), headache (13 cases; 31.7%), and ear noise (9 cases; 22.0%). A significant reduction of visual disturbances was seen at follow-up. Overall, CD patients presented with fairly low headache-related emotional and functional restrictions before and after surgery. One of 34 (2.9%) patients with sufficient ophthalmological follow-up showed new-onset papilledema combined with temporary worsening of visual acuity and scotoma. Conclusion Our results suggest a very low frequency of signs and symptoms of PTCS after surgical treatment for CD in adults. This estimate is in line with previous outcomes from retrospective pediatric CD series. Further large-scale studies are needed to determine the actual prevalence of this condition following biochemical remission of CD.

Comparing Quality of Life Before and After Surgery in Patients with Cushing Disease: A Before-After Study

“…Also, there was no association between QoL and the patient's sex, age, replacement steroid use, follow-up with an endocrinologist, or surgical approach. Although returning to normal life after surgery and medication is very important for patients with Cushing disease [8,9], few studies have been performed on the epidemiology of the disease and the quality of life of patients in Iran [7,10]. We compared QoL scores before, 6, and 12 months after surgery in the CD patients and determined predictor factors for QoL score improvement in patients.…”