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Table 2 Outcome of five patients with persistent hypercortisolaemia after initial ETSS

From: Outcomes of endoscopic transsphenoidal surgery for Cushing's disease

  Pre-operative MRI D3 0800h serum cortisol (nmol/L)
1st ETSS
Subsequent management
1 Microadenoma 555 Second ETSS – in remission, D3 cortisol 41 nmol/L.
2 Microadenoma 306 Second ETSS – persistent mild hypercortisolemia, D3 cortisol 80 nmol/L.
3 Nil visible 386 Second ETSS – persistent disease, D3 cortisol 379 nmol/L.
Medical therapy with cabergoline and stereotactic radiosurgery.
4 Nil visible 779 Bilateral adrenalectomy
5 Macroadenoma with cavernous sinus invasion 497 Medical therapy with metyrapone.
Fractionated pituitary radiotherapy