Sinonasal Outcomes after Pituitary Surgery in Patient's with Cushing's Disease

Background: Endoscopic endonasal skull base surgery is a common treatment intervention for pituitary tumors, with minimal sinonasal morbidity after the initial postoperative healing period. However, patients with Cushing’s disease may represent a subgroup of these patients who may demonstrate poor healing due to their endocrinopathy.

Objectives: The aim of the study is to investigate if patients with Cushing’s disease have worse sinonasal outcomes after endoscopic endonasal skull base surgery compared with patients without Cushing’s disease.

Methods: We identified patients with Cushing’s disease who had undergone endonasal endoscopic skull base surgery at our institution between December 1, 2016 and April 31, 2019. Case-controls patients with pituitary tumors were matched by age, gender, and the extent of endoscopic approach. Patients with prior surgical or radiation treatment were excluded, as were patients with chronic rhinosinusitis. A retrospective chart review was conducted for all included patients. The primary outcome was the 22-item Sino-Nasal Outcome Test (SNOT-22) scores collected at 1, 3, and 6 months postoperatively. Statistical analysis of data was performed using a two-tailed t-tests. p-Values less than 0.05 were considered significant.

Results: Ten patients with Cushing’s disease met the selection criteria and were included in the study. Seventeen case controls were selected for comparison. Comparing patients with Cushing’s to the controls, there was no difference in postoperative SNOT-22 score at 1 month (30.8 ± 28.5 vs. 25.9 ± 18, p = 0.71) and at 3 months (26.4 ± 24.6 vs. 17.7 ± 12.9, p = 0.21). However, at 6-months postoperatively, SNOT-22 scores were significantly higher in patients with Cushing’s disease (28.8 ± 23.2 vs. 3.0 ± 2.2, p = 0.04). [Fig. 1] shows SNOT-22 scores over time. While SNOT-22 scores improved from 1 month to 6-months postoperatively in patient’s without Cushing’s (p < 0.01), in patients with Cushing’s disease scores were not significantly different at 1 and 6 months postoperatively (p = 0.71).

Fig. 1 SNOT-22 scores of patients with Cushing’s disease.

Conclusion: Patients with and without Cushing’s disease have similar initial postoperative SNOT-22 scores after endoscopic endonasal skull base surgery. Control patients show a return to baseline SNOT-22 scores after 6 months while in patients with Cushing’s disease, these scores remain fairly stagnant and do not improve over time. This suggests that the endocrinopathies associated with Cushing’s disease impair postoperative wound healing with resulting sinonasal morbidities.