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Table 3 short- and long-term morbidity

From: Microscopic versus endoscopic transsphenoidal surgery in the Leiden cohort treated for Cushing’s disease: surgical outcome, mortality, and complications

  Hazard ratio (95% CI; p-value)#, unadjusted Hazard ratio (95% CI; p-value)#, adjusted for age at diagnosis and tumor size (microadenoma or macroadenoma)
Surgical outcome
-Persistent disease 0.82 (0.34 to 2.01; p = 0.663) 0.88 (0.35 to 2.21; p = 0.789)
-Recurrent disease 0.47 (0.19 to 1.14; p = 0.093) 0.40 (0.16 to 1.01; p = 0.052)
-Hydrocortisone dependency
- Absolute deficiency
- Normal cortisol response*
- Pragmatic replacement $
1.11 (0.73 to 1.68; p = 0.625)
1.06 (0.69 to 1.62; p = 0.793)
1.04 (0.68 to 1.60; p = 0.845)
0.97 (0.63 to 1.50; p = 0.888)
-Repeat surgery
-Remission after first repeat surgery
0.30 (0.13 to 0.70; p = 0.005)
0.21 (0.04 to 1.13; p = 0.069)
0.27 (0.11 to 0.64; p = 0.003)
0.17 (0.02 to 1.16; p = 0.070)
Short term morbidity: ≤3 month after first surgery
-Cerebrospinal fluid leakage ° °
-Meningitis ° °
-Bleeding, all 0.56 (0.22 to 1.41; p = 0.221) 0.56 (0.22 to 1.44; p = 0.227)
-Bleeding, severe ° °
-Syndrome of inappropriate antidiuretic hormone release 0.32 (0.09 to 1.09; p = 0.069) 0.29 (0.08 to 1.02; p = 0.054)a
-Diabetes insipidus 1.04 (0.54 to 1.99; p = 0.904) 0.96 (0.49 to 1.86; p = 0.901)
-Anterior pituitary deficiency
- one axis
- two axes
- three axes
0.76 (0.37 to 1.54; p = 0.444)
0.85 (0.37 to 1.96; p = 0.704)
0.41 (0.09 to 1.83; p = 0.243)
1.06 (0.51 to 2.22; p = 0.870)
1.18 (0.50 to 2.79; p = 0.708)
0.52 (0.11 to 2.45; p = 0.409)
-Corticosteroid withdrawal syndrome 0.39 (0.21 to 0.72; p = 0.003) 0.38 (0.20 to 0.72; p = 0.003)
-Cardiovascular morbidity ° °
Long term morbidity: > 3 months after first surgery
-Anterior pituitary deficiency after 1 year
- one axis
- two axes
- three axes
0.79 (0.42 to 1.52; p = 0.488)
0.83 (0.38 to 1.83; p = 0.642)
0.65 (0.17 to 2.41; p = 0.517)
1.03 (0.52 to 2.01; p = 0.056)
1.10 (0.48 to 2.48; p = 0.827)
0.74 (0.19 to 2.89; p = 0.663)
-Hydrocortisone dependency > 3 years 1.05 (0.56 to 1.96; p = 0.878) 1.11 (0.59 to 2.10; p = 0.742)
-Diabetes insipidus > 3 months 1.71 (0.68 to 4.29; p = 0.251) 1.84 (0.72 to 4.69; p = 0.204)
-Cardiovascular morbidity 0.37 (0.12 to 1.16; p = 0.088) 0.43 (0.13 to 1.38; p = 0.155)
-Hypertension 0.85 (0.51 to 1.41; p = 0.529) 0.92 (0.53 to 1.58; p = 0.749)
-Diabetes mellitus 0.53 (0.22 to 1.29; p = 0.160) 0.56 (0.23 to 1.36; p = 0.198)
-Neuropsychiatric morbidity 0.14 (0.03 to 0.68; p = 0.015) 0.15 (0.03 to 0.76; p = 0.022)
  1. CI = confidence interval
  2. #Reference group for hazard ratios was endoscopic surgery
  3. aAdjusted for age at diagnosis only
  4. *Hydrocortisone for symptoms despite normal cortisol response to CRH stimulation. °Insufficient data for analysis
  5. $Pragmatic hydrocortisone replacement (without stimulation test)