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Transsphenoidal adenomectomy is the treatment of choice for ACTH-secreting adenomas, but pharmacological therapy may be used for several weeks prior to surgery to control significant manifestations of hypercortisolism (such as diabetes, hypertension, and psychiatric disturbances).
Ketoconazole, an antifungal agent that blocks adrenal steroid synthesis, is the initial drug used to treat ACTH-secreting adenomas. Over 75% of patients achieve normal levels of urinary free cortisol and 17-hydroxycorticosteroid while on ketoconazole (Greenberg, 2001).
The majority of patients with Cushing syndrome have ACTH-secreting adenomas in the pituitary, which can be treated by hemi-resection of the involved part of the pituitary or by enucleation of the adenoma.
The vascular architecture parameters in different histotypes of adenomas are shown in Table 3 and ACTH-secreting adenomas than nonfunctioning adenomas, although the differences were not significant.
Significance of Vessel Architecture in ACTH-Secreting Adenomas. There are few studies concerning ACTH-secreting adenomas, vascularity, and/or vascular architecture.