This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: All India exam, Subject name: Surgery
The treatment of choice in Cushing's disease is 
Select and explain. 
A. Open adrenalectomy, B. Bilateral adrenalectomy, C. Medical management, D. Transsphenoidal excision of the pituitary adenoma
D: Transsphenoidal excision of the pituitary adenoma
Answer: D: Transsphenoidal excision of the pituitary adenoma 
Explanation: The treatment of choice in Cushing's disease is transsphenoidal excision of the pituitary adenoma, which is successful in 80% of patients. Pituitary irradiation has been used for patients with persistent or recurrent disease after surgery. However, it is associated with a high rate of panhypopituitarism, and some patients develop visual deficits. This has led to increased use of stereotactic radiosurgery, which uses CT guidance to deliver high doses of radiotherapy to the tumour (photon or gamma knife) and also bilateral laparoscopic adrenalectomy. Patients who fail to respond to either treatment are candidates for pharmacologic therapy with adrenal inhibitors (medical adrenalectomy) such as ketoconazole, metyrapone, or aminoglutethimide