Czirják S, Bezzegh A, Gál A, Rácz K
National Institute of Neurosurgery, Budapest, Hungary.
Acta Neurochir (Wien). 2002 Oct;144(10):971-7; discussion 977. doi: 10.1007/s00701-002-0984-8.
The optimal treatment of choice for ACTH-producing pituitary adenomas is their complete removal by the transsphenoidal surgical approach. ACTH-producing pituitary adrenomas are, however, often small in size not detectable with neuro-imaging techniques, which may result in difficulties during their surgical removal. With the advent of rapid methods for plasma ACTH measurement, a few neurosurgical centers introduced intra-operative plasma ACTH determinations in peripheral and central blood samples to help improve the outcome of pituitary surgery in patients with Cushing's disease.
To evaluate the usefulness of this new method, we performed, under standardized conditions, intra-operative plasma ACTH measurements with a rapid immunochemiluminometric method at different stages of transsphenoidal pituitary surgery in 7 patients with Cushing's disease.
We found that from the beginning of anesthesia until the end of operation, ACTH concentrations in venous plasma were highly variable by both the rapid and the standard methods. In most cases the changes in venous plasma ACTH concentrations that occurred until the end of surgery failed to indicate the removal of the ACTH-producing pituitary adenoma. However, a more than 50% decrease of venous plasma ACTH concentrations by the rapid assay was observed 2 h after completion of the operation in all but one of the patients. As evidenced by a long-term hormonal and clinical remission, these changes in plasma ACTH levels in all patients were accompanied by a complete removal of the ACTH-producing pituitary adenoma.
These findings indicate a slow disappearance of ACTH from the circulation after a successful pituitary surgery in patients with Cushing's disease.
分泌促肾上腺皮质激素（ACTH）的垂体腺瘤的最佳治疗选择是经蝶窦手术完全切除。然而，分泌ACTH的垂体腺瘤通常体积较小，神经影像学技术无法检测到，这可能导致手术切除困难。随着血浆ACTH快速检测方法的出现，一些神经外科中心引入了术中测定外周血和中心血样本中血浆ACTH的方法，以帮助改善库欣病患者垂体手术的效果。
为了评估这种新方法的有效性，我们在标准化条件下，对7例库欣病患者在经蝶窦垂体手术的不同阶段，采用快速免疫化学发光法进行术中血浆ACTH测定。
我们发现，从麻醉开始到手术结束，无论是快速检测方法还是标准检测方法，静脉血浆中的ACTH浓度都有很大变化。在大多数情况下，直到手术结束时静脉血浆ACTH浓度的变化未能表明分泌ACTH的垂体腺瘤已被切除。然而，除1例患者外，所有患者在手术结束2小时后，通过快速检测法观察到静脉血浆ACTH浓度下降超过50%。从长期的激素和临床缓解情况可以证明，所有患者血浆ACTH水平的这些变化都伴随着分泌ACTH的垂体腺瘤被完全切除。
这些发现表明，库欣病患者垂体手术成功后，循环中的ACTH会缓慢消失。
