Sasaki M, Umeda T, Iwaoka T, Inoue J, Sato T
Third Department of Internal Medicine, Kumamoto University Medical School, Japan.
Endocrinol Jpn. 1990 Aug;37(4):591-7. doi: 10.1507/endocrj1954.37.591.
The effectiveness of treatment with reserpine and pituitary irradiation, and with reserpine alone was evaluated in three female patients with Cushing's disease whose transsphenoidal pituitary microsurgery (TPM) had been unsuccessful. In these patients, endocrinological examination after the surgery demonstrated a recurrence of the disease although the microadenomas had apparently been curetted out from the pituitary in all patients. The first patient therefore received 1.0-2.0 mg/day of reserpine with 60 Gy x-ray irradiation, and there was complete remission within 3 months and the patient remained asymptomatic even when reserpine was reduced to 0.1 mg/day 10 years later. The second case was treated with low dose x-ray (20 Gy) and reserpine (0.5-2.0 mg/day), which were also effective. However, 2 weeks discontinuation of the drug caused urinary 17-hydroxycorticosteroids (17-OHCS) and serum cortisol to increase abnormally again, but these were finally re-normalized by an additional administration of reserpine. The third case was given reserpine alone (1.0-2.0 mg/day). She also had a remission in 3 months and the treatment was continued for one year, requiring no further treatment. These results suggest that additional treatment with reserpine and pituitary irradiation or with reserpine alone after unsuccessful TPM may be an effective alternative for patients with Cushing's disease.
对三名库欣病女性患者进行了评估，她们经蝶窦垂体显微手术（TPM）均未成功，分别接受了利血平和垂体照射联合治疗以及单独使用利血平治疗。在这些患者中，手术后的内分泌检查显示疾病复发，尽管所有患者垂体中的微腺瘤显然已被刮除。第一名患者因此接受了每天1.0 - 2.0毫克的利血平，并进行了60 Gy的x光照射，3个月内完全缓解，即使10年后利血平减至每天0.1毫克，患者仍无症状。第二例患者接受了低剂量x光（20 Gy）和利血平（每天0.5 - 2.0毫克）治疗，也有效果。然而，停药2周导致尿17 - 羟皮质类固醇（17 - OHCS）和血清皮质醇再次异常升高，但通过再次给予利血平最终恢复正常。第三例患者仅接受利血平治疗（每天1.0 - 2.0毫克）。她也在3个月内缓解，治疗持续了一年，无需进一步治疗。这些结果表明，TPM失败后，加用利血平和垂体照射或单独使用利血平可能是库欣病患者的一种有效替代治疗方法。
