Department of Neurosurgery, Keck School of Medicine of USC, 1200 North State Street, Suite 3300, Los Angeles, CA 90089, USA.
Int J Endocrinol. 2013;2013:893781. doi: 10.1155/2013/893781. Epub 2013 Jan 15.
Cushing's Disease is caused by oversecretion of ACTH from a pituitary adenoma and results in subsequent elevations of systemic cortisol, ultimately contributing to reduced patient survival. The diagnosis of Cushing's Disease frequently involves a stepwise approach including clinical, laboratory, neuroimaging, and sometimes interventional radiology techniques, often mandating multidisciplinary collaboration from numerous specialty practitioners. Pituitary microadenomas that do not appear on designated pituitary MRI or dynamic contrast protocols may pose a particularly challenging subset of this disease. The treatment of Cushing's Disease typically involves transsphenoidal surgical resection of the pituitary adenoma as a first-line option, yet may require the addition of adjunctive measures such as stereotactic radiosurgery or medical management to achieve normalization of serum cortisol levels. Vigilant long-term serial endocrine monitoring of patients is imperative in order to detect any recurrence that may occur, even years following initial remission. In this paper, a stepwise approach to the diagnosis, and various management strategies and associated outcomes in patients with Cushing's Disease are discussed.
库欣病是由垂体腺瘤过度分泌 ACTH 引起的，导致全身皮质醇水平升高，最终导致患者生存率降低。库欣病的诊断通常涉及一个逐步的方法，包括临床、实验室、神经影像学，有时还包括介入放射学技术，通常需要来自多个专业医生的多学科合作。在指定的垂体 MRI 或动态对比方案上不显示的垂体微腺瘤可能是这种疾病的一个特别具有挑战性的亚组。库欣病的治疗通常包括经蝶窦手术切除垂体腺瘤作为一线选择，但可能需要添加辅助措施，如立体定向放射外科或药物治疗，以实现血清皮质醇水平的正常化。为了检测可能发生的任何复发，即使在最初缓解多年后，对患者进行警惕的长期内分泌监测也是至关重要的。本文讨论了库欣病患者的诊断、各种治疗策略和相关结局的逐步方法。
