Yedinak Chris, Hameed Nadia, Gassner Marika, Brzana Jessica, McCartney Shirley, Fleseriu Maria
Department of Neurological Surgery, and Northwest Pituitary Center, Oregon Health & Science University, CH8N, 3303 SW Bond Ave, Portland, OR, 97239, USA.
Pituitary. 2015 Oct;18(5):701-9. doi: 10.1007/s11102-015-0643-8.
To compare hypothalamus-pituitary-adrenal (HPA) axis integrity at diagnosis and recovery after transsphenoidal surgery (TSS), in acromegaly patients, compared with tumor size matched non-functioning adenoma (NFA) patients.
A retrospective 7-year evaluation of acromegaly patients, who underwent TSS with 52 weeks follow-up at a single institution, was undertaken. 50 acromegaly with complete follow-up data at all points and 50 NFA patients were matched for tumor size; HPA axis was similarly assessed pre-operatively and at 6, 12 and 52 weeks post-operatively. Recovery of HPA axis and gender specific prevalence of adrenal insufficiency (AI), were analyzed in both groups. We also studied AI in acromegaly patients requiring medical therapy post-operatively vs those in remission after surgery.
AI remained less prevalent in acromegaly vs NFA (acromegaly, p = 0.01; NFA, p = 0.15) at 52 weeks after surgery, although the prevalence of AI decreased in both groups from baseline by 52 weeks. Additionally, recovery from baseline AI was significantly greater by 52 weeks in acromegaly patients over NFA patients (p = 0.001). Recovery of HPA axis in acromegaly patients remained significant (p = 0.03) despite the need for medical therapy. AI at baseline was proportionately more prevalent in acromegalic males at baseline (p = 0.002) but no gender difference was apparent at 52 weeks (p = 0.35). Conversely, in NFA patients, no gender difference was apparent pre-operatively (p = 0.49), but AI was more prevalent in males at 52 weeks (p = 0.001).
In the longest comparative study to date using a standard assessment modality, HPA axis recovery was more frequent in acromegaly compared to NFA patients, independent of tumor size, cavernous sinus invasion (CSI), and body mass index (BMI). HPA axis integrity must be carefully and periodically monitored in acromegaly patients during short- and long-term follow-up to prevent overtreatment with glucocorticoids.
比较肢端肥大症患者经蝶窦手术（TSS）诊断时和恢复后的下丘脑 - 垂体 - 肾上腺（HPA）轴完整性，并与肿瘤大小匹配的无功能腺瘤（NFA）患者进行对比。
对在单一机构接受TSS并进行了52周随访的肢端肥大症患者进行了为期7年的回顾性评估。50例有完整各阶段随访数据的肢端肥大症患者和50例NFA患者按肿瘤大小进行匹配；术前以及术后6周、12周和52周对HPA轴进行类似评估。分析两组中HPA轴的恢复情况以及肾上腺功能不全（AI）的性别特异性患病率。我们还研究了术后需要药物治疗的肢端肥大症患者与术后缓解患者中的AI情况。
术后52周时，肢端肥大症患者中AI的患病率仍低于NFA患者（肢端肥大症，p = 0.01；NFA，p = 0.15），尽管两组中AI的患病率从基线到52周均有所下降。此外，与NFA患者相比，肢端肥大症患者在52周时从基线AI恢复的程度明显更大（p = 0.001）。尽管需要药物治疗，但肢端肥大症患者的HPA轴恢复仍很显著（p = 0.03）。基线时，肢端肥大症男性中AI的比例更高（p = 0.002），但在52周时无明显性别差异（p = 0.35）。相反，在NFA患者中，术前无明显性别差异（p = 0.49），但在52周时男性中AI更常见（p = 0.001）。
在迄今为止使用标准评估方式进行的最长对比研究中，与NFA患者相比，肢端肥大症患者中HPA轴恢复更为常见，与肿瘤大小、海绵窦侵袭（CSI）和体重指数（BMI）无关。在肢端肥大症患者的短期和长期随访期间，必须仔细且定期监测HPA轴完整性，以防止糖皮质激素过度治疗。
