Chandler William F, Barkan Ariel L, Hollon Todd, Sakharova Alla, Sack Jayson, Brahma Barunashish, Schteingart David E
*Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; ‡Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan; §Michigan Endocrine Consultants, Berkley, Michigan; ¶Department of Neurosurgery, University of San Diego Health System, San Diego, California; ‖Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta, Atlanta, Georgia.
Neurosurgery. 2016 Feb;78(2):216-23. doi: 10.1227/NEU.0000000000001011.
Transsphenoidal surgery is the standard approach for treating Cushing disease. Evidence is needed to document effectiveness.
To analyze results of transsphenoidal surgery in 276 consecutive patients, including 19 children.
Medical records were reviewed for patients treated initially with surgery for Cushing disease from 1980 to 2012. Radiographic features, pathology, remissions, recurrences, and complications were recorded. Patients were categorized for statistical analysis based on tumor size (microadenomas, macroadenomas, and negative imaging) and remission type (type 1 = morning cortisol ≤3 μg/dL; type 2 = morning cortisol normal).
Females comprised 78% of patients and were older than men. Imaging showed 50% microadenomas, 13% macroadenomas, and 37% negative for tumor. Remission rates for microadenomas, macroadenomas, and negative imaging were 89%, 66%, and 71%, respectively. Patients with microadenomas were more likely to have type 1 remission. Pathology showed adrenocorticotropic hormone-secreting adenomas in 82% of microadenomas, in 100% of macroadenomas, and in 43% of negative imaging. The incidence of hyperplasia was 8%. The finding of hyperplasia or no tumor on pathology predicted treatment failure. The recurrence rate was 17%, with an average time to recurrence of 4.0 years. Patients with type 1 remission had a lower rate of recurrence (13% type 1 vs 50% type 2) and a longer time to recurrence. Children had similar imaging findings, remission rates, and pathology. There were no operative deaths.
Transsphenoidal surgery provides a safe and effective treatment for Cushing disease. For both adults and children, the best outcomes occurred in patients with microadenomas and/or those with type 1 remission.
经蝶窦手术是治疗库欣病的标准方法。需要证据来证明其有效性。
分析276例连续患者（包括19名儿童）经蝶窦手术的结果。
回顾1980年至2012年最初接受库欣病手术治疗患者的病历。记录影像学特征、病理、缓解情况、复发情况及并发症。根据肿瘤大小（微腺瘤、大腺瘤和影像学阴性）和缓解类型（1型 = 晨皮质醇≤3μg/dL；2型 = 晨皮质醇正常）对患者进行分类以进行统计分析。
女性占患者的78%，且年龄大于男性。影像学显示50%为微腺瘤，13%为大腺瘤，37%未发现肿瘤。微腺瘤、大腺瘤和影像学阴性患者的缓解率分别为89%、66%和71%。微腺瘤患者更易出现1型缓解。病理显示82%的微腺瘤、100%的大腺瘤和43%的影像学阴性患者为促肾上腺皮质激素分泌腺瘤。增生发生率为8%。病理发现增生或无肿瘤预示治疗失败。复发率为17%，平均复发时间为4.0年。1型缓解患者的复发率较低（1型为13%，2型为50%），复发时间较长。儿童的影像学表现、缓解率和病理情况相似。无手术死亡病例。
经蝶窦手术为库欣病提供了一种安全有效的治疗方法。对于成人和儿童，微腺瘤患者和/或1型缓解患者的治疗效果最佳。
Zotero 插件