Ramm-Pettersen Jon, Halvorsen Helene, Evang Johan Arild, Rønning Pål, Hol Per Kristian, Bollerslev Jens, Berg-Johnsen Jon, Helseth Eirik
Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
BMC Endocr Disord. 2015 Oct 25;15:62. doi: 10.1186/s12902-015-0055-9.
Cushing's disease is an ACTH-producing pituitary adenoma, and the primary treatment is microscopic or endoscopic transsphenoidal selective adenectomy. The aims of the present study were to evaluate whether the early postoperative S-cortisol level can serve as a prognostic marker for short- and long-term remission, and retrospectively review our own short and long term results after surgery for Cushing's disease.
This single centre, retrospective study consists of 19 consecutive patients with Cushing's disease who underwent transsphenoidal surgery. S-cortisol was measured every 6 h after the operation without any glucocorticoid replacement. We have follow-up on all patients, with a mean follow-up of 68 months.
At the three-month follow-up, 16 patients (84 %) were in remission; at 12 months, 18 (95 %) were in remission and at the final follow-up (mean 68 months), 13 (68 %) were in remission. Five-years recurrence rate was 26 %. The mean postoperative S-cortisol nadir was significantly lower in the group of patients in remission than in the non-remission group at 3 months, but there was no difference between those in long-term remission compared to those in long-term non-remission. The optimal cut-off value for classifying 3-month remission was 74 nmol/l.
We achieved a 95 % 1-year remission rate with transsphenoidal surgery for Cushing's disease in this series of consecutive patients. However, the 5-year recurrence rate was 26 %, showing the need for regular clinical and biochemical controls in this patient group. The mean postoperative serum-cortisol nadir was significantly lower in patients in remission at 3 months compared to patients not in remission at 3 months, but a low postoperative S-cortisol did not predict long-term remission.
库欣病是一种分泌促肾上腺皮质激素（ACTH）的垂体腺瘤，主要治疗方法是显微镜下或内镜经蝶窦选择性腺瘤切除术。本研究的目的是评估术后早期血清皮质醇水平是否可作为短期和长期缓解的预后标志物，并回顾性分析我们自己治疗库欣病手术后的短期和长期结果。
这项单中心回顾性研究纳入了19例连续接受经蝶窦手术的库欣病患者。术后每6小时测量一次血清皮质醇，且不进行任何糖皮质激素替代治疗。我们对所有患者进行了随访，平均随访时间为68个月。
在3个月的随访中，16例患者（84%）缓解；12个月时，18例（95%）缓解；在最后一次随访（平均68个月）时，13例（68%）缓解。5年复发率为26%。缓解组患者术后血清皮质醇最低点在3个月时显著低于未缓解组，但长期缓解组与长期未缓解组之间无差异。用于判断3个月缓解的最佳临界值为74 nmol/l。
在这一系列连续患者中，经蝶窦手术治疗库欣病的1年缓解率达到95%。然而，5年复发率为26%，表明该患者群体需要定期进行临床和生化检查。缓解的患者术后3个月时血清皮质醇最低点显著低于3个月时未缓解的患者，但术后血清皮质醇水平低并不能预测长期缓解。
