Kuo Chun-Heng, Shih Shyang-Rong, Li Hung-Yuan, Chen Szu-Chi, Hung Po-Ju, Tseng Fen-Yu, Chang Tien-Chun
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; New Taipei City Hospital, New Taipei City, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan; Center of Anti-aging and Health Consultation, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2017 Jun;116(6):441-447. doi: 10.1016/j.jfma.2016.08.008. Epub 2016 Oct 28.
BACKGROUND/PURPOSE: Cushing's disease (CD) is the most common cause of endogenous Cushing's syndrome. Transsphenoidal surgery (TSS) is the first choice of treatment. Predicting prognosis after treatment can benefit further strategies of management, but currently there is no convenient predictor. This study aims to investigate characteristic changes after treatment and to identify potential prognostic predictors.
We retrospectively studied the records of CD patients presenting to the National Taiwan University Hospital, Taipei, Taiwan between 1992 and 2011. They were categorized according to treatment response. Clinical features and examination findings were compared between groups.
Forty-one patients with CD were included. The follow-up time was 0.26-19.3 years. The time interval between the onset of symptoms and diagnosis was 2.1-120.0 months. The initial remission rate of CD after the first treatment was 82.9%. Mean body mass index (BMI) was 27.4 kg/m before treatment and 26.0 kg/m 3 months after treatment. The patients in remission had a greater decrease in BMI after treatment and lower dehydroepiandrosterone sulfate (DHEAS) levels before treatment, compared with the recurrent group (both p < 0.05). Adrenocorticotropic hormone (ACTH) levels before treatment showed a significant positive correlation with recurrent diseases (p < 0.05).
A larger decrease in BMI after treatment and lower DHEAS levels before treatment were noted for the patients who stayed in CD remission. Higher ACTH levels before treatment predicted a recurrence of CD. These are potentially simple and practical predictors of prognosis.
背景/目的：库欣病（CD）是内源性库欣综合征最常见的病因。经蝶窦手术（TSS）是首选的治疗方法。预测治疗后的预后有助于进一步的管理策略，但目前尚无便捷的预测指标。本研究旨在探讨治疗后的特征性变化，并确定潜在的预后预测指标。
我们回顾性研究了1992年至2011年间就诊于台湾台北国立台湾大学医院的CD患者的记录。根据治疗反应对他们进行分类。比较各组之间的临床特征和检查结果。
纳入41例CD患者。随访时间为0.26 - 19.3年。症状出现与诊断之间的时间间隔为2.1 - 120.0个月。首次治疗后CD的初始缓解率为82.9%。治疗前平均体重指数（BMI）为27.4kg/m²，治疗后3个月为26.0kg/m²。与复发组相比，缓解组患者治疗后BMI下降幅度更大，治疗前硫酸脱氢表雄酮（DHEAS）水平更低（均p < 0.05）。治疗前促肾上腺皮质激素（ACTH）水平与复发疾病呈显著正相关（p < 0.05）。
CD缓解的患者治疗后BMI下降幅度更大，治疗前DHEAS水平更低。治疗前ACTH水平较高预示着CD会复发。这些是潜在的简单实用的预后预测指标。
