Departments of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Acta Neurochir (Wien). 2019 Jan;161(1):119-127. doi: 10.1007/s00701-018-3736-0. Epub 2018 Nov 21.
The results of trans-sphenoidal surgery (TSS) in Cushing's disease (CD) vary widely depending upon patient characteristics as well as surgical experience. Patients in India are often referred late to referral centers. We studied the rates of remission and endocrine deficiencies after TSS in patients with CD presenting to a referral hospital in India.
Sixty consecutive patients (45 females, median age 24.5 years) who underwent TSS between 2000 and 2015 were studied. The median (range) duration of follow-up was 40 (3-138) months. Initial and long-term remission and relapse rates and pituitary hypofunction post-TSS were evaluated.
Eighteen (30%) patients harbored macroadenomas. Twenty-eight (47%) patients achieved remission in the immediate post-operative period (8 AM serum cortisol < 140 nmol/l), while a higher remission rate was noted at 6 months (39/54 patients, 72%). At 1 year 70% patients and at final follow-up [median duration 40 (range 3-138) months], 58% of patients were in remission. No pre- or post-surgical variables were consistently associated with remission, except for the 8-AM serum cortisol level on the fifth day after surgery. Seven (18%) patients relapsed on follow-up, including five patients who had fifth post-operative day 8 AM serum cortisol < 140 nmol/l. Twelve (25%) patients newly developed hypothyroidism and one (1.6%) patient developed amenorrhoea after TSS.
Remission rate at 6 months was higher than immediately after TSS. A significant proportion of patients relapsed, thus necessitating life-long follow-up. New-onset hypothyroidism was frequent after TSS.
经蝶窦手术（TSS）治疗库欣病（CD）的结果因患者特征和手术经验的不同而差异很大。印度的患者通常被转诊到转诊中心较晚。我们研究了在印度转诊医院就诊的 CD 患者 TSS 后的缓解率和内分泌功能减退症的发生率。
研究了 2000 年至 2015 年间接受 TSS 的 60 例连续患者（45 例女性，中位年龄 24.5 岁）。中位（范围）随访时间为 40（3-138）个月。评估了 TSS 后的初始和长期缓解率、复发率以及垂体功能减退症。
18 例（30%）患者存在大腺瘤。28 例（47%）患者在术后即刻达到缓解（8 AM 血清皮质醇 < 140 nmol/l），而在术后 6 个月时缓解率更高（39/54 例，72%）。在 1 年时 70%的患者和最终随访时[中位随访时间 40（3-138）个月]，58%的患者缓解。除了术后第 5 天的 8 AM 血清皮质醇水平外，没有术前或术后变量与缓解率一致。7 例（18%）患者在随访中复发，其中 5 例术后第 5 天的 8 AM 血清皮质醇 < 140 nmol/l。12 例（25%）患者在 TSS 后新发甲状腺功能减退症，1 例（1.6%）患者出现闭经。
术后 6 个月的缓解率高于 TSS 后即刻。相当一部分患者复发，因此需要终身随访。TSS 后新发甲状腺功能减退症较为常见。
