Department of Neurological Surgery, University of Virginia, Room G512 1221 Lee St., Charlottesville, VA, 22908, USA.
Department of Neurological Surgery, University of Virginia Health System, P. O. Box 800212, Charlottesville, VA, 22908, USA.
J Neurooncol. 2019 Mar;142(1):171-181. doi: 10.1007/s11060-018-03078-8. Epub 2019 Jan 3.
The objective of this study is to evaluate the role of Crooke's changes (CC) in normal the peri-tumoral anterior pituitary gland, in patients with Cushing's disease (CD) with a histopathological confirmed corticotroph adenoma, and determine if there is any difference in the recurrence and remission rates in CD patients after treatment with Gamma Knife Radiosurgery (GKRS).
All patients treated with GKRS for CD from 2005 to 2016 at our institution were identified. Patients had a confirmed adrenocorticotropic (ACTH)-secreting adenoma, i.e. corticotroph adenoma, and normal pituitary gland included in the surgical specimen, and specimens were stained with hematoxylin and eosin and also immunostaining for cytokeratin and ACTH. Statistical analyses were performed in a total of 61 patients who met the inclusion criteria. Additionally, we analyzed 20 patients in each group, with and without CC, after they were matched in a propensity score fashion.
Endocrine remission defined as, a normal 24 h urine free cortisol while off suppressive medication, occurred in 48 patients (78.7%), with 76.9% in those with CC and 81.8% in those without CC. There was no statistical significant difference between the two groups in regarding remission (p = 0.312) or recurrence (p = 0.659) in either the unmatched or matched cohorts.
The presence or absence of CC in normal pituitary gland does not appear to confer a lower rate of remission or a higher rate of recurrence after GKRS. Patients with pituitary corticotroph adenomas that present with CC features may be well served by Stereotactic radiosurgery (SRS).
本研究旨在评估 Crooke 氏变（CC）在伴有组织病理学证实的促肾上腺皮质激素（ACTH）分泌腺瘤的库欣病（CD）患者正常围肿瘤前垂体中的作用，并确定伽玛刀放射外科（GKRS）治疗后 CD 患者的复发率和缓解率是否存在差异。
本研究回顾性分析了 2005 年至 2016 年在我院接受 GKRS 治疗的所有 CD 患者。所有患者均有明确的促肾上腺皮质激素（ACTH）分泌腺瘤，即促皮质激素腺瘤，并在手术标本中包含正常垂体，标本均用苏木精和伊红染色，也用细胞角蛋白和 ACTH 免疫染色。对符合纳入标准的 61 例患者进行了统计学分析。此外，我们在倾向评分匹配后，分别对有和无 CC 的每组 20 例患者进行了分析。
内分泌缓解定义为在停用抑制药物时，24 小时尿液游离皮质醇正常，48 例患者（78.7%）达到缓解，有 CC 的患者缓解率为 76.9%，无 CC 的患者缓解率为 81.8%。两组在未匹配和匹配队列中，缓解率（p=0.312）或复发率（p=0.659）均无统计学差异。
在 GKRS 后，正常垂体中有无 CC 的存在似乎不会导致缓解率降低或复发率升高。存在 CC 特征的垂体促皮质激素腺瘤患者可能适合立体定向放射外科（SRS）治疗。
