Braun Leah T, Rubinstein German, Zopp Stephanie, Vogel Frederick, Schmid-Tannwald Christine, Escudero Montserrat Pazos, Honegger Jürgen, Ladurner Roland, Reincke Martin
Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany.
Klinik und Poliklinik für Radiologie, Klinikum der Universität München, München, Germany.
Endocrine. 2020 Nov;70(2):218-231. doi: 10.1007/s12020-020-02432-z. Epub 2020 Aug 2.
Recurrence after pituitary surgery in Cushing's disease (CD) is a common problem ranging from 5% (minimum) to 50% (maximum) after initially successful surgery, respectively. In this review, we give an overview of the current literature regarding prevalence, diagnosis, and therapeutic options of recurrent CD.
We systematically screened the literature regarding recurrent and persistent Cushing's disease using the MESH term Cushing's disease and recurrence. Of 717 results in PubMed, all manuscripts in English and German published between 1980 and April 2020 were screened. Case reports, comments, publications focusing on pediatric CD or CD in veterinary disciplines or studies with very small sample size (patient number < 10) were excluded. Also, papers on CD in pregnancy were not included in this review.
Because of the high incidence of recurrence in CD, annual clinical and biochemical follow-up is paramount. 50% of recurrences occur during the first 50 months after first surgery. In case of recurrence, treatment options include second surgery, pituitary radiation, targeted medical therapy to control hypercortisolism, and bilateral adrenalectomy. Success rates of all these treatment options vary between 25 (some of the medical therapy) and 100% (bilateral adrenalectomy). All treatment options have specific advantages, limitations, and side effects. Therefore, treatment decisions have to be individualized according to the specific needs of the patient.
库欣病（CD）垂体手术后复发是一个常见问题，初次手术成功后复发率分别为5%（最低）至50%（最高）。在本综述中，我们概述了有关复发性CD的患病率、诊断和治疗选择的当前文献。
我们使用医学主题词“库欣病”和“复发”系统筛选了有关复发性和持续性库欣病的文献。在PubMed中的717条结果中，筛选了1980年至2020年4月期间发表的所有英文和德文手稿。排除病例报告、评论、专注于儿童CD或兽医学科CD的出版物或样本量非常小（患者数量<10）的研究。此外，本综述不包括关于妊娠期间CD的论文。
由于CD复发率高，每年进行临床和生化随访至关重要。50%的复发发生在首次手术后的前50个月内。复发时，治疗选择包括二次手术、垂体放疗、控制高皮质醇血症的靶向药物治疗和双侧肾上腺切除术。所有这些治疗选择的成功率在25%（某些药物治疗）至100%（双侧肾上腺切除术）之间。所有治疗选择都有特定的优点、局限性和副作用。因此，治疗决策必须根据患者的具体需求个体化。
