Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
World Neurosurg. 2021 Apr;148:188. doi: 10.1016/j.wneu.2021.01.036. Epub 2021 Jan 21.
Cushing disease (CD), or hypercortisolemia secondary to an adrenocorticotropic hormone-secreting (ACTH-secreting) pituitary adenoma, is the most common etiology of noniatrogenic Cushing syndrome. The diagnostic algorithm employed in the patient with suspected CD is complex and includes consideration for inferior petrosal sinus sampling (IPSS). When workup is consistent with CD, extracapsular resection of the ACTH-secreting pituitary adenoma through the endonasal corridor is the preferred operative strategy. In this publication, we discuss the case of a 26-year-old woman who presented with 9 months of weight gain (Video 1). Initial labs, including low- and high-dose dexamethasone suppression tests, were consistent with CD. Findings on dynamic magnetic resonance imaging were suggestive of a left 2-mm microadenoma. IPSS confirmed central origin of hypercortisolemia and was indicative of a left-sided focus. The patient was taken to the operating room for endoscopic endonasal approach for extracapsular resection of left-sided, ACTH-secreting microadenoma. Following surgery, the patient required glucocorticoid supplementation after her cortisol levels decreased to 2 ug/dL the evening of surgery. Subsequent laboratory analysis has been consistent with hormonal cure. The accompanying video manuscript describes 1) preoperative diagnostic evaluation of the patient with suspected CD, 2) indications for and techniques of IPSS, 3) nuances of endoscopic transsphenoidal surgical management, and 4) relevant considerations in postoperative care. Of note, full patient consent for photography and/or recording of other forms of video/imaging was obtained in the preoperative period..
库欣病（CD），或因促肾上腺皮质激素分泌（ACTH 分泌）垂体腺瘤引起的皮质醇增多症，是最常见的非医源性库欣综合征病因。疑似 CD 患者的诊断算法较为复杂，包括考虑岩下窦采样（IPSS）。如果检查结果符合 CD，通过经鼻内镜切除 ACTH 分泌垂体腺瘤是首选的手术策略。在本出版物中，我们讨论了一位 26 岁女性患者的病例，她出现了 9 个月的体重增加（视频 1）。初步实验室检查，包括低剂量和高剂量地塞米松抑制试验，均符合 CD。动态磁共振成像的结果提示左侧有 2 毫米微腺瘤。IPSS 证实了皮质醇增多症的中枢起源，并提示左侧有病灶。患者被送往手术室，通过内镜经鼻入路行左侧 ACTH 分泌微腺瘤的囊外切除术。手术后，患者的皮质醇水平在手术当晚降至 2ug/dL 以下，需要补充糖皮质激素。随后的实验室分析结果符合激素治愈。随附的视频手稿描述了 1）疑似 CD 患者的术前诊断评估，2）IPSS 的适应证和技术，3）经蝶窦内镜手术管理的细节，以及 4）术后护理的相关注意事项。值得注意的是，在术前已获得患者对摄影和/或其他形式的视频/影像记录的完全同意。
