Medical University of Varna, Varna, Bulgaria.
Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland.
BMC Endocr Disord. 2021 Mar 3;21(1):36. doi: 10.1186/s12902-021-00679-9.
Transsphenoidal surgery (TSS) to resect an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma is the first-line treatment for Cushing's disease (CD), with increasing usage of endoscopic transsphenoidal (ETSS) technique. The aim of this study was to assess remission rates and postoperative complications following ETSS for CD.
A retrospective analysis of a prospective single-surgeon database of consecutive patients with CD who underwent ETSS between January 2012-February 2020. Post-operative remission was defined, according to Endocrine Society Guidelines, as a morning serum cortisol < 138 nmol/L within 7 days of surgery, with improvement in clinical features of hypercortisolism. A strict cut-off of < 50 nmol/L at day 3 post-op was also applied, to allow early identification of remission.
A single surgeon (MJ) performed 43 ETSS in 39 patients. Pre-operative MRI localised an adenoma in 22 (56%) patients; 18 microadenoma and 4 macroadenoma (2 with cavernous sinus invasion). IPSS was carried out in 33 (85%) patients. The remission rates for initial surgery were 87% using standard criteria, 58% using the strict criteria (day 3 cortisol < 50 nmol/L). Three patients had an early repeat ETSS for persistent disease (day 3 cortisol 306-555 nmol/L). When the outcome of repeat early ETSS was included, the remission rate was 92% (36/39) overall. Remission rate was 94% (33/35) when patients with macroadenomas were excluded. There were no cases of CSF leakage, meningitis, vascular injury or visual deterioration. Transient and permanent diabetes insipidus occurred in 33 and 23% following first ETSS, respectively. There was one case of recurrence of CD during the follow-up period of 24 (4-79) months.
Endoscopic transsphenoidal surgery produces satisfactory remission rates for the primary treatment of CD, with higher remission rates for microadenomas. A longer follow-up period is required to assess recurrence rates. Patients should be counselled regarding risk of postoperative diabetes insipidus.
经蝶窦手术（TSS）切除促肾上腺皮质激素（ACTH）分泌垂体腺瘤是库欣病（CD）的一线治疗方法，内镜经蝶窦（ETSS）技术的应用越来越多。本研究旨在评估 ETSS 治疗 CD 的缓解率和术后并发症。
对 2012 年 1 月至 2020 年 2 月期间连续接受 ETSS 治疗的 CD 患者的前瞻性单外科医生数据库进行回顾性分析。根据内分泌学会指南，术后缓解定义为术后 7 天内早晨血清皮质醇<138nmol/L，皮质醇增多症的临床特征改善。还应用了术后第 3 天<50nmol/L 的严格截止值，以早期识别缓解。
一名外科医生（MJ）对 39 例患者中的 43 例进行了 ETSS。术前 MRI 在 22 例（56%）患者中定位了腺瘤；18 例微腺瘤和 4 例大腺瘤（2 例伴有海绵窦侵犯）。33 例（85%）患者进行了 IPSS。根据标准标准，初次手术的缓解率为 87%，根据严格标准（术后第 3 天皮质醇<50nmol/L），缓解率为 58%。3 例患者因持续疾病行早期重复 ETSS（术后第 3 天皮质醇 306-555nmol/L）。当包括早期重复 ETSS 的结果时，总体缓解率为 92%（36/39）。排除大腺瘤患者后，缓解率为 94%（33/35）。没有发生脑脊液漏、脑膜炎、血管损伤或视力恶化的情况。初次 ETSS 后分别有 33%和 23%的患者出现暂时性和永久性尿崩症。在 24（4-79）个月的随访期间，有 1 例 CD 复发。
内镜经蝶窦手术治疗 CD 的原发性治疗可获得满意的缓解率，微腺瘤的缓解率更高。需要更长的随访时间来评估复发率。应向患者告知术后尿崩症的风险。
