Araujo-Castro Marta, Marchán Pinedo Marta, Fernández-Argüeso María, Pérez Pérez María, Barrero Ruíz Estrella, Pian Héctor, Rodríguez Berrocal Víctor, Pascual-Corrales Eider
Neuroendocrinology Unit, Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal, Madrid, Spain; Universidad de Alcalá, Departamento de Ciencias de la Salud, Madrid, Spain.
Neuroendocrinology Unit, Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal, Madrid, Spain.
Endocrinol Diabetes Nutr (Engl Ed). 2021 Sep 2. doi: 10.1016/j.endinu.2021.07.004.
Identify presurgical factors associated with surgical remission in Cushing's disease (CD).
All the patients with ACTH-dependent Cushing's Syndrome in follow-up at our centre between 2014-2021 (n=40) were identified. Those patients with CD diagnosis who underwent transsphenoidal surgery by the same neurosurgeon (n=32) were included. Surgical remission was defined as plasma cortisol <1.8μg/dl and normal or low urinary free cortisol (UFC) after surgery.
Sixty-three per cent (n=20) were women, and the mean age at diagnosis was 42.3±17.9 years. Six patients had macroadenomas, 17 had microadenomas, and in the other 9 patients, no pituitary lesion was identified on the MRI. Seven patients were previously operated on in another centre. Surgical remission was achieved in 75% (n=24). Only three patients experienced recurrence. No association between pre-surgical demographic (age, sex, comorbidities) or hormonal (UFC, ACTH, late-night salivary cortisol levels) characteristics and the probability of surgical remission was observed. The only variable associated with a greater chance of remission was the presurgical visualisation of the adenoma on MRI (OR 8.3, P=0.02). It was also observed that patients with a history of a previous pituitary surgery had a lower tendency to achieve remission, although statistical significance was not reached (OR 0.17, P=0.09).
In our experience, 75% of patients with CD achieved biochemical cure after the intervention. Surgical remission was up to eight times more frequent in those patients in whom the adenoma was visualised before the intervention, but no other presurgical predictive factors of cure were identified.
确定与库欣病（CD）手术缓解相关的术前因素。
识别2014年至2021年在我们中心接受随访的所有促肾上腺皮质激素（ACTH）依赖性库欣综合征患者（n = 40）。纳入由同一位神经外科医生进行经蝶窦手术的CD诊断患者（n = 32）。手术缓解定义为术后血浆皮质醇<1.8μg/dl且尿游离皮质醇（UFC）正常或降低。
63%（n = 20）为女性，诊断时的平均年龄为42.3±17.9岁。6例患者有大腺瘤，17例有微腺瘤，另外9例患者在磁共振成像（MRI）上未发现垂体病变。7例患者曾在其他中心接受过手术。75%（n = 24）的患者实现了手术缓解。只有3例患者复发。未观察到术前人口统计学特征（年龄、性别、合并症）或激素特征（UFC、ACTH、午夜唾液皮质醇水平）与手术缓解概率之间存在关联。与缓解机会更大相关的唯一变量是术前MRI上腺瘤的可视化（比值比[OR] 8.3，P = 0.02）。还观察到有垂体手术史的患者缓解倾向较低，尽管未达到统计学显著性（OR 0.17，P = 0.09）。
根据我们的经验，75%的CD患者在干预后实现了生化治愈。在干预前腺瘤可视化的患者中，手术缓解的频率高达八倍，但未发现其他术前治愈预测因素。
