Kuritsyna Natalia V, Tsoy Uliana A, Cherebillo Vladislav Y, Paltsev Artem A, Ryzhkov Anton V, Ryazanov Pavel A, Ryzhkov Vladimir K, Grineva Elena N
Almazov National Medical Research Centre, Akkuratova Str., 197341 Saint Petersburg, Russia.
J Pers Med. 2022 May 16;12(5):798. doi: 10.3390/jpm12050798.
Persistent and recurrent hypercortisolism after transsphenoidal endoscopic surgery (TSS) is considered to be an urgent issue prompting the search for Cushing's disease (CD) remission predictors. The goal was to find a combination of predictors that can forecast the remission of CD after TSS. A total of 101 patients with CD who had undergone TSS were included. One year after surgery, CD remission status was evaluated. Preoperative pituitary magnetic resonance imaging (MRI) data, preoperative results of a high-dose dexamethasone suppression test (HDDST) and morning serum cortisol level collected 24 h after TSS (24 h MSeC) were compared in patients with and without remission of hypercortisolism. Remission one year after TSS was confirmed in 63 patients. CD remission predictors one year after TSS were: adenoma size ≥ 3 mm in the absence of invasive growth and the suppression of serum cortisol ≥ 74% in the HDDST, 24 h MSeC ≤ 388 nmol/L. A total of 38 patients had three favorable values of detected predictors; all of them had CD remission one year after TSS. With long-term follow-up, 36 of them remained in remission. Patients who had no one favorable predictor had no remission of hypercortisolism one year after TSS. Our data confirmed the prospects of using a combination of selected predictors to forecast CD remission after TSS.
经蝶窦内镜手术（TSS）后持续性和复发性皮质醇增多症被认为是一个亟待解决的问题，促使人们寻找库欣病（CD）缓解的预测因素。目标是找到一组能够预测TSS后CD缓解情况的预测因素组合。共纳入101例接受过TSS的CD患者。术后1年评估CD缓解状态。比较了皮质醇增多症缓解和未缓解患者的术前垂体磁共振成像（MRI）数据、术前高剂量地塞米松抑制试验（HDDST）结果以及TSS后24小时采集的早晨血清皮质醇水平（24小时MSeC）。63例患者在TSS后1年确认缓解。TSS后1年CD缓解的预测因素为：腺瘤大小≥3mm且无侵袭性生长，HDDST中血清皮质醇抑制≥74%，24小时MSeC≤388nmol/L。共有38例患者检测到的预测因素有三个有利值；他们在TSS后1年均实现了CD缓解。经过长期随访，其中36例仍处于缓解状态。没有一个有利预测因素的患者在TSS后1年皮质醇增多症未缓解。我们的数据证实了使用选定预测因素组合来预测TSS后CD缓解情况的前景。
