Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.
Université de Paris Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France.
J Neuroendocrinol. 2022 Aug;34(8):e13186. doi: 10.1111/jne.13186. Epub 2022 Aug 18.
Transsphenoidal surgery is the first-line treatment for Cushing's disease to selectively remove the tumor. The rate of postoperative remission is estimated around 70%-80% in expert centers. However, the long-term remission rate is lower because of recurrence during follow-up that can be observed in 15% to 25% of the patients depending on the studies and duration of follow-up. There is no significant predictive factor of recurrence before surgery, but postoperative corticotroph insufficiency and its duration has been found to be a protective factor for recurrence in many studies. The persistence of a positive response to desmopressin after surgery is associated with a higher rate of recurrence. Long term monitoring for recurrence with annual clinical and hormonal investigations after the hypothalamic-pituitary-adrenal axis postoperative recovery is advised. The biological tests used for the diagnosis of Cushing's syndrome (24 h-urinary-free cortisol [UFC], late-night salivary or serum cortisol, 1 mg dexamethasone suppression test) can be used to screen for recurrence. Several studies report that increased late night cortisol and alterations of dynamic testing can be observed before the increased 24 h-UFC. For this reason it is suggested that late-night salivary cortisol would be a very sensitive tool to diagnose recurrence, pending the realization of several assays in case of borderline or discrepant result. This review will summarize the knowledge about recurrence of Cushing's disease after pituitary surgery and the current recommendations for its monitoring and diagnosis.
经蝶窦手术是库欣病的一线治疗方法，可选择性地切除肿瘤。在专家中心，术后缓解率估计在 70%-80%左右。然而，由于在随访期间观察到 15%-25%的患者会出现复发，因此长期缓解率较低，具体取决于研究和随访时间。手术前没有明显的复发预测因素，但术后促肾上腺皮质激素细胞功能不全及其持续时间已在许多研究中被发现是复发的保护因素。手术后对去氨加压素仍有阳性反应与较高的复发率相关。建议在术后下丘脑-垂体-肾上腺轴恢复后，每年进行临床和激素检查以长期监测复发情况。用于库欣综合征诊断的生物学检测（24 小时尿游离皮质醇[UFC]、深夜唾液或血清皮质醇、1 毫克地塞米松抑制试验）可用于筛查复发。几项研究报告称，在 24 小时 UFC 增加之前，可观察到深夜皮质醇升高和动态检测改变。因此，有人建议深夜唾液皮质醇将是诊断复发的非常敏感的工具，尤其是在出现边界或不一致结果的情况下，需要进行多次检测。本综述将总结关于垂体手术后库欣病复发的知识，以及目前对其监测和诊断的建议。
