Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
School of Life Sciences, Fudan University, Shanghai, 200438, China.
Endocrine. 2023 Aug;81(2):349-356. doi: 10.1007/s12020-023-03405-8. Epub 2023 Jun 7.
Patients with Cushing's disease (CD) experienced transient central adrenal insufficiency (CAI) after successful surgery. However, the reported recovery time of hypothalamic-pituitary-adrenal (HPA) axis varied and the related factors which could affect recovery time of HPA axis had not been extensively studied. This study aimed to analyze the duration of CAI and explore the factors affecting HPA axis recovery in post-operative CD patients with biochemical remission.
Medical records of diagnosis with CD in Huashan Hospital were reviewed between 2014 and 2020. 140 patients with biochemical remission and regular follow-up after surgery were enrolled in this retrospective cohort study according to the criteria. Demographic details, clinical and biochemical information at baseline and each follow-up (within 2 years) were collected and analyzed.
Overall, 103 patients (73.6%) recovered from transient CAI within 2 years follow-up and the median recovery time was 12 months [95% confidence intervals (CI): 10-14]. The age was younger and midnight ACTH at baseline was significantly lower, while the TT3 and FT3 levels were significantly higher in patients with recovered HPA compared to patients with persistent CAI at 2-year follow-up (p < 0.05). In persistent CAI group, more patients underwent partial hypophysectomy. TT3 at diagnosis was an independent related factor of the recovery of HPA axis, even after adjusting for gender, age, duration, surgical history, maximum tumor diameter, surgical strategy, and postoperative nadir serum cortisol level (p = 0.04, OR: 6.03, 95% CI: 1.085, 22.508). Among patients with unrecovered HPA axis at 2-year follow-up, 23 CAI patients (62%) were accompanied by multiple pituitary axis dysfunction besides HPA axis, including hypothyroidism, hypogonadism, or central diabetes insipidus.
HPA axis recovered in 73.6% of CD patients within 2 years after successful surgery, and the median recovery time was 12 months. TT3 level at diagnosis was an independent related factor of postoperative recovery of HPA axis in CD patients. Moreover, patients coexisted with other hypopituitarism at 2-year follow-up had a high probability of unrecovered HPA axis.
库欣病（CD）患者经成功手术后会经历短暂的中枢肾上腺功能不全（CAI）。然而，已有报道的下丘脑-垂体-肾上腺（HPA）轴恢复时间存在差异，且影响 HPA 轴恢复时间的相关因素尚未得到广泛研究。本研究旨在分析 CAI 的持续时间，并探讨术后生化缓解的 CD 患者中影响 HPA 轴恢复的因素。
回顾性分析 2014 年至 2020 年华山医院确诊为 CD 的患者的病历资料。根据标准，本回顾性队列研究纳入了 140 例术后生化缓解且定期随访的患者。收集并分析基线和每次随访（2 年内）的人口统计学细节、临床和生化信息。
总体而言，103 例（73.6%）患者在 2 年随访期间恢复了短暂的 CAI，中位恢复时间为 12 个月[95%置信区间（CI）：10-14]。与 2 年随访时仍存在持续 CAI 的患者相比，恢复 HPA 的患者年龄更小，基线时午夜 ACTH 明显更低，而 TT3 和 FT3 水平明显更高（p<0.05）。在持续 CAI 组中，更多患者接受了部分垂体切除术。TT3 是 HPA 轴恢复的独立相关因素，即使在校正性别、年龄、病程、手术史、最大肿瘤直径、手术策略和术后最低血清皮质醇水平后（p=0.04，OR：6.03，95%CI：1.085，22.508）。在 2 年随访时未恢复 HPA 轴的患者中，23 例（62%）CAI 患者除 HPA 轴外还伴有多种垂体轴功能障碍，包括甲状腺功能减退、性腺功能减退或中枢性尿崩症。
CD 患者经成功手术后，73.6%的患者在 2 年内 HPA 轴恢复，中位恢复时间为 12 个月。TT3 水平是 CD 患者术后 HPA 轴恢复的独立相关因素。此外，在 2 年随访时伴有其他垂体功能减退的患者 HPA 轴未恢复的可能性较高。
