Yazidi Meriem, Oueslati Ibtissem, Khessairi Nadia, Chaker Fatma, Chihaoui Melika
Tunis Med. 2022;100(12):843-846.
The first-line treatment for Cushing's disease (CD) is transsphenoidal excision of the corticotropic adenoma.
To identify the predictive factors of recurrence of corticotropic adenomas after pituitary surgery.
This is a retrospective and longitudinal study conducted in 28 patients operated for corticotropic adenoma between 1987 and 2014 and followed up in the department of endocrinology of La Rabta Hospital in Tunis (Tunisia). The mean duration of follow-up was 82 ± 65.9 months. The population was subdivided into two groups according to the occurrence or not of a recurrence. Recurrence was defined by hormonally confirmed postoperative recurrence of Cushing's syndrome.
The mean age of the patients was 30.8±11.8 years (24 women and 4 men). CD was related to a microadenoma in 46% of cases (n=13) and a macroadenoma in 54% of cases (n=15). The recurrence rate was 28% (n=8/28). The mean time to diagnosis of recurrence was 5.6±4 years. The sex ratio (F/M) was 7 in the recurrence group (R) and 5.6 in the non-recurrence group (NR); p= NS. The mean age of patients in the (R) group was 27.2±11.8 years and 32.2±11.9 years in the (NR) group; p= NS. The recurrence rate was 63% in case of macroadenoma and 37% in case of microadenoma; p= NS. Postoperative cortisolemia was significantly higher in the recurrence group (23.2 ± 13.5 µg/dl vs 4.4 ± 3.9 µg/dl; p 4.4 µg/dl was significantly associated with recurrence (100% vs 26.3%; p= 0.001). The duration of corticotropic axis inertia was 67.2 ± 47.7 months in the (R) group versus 88.37 ± 72.14 months in the (NR) group; p= NS.
Nearly a quarter of patients operated for CD develop a recurrence within five years. A postoperative cortisol level > 4.4 µg/dl is predictive of disease recurrence. Multicenter studies and a larger sample are needed to support these results.
库欣病（CD）的一线治疗方法是经蝶窦切除促肾上腺皮质激素腺瘤。
确定垂体手术后促肾上腺皮质激素腺瘤复发的预测因素。
这是一项回顾性纵向研究，对1987年至2014年间接受促肾上腺皮质激素腺瘤手术的28例患者进行了研究，并在突尼斯突尼斯市拉巴塔医院内分泌科进行了随访。平均随访时间为82±65.9个月。根据是否复发将人群分为两组。复发定义为经激素证实的库欣综合征术后复发。
患者的平均年龄为30.8±1,1.8岁（24名女性和4名男性）。46%的病例（n=13）中CD与微腺瘤有关，54%的病例（n=15）中与大腺瘤有关。复发率为28%（n=8/•28）。复发诊断的平均时间为5.6±4年。复发组（R）的性别比（F/M）为7，非复发组（NR）为5.6；p=无统计学意义。（R）组患者的平均年龄为27.2±11.8岁，（NR）组为32.2±11.9岁；p=无统计学意义。大腺瘤患者的复发率为63%，微腺瘤患者为37%；p=无统计学意义。复发组术后皮质醇血症明显更高（23.2±13.5µg/dl对4.4±3.9µg/dl；p<0.001）。术后皮质醇水平>4.4µg/dl与复发显著相关（100%对26.3%；p=0.001）。促肾上腺皮质激素轴惰性持续时间在（R）组为67.2±47.7个月，在（NR）组为88.37±72.14个月；p=无统计学意义。
近四分之一接受CD手术的患者在五年内复发。术后皮质醇水平>4.4µg/dl可预测疾病复发。需要多中心研究和更大的样本量来支持这些结果。
