Burch W M
Arch Intern Med. 1985 Jun;145(6):1106-11.
Cushing's syndrome continues to tax the most discerning clinician. I review pituitary-dependent adrenal hyperplasia (Cushing's disease), including recent experiences with Cushing's disease at Duke University, Durham, NC, and relate these observations to the current ideas as to pathophysiology, etiology, and management of Cushing's disease. Transsphenoidal microsurgery (TPS) performed by an experienced neurosurgeon offers selective removal of corticotropin (ACTH)-secreting adenoma, immediately cures the hypercortisolism, preserves pituitary function, and is associated with minimal morbidity. Postoperative hypoadrenalism appears to be the best marker of surgical cure. Transsphenoidal surgery has revolutionized our thoughts as to etiology and treatment of Cushing's disease, yet failures with TPS and uncertainty of recurrences leave room for radiotherapy, adrenalectomy, and adjunctive drug therapy in the management of this entity.
库欣综合征仍然是对最具洞察力的临床医生的一大挑战。我回顾垂体依赖性肾上腺增生（库欣病），包括北卡罗来纳州达勒姆市杜克大学近期关于库欣病的经验，并将这些观察结果与当前关于库欣病病理生理学、病因学和管理的观点联系起来。由经验丰富的神经外科医生进行的经蝶窦显微手术（TPS）可选择性切除分泌促肾上腺皮质激素（ACTH）的腺瘤，立即治愈高皮质醇血症，保留垂体功能，且发病率极低。术后肾上腺功能减退似乎是手术治愈的最佳标志。经蝶窦手术彻底改变了我们对库欣病病因和治疗的看法，然而TPS手术的失败以及复发的不确定性使得放疗、肾上腺切除术和辅助药物治疗在该疾病的管理中仍有空间。
