Bakiri F, Tatai S, Aouali R, Semrouni M, Derome P, Chitour F, Benmiloud M
Services d'Endocrinologie, Algiers, Algeria.
J Endocrinol Invest. 1996 Oct;19(9):572-80. doi: 10.1007/BF03349020.
Transsphenoidal pituitary microsurgery is considered as the best treatment of Cushing's disease. However, some recent studies reported disappointing results, leading their authors to suggest the possibility of returning to a first line adrenalectomy treatment. The aim of this study was to evaluate long-term results of transsphenoidal surgery in Cushing's disease, with special interest in factors that could affect the surgical outcome on the one hand and particular attention to surgical endocrine effects on the other. Fifty consecutive patients (34 females, 16 males, mean age 29.64 +/- 1.52 yr) were studied. The median post-operative follow-up was 71.5 months (range 25-219). Clinical, biological, surgical and pathological data between the success and failure groups were compared. Criteria of cure were: normal urinary free cortisol excretion, circadian cortisol rhythm and low dose dexamethasone test. Recovery of corticotroph and somatotroph functions were followed using the insulin test. Particular attention is given to clinical evolution in evaluating other pituitary functions. T4 or FT4, prolactin, E2 in women, testosterone in men, were measured. TRH and LHRH tests were not systematically performed. Only two parameters differed significantly between the cured and failure groups: the size of the adenomas was smaller and the pathological confirmation of the adenoma more frequent in the cured group. One patient had permanent corticotropic failure while two other had impaired response to hypoglycemia with normal cortisol basal levels. No acquired hypothyroidism nor hypogonadism were observed except in a patient who underwent two operations and radiotherapy. Recovery of GH function was slow. Definitive short stature was observed in all the patients whose disease began before the age of 16. Two patients had permanent diabetes insipidus. In conclusion, the most favorable prognosis in transsphenoidal surgery for Cushing's disease is observed in case of microadenoma confirmed by pathological examination. With this treatment, we obtained satisfactory results in Cushing's disease with minimal complications and no necessity of life-long endocrine substitutive therapy.
经蝶窦垂体显微手术被认为是库欣病的最佳治疗方法。然而，最近的一些研究报告了令人失望的结果，导致其作者建议可能回归一线肾上腺切除术治疗。本研究的目的是评估经蝶窦手术治疗库欣病的长期结果，一方面特别关注可能影响手术结果的因素，另一方面特别关注手术的内分泌影响。对连续50例患者（34例女性，16例男性，平均年龄29.64±1.52岁）进行了研究。术后中位随访时间为71.5个月（范围25 - 219个月）。比较了成功组和失败组之间的临床、生物学、手术和病理数据。治愈标准为：尿游离皮质醇排泄正常、皮质醇昼夜节律正常和小剂量地塞米松试验正常。使用胰岛素试验跟踪促肾上腺皮质激素和生长激素功能的恢复情况。在评估其他垂体功能时特别关注临床演变。测量了女性的T4或FT4、催乳素、E2，男性的睾酮。未系统进行促甲状腺激素释放激素（TRH）和促黄体生成素释放激素（LHRH）试验。治愈组和失败组之间只有两个参数有显著差异：治愈组腺瘤体积较小，腺瘤的病理确诊更为常见。1例患者出现永久性促肾上腺皮质激素功能减退，另外2例患者对低血糖反应受损，但皮质醇基础水平正常。除1例接受了两次手术和放疗的患者外，未观察到获得性甲状腺功能减退或性腺功能减退。生长激素功能恢复缓慢。所有在16岁之前发病的患者均出现了最终的身材矮小。2例患者出现永久性尿崩症。总之，经病理检查证实为微腺瘤的情况下，经蝶窦手术治疗库欣病的预后最为有利。通过这种治疗方法，我们在库欣病中获得了满意的结果，并发症最少，且无需终身内分泌替代治疗。
