Treatment of Cushing's disease in childhood and adolescence by transsphenoidal microadenomectomy.
Treatment of Cushing's disease in childhood and adolescence by transsphenoidal microadenomectomy.
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通过经蝶微腺瘤切除术治疗儿童和青少年库欣病。
DOI：
10.1056/nejm198404053101405
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
Conte,FA
中科院分区：
文献类型：
--
作者：
Styne,DM;Grumbach,MM;Kaplan,SL;Wilson,CB;Conte,FA
对15例未经选择的儿童和青少年库欣病患者行经蝶窦探查和微腺瘤切除术。只有3例患者进行了鞍区放射检查，包括计算机断层扫描，这有助于显示垂体微腺瘤的存在和位置。15例患者中14例经蝶显微腺瘤切除术纠正了皮质醇增多症；1例未发现腺瘤，1例因腺瘤未完全切除而在第一次手术后6个月再次手术。所有14例患者的体重和库欣样斑均减轻，并有正常或追赶生长(如果骨痂未融合)和青春期进展。在1例患者中，第一次手术6年后通过重复微腺瘤切除术成功地治疗了复发。该手术的低发病率和失败率、低复发率、皮质醇增多症状的迅速改善以及本研究中的垂体功能的保留支持了经蝶窦微腺瘤切除术作为儿童和青春期库欣病初始治疗的低风险方法。(n Engl J Med 1984；310：889-93)
Fifteen unselected children and adolescents with Cushing's disease were treated by transsphenoidal exploration and microadenomectomy. In only three patients was radiographic examination of the sella turcica, including computed tomography, useful in indicating the presence and location of a pituitary microadenoma. Transsphenoidal microadenomectomy corrected hypercortisolism in 14 of the 15 patients; no adenoma was detected in one patient, and one required a second operation six months after the first because of incomplete removal of the adenoma. All 14 lost weight and cushingoid stigmata and had normal or catch-up growth (if epiphyses were not fused) and progression of puberty. In one patient, a recurrence was successfully treated by repeat microadenomectomy six years after the first procedure.The low morbidity and failure rate of the procedure, the low recurrence rate, the rapid amelioration of signs of hypercortisolism, and the preservation of pituitary function in the present study support transsphenoidal microadenomectomy as a low-risk approach to the initial treatment of Cushing's disease in childhood and adolescence. (N Engl J Med 1984;310:889–93.)