Transsphenoidal microsurgical treatment of Cushing disease: postoperative assessment of surgical efficacy by application of an overnight low-dose dexamethasone suppression test
Transsphenoidal microsurgical treatment of Cushing disease: postoperative assessment of surgical efficacy by application of an overnight low-dose dexamethasone suppression test
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DOI：
10.3171/jns.2003.98.5.0967
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发表时间：
2003-05-01
影响因子：
4.1
通讯作者：
Weiss, MH
中科院分区：
文献类型：
--
作者：
Chen, JCT;Amar, AP;Weiss, MH
Object.在过去的30年里，经蝶窦腺瘤切除术和明确的垂体腺瘤切除术一直是CD的治疗选择。然而，手术切除并不总是导致CD的长期缓解。鉴于治疗不成功的库欣样状态患者的发病率和死亡率高风险，这一点尤其重要。因此，识别可能预测长期缓解可能性的预后因素是有趣的。作者回顾了他们的174例患者的系列研究，这些患者在20年内接受了CD经蝶手术，至少随访5年。这些患者的选择是基于临床，影像学和实验室标准，包括血清皮质醇水平，血清皮质醇水平的昼夜变化的损失，尿游离皮质醇浓度，和地塞米松抑制试验，岩窦采样，和促肾上腺皮质激素释放激素刺激试验的结果。所有符合生化标准的患者都接受了经蝶显微手术，作者发现术后5年的总缓解率为74%。术后第3天早晨血清皮质醇浓度低于3 mug/dl（83 nmol/L）的患者，在过夜地塞米松抑制试验后，在5年随访检查时有93%的机会缓解。皮质醇浓度高于此水平的患者均未能实现长期缓解。经蝶窦显微手术是治疗促肾上腺皮质激素分泌性微腺瘤的有效手段。临床结果与术前影像学检查测量的肿瘤大小以及术后过夜地塞米松抑制试验后早晨皮质醇水平相关。术后皮质醇水平可作为预测CD患者经蝶窦腺瘤切除术后复发可能性的有用指标。
Object. Transsphenoidal adenomectomy with resection of a defined pituitary adenoma has been the treatment of choice for CD for the last 30 years. Surgical resection, however, may not always result in long-term remission of CD. This is particularly important in light of the high risk of morbidity and mortality in patients in the unsuccessfully treated cushingoid state. As such, it is interesting to identify prognostic factors that may predict the likelihood of long-term remission.Methods. The authors review their series of 174 patients who have undergone transsphenoidal procedures for CD over a period of 20 years with minimum follow-up periods of 5 years. Selection of these patients was based on clinical, imaging, and laboratory criteria that included serum cortisol levels, loss of diurnal variation in serum cortisol levels, urinary free cortisol concentration, and results of a dexamethasone suppression test, petrosal sinus sampling, and corticotroph-releasing hormone stimulation tests as indicated. All patients who met the biochemical criteria underwent transsphenoidal microsurgery.The authors found an overall rate of remission of 74% at 5 years postoperatively. Patients in whom morning serum cortisol concentrations were lower than 3 mug/dl (83 nmol/L) on postoperative Day 3, following an overnight dexamethasone suppression test, had a 93% chance of remission at the 5-year follow-up examination. Patients with cortisol concentrations higher than this level uniformly failed to achieve long-term remission.Conclusions. Transsphenoidal microsurgery is an effective means of control for patients with adrenocorticotrophic hormone-producing microadenomas. Clinical outcome correlated well with the size of the tumor, as measured on preoperative imaging studies, and with postoperative morning cortisol levels following an overnight dexamethasone suppression test. Postoperative cortisol levels can be used as a useful prognostic indicator of the likelihood of future recurrence following transsphenoidal adenomectomy in CD.