Characterization of persistent and recurrent Cushing's disease.
Characterization of persistent and recurrent Cushing's disease.
复制标题
持续性和复发性库欣病的特征。
DOI：
10.1007/s11102-013-0511-3
复制
发表时间：
2014
期刊：
影响因子：
3.8
通讯作者：
Geer,ElizaB
中科院分区：
文献类型：
--
作者：
Sundaram,NinaK;Carluccio,Alessia;Geer,ElizaB
介绍了一例可能复发的库欣病（CD）病例，并回顾了CD缓解、持续和复发的当前定义的数据。虽然现行指南建议使用血清皮质醇在术后第一周定义初始缓解和预测持续缓解，如果血清皮质醇值不明确，则使用24小时尿游离皮质醇测量，但对于哪种方法和阈值最能定义CD缓解并预测成功结局存在争议。用于定义缓解（以及因此持续和复发）的其他方法包括地塞米松后皮质醇抑制的恢复和通过午夜唾液游离皮质醇测量的生理性昼夜皮质醇节律。然而，定义复发所需的异常检测结果的数量和程度，以及当标志物之间存在差异时确定哪种生化检测更有意义，在研究中并不一致。需要进一步调查，以检查具有轻微下丘脑-垂体-肾上腺（HPA）轴异常的CD明显缓解患者是否代表不同的缓解亚型，而不是轻度或早期复发。进一步的研究也可以探索这些HPA轴异常，如皮质醇昼夜节律的改变或对地塞米松的部分抵抗，与CD发病率持续存在的相关程度，包括神经精神损害，身体成分的改变和心血管风险。
A case of possible recurrent Cushing’s disease (CD) is presented and data on current definitions of CD remission, persistence, and recurrence are reviewed. While prevailing guidelines recommend the use of serum cortisol in the first post-operative week for defining initial remission and predicting sustained remission, with the use of 24 h urinary free cortisol measurements if serum cortisol values are equivocal, there is debate as to which methods and thresholds best define CD remission and predict successful outcomes. Other methods used to define remission (and hence persistence and recurrence) include restoration of cortisol suppression after dexamethasone and physiologic diurnal cortisol rhythm as measured by midnight salivary free cortisol. However, the number and degree of abnormal test results needed to define recurrence, and the determination of which biochemical test has more significance when there are discrepancies between markers is inconsistent among studies. Further inquiry is warranted to examine if patients in apparent CD remission who have subtle hypothalamic pituitary adrenal (HPA) axis abnormalities represent distinctive remission subtypes versus mild or early recurrence. Additional investigation could also explore the degree to which these HPA axis abnormalities, such as alterations in cortisol circadian rhythm or partial resistance to dexamethasone, are associated with persistence of CD morbidities, including neuropsychiatric impairments, alterations in body composition, and cardiovascular risk.