FACTORS INFLUENCING THE IMMEDIATE AND LATE OUTCOME OF CUSHINGS-DISEASE TREATED BY TRANSSPHENOIDAL SURGERY - A RETROSPECTIVE STUDY BY THE EUROPEAN CUSHINGS-DISEASE SURVEY GROUP
FACTORS INFLUENCING THE IMMEDIATE AND LATE OUTCOME OF CUSHINGS-DISEASE TREATED BY TRANSSPHENOIDAL SURGERY - A RETROSPECTIVE STUDY BY THE EUROPEAN CUSHINGS-DISEASE SURVEY GROUP
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DOI：
10.1210/jc.80.11.3114
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发表时间：
1995-11-01
影响因子：
5.8
通讯作者：
TEASDALE, GM
中科院分区：
文献类型：
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作者：
BOCHICCHIO, D;LOSA, M;TEASDALE, GM
垂体腺瘤引起的促肾上腺皮质激素分泌过多引起的皮质醇增多症是一种少见的进行性致死性疾病。由于其罕见性，很难收集大量的患者，以确定影响经蝶手术后预后的因素。我们对库欣病手术治疗的早期和晚期结果进行了多中心回顾性分析，收集了1975年至1990年间欧洲25家机构接受经蝶手术的库欣病患者的资料。716例患者中有668例的数据适用于统计分析。手术死亡率为1.9%，97例患者（14.5%）发生严重并发症。术后库欣病临床和生化缓解510例（76.3%）。通过神经放射学成像或手术中的组织病理学证实的肿瘤识别与皮质醇增多症的缓解相关。510例术后缓解患者中有65例（12.7%）复发，平均时间为39.3个月（范围6-104个月）。在整个随访期间，复发灶的分布没有显示任何明显的平台或集群。术后激素水平低，皮质醇反应CRH的缺乏，以及长期糖皮质激素替代治疗的需要都与长期缓解的可能性高。我们的研究表明，经蝶手术是一种安全有效的治疗库欣病的患者。然而，手术成功后，复发率会随着时间的推移而稳步上升。术后肾上腺皮质功能减退、需长期糖皮质激素替代治疗的患者复发风险最低。
Hypercortisolism attributable to hypersecretion of ACTH by a pituitary adenoma is an uncommon and progressively lethal disease. Because of its rarity, it has been difficult to collect a large series of patients in order to identify the prognostic factors influencing the outcome after transsphenoidal surgery. We conducted a multicenter, retrospective analysis of the early and late results of surgical treatment of Cushing's disease.Files of patients with Cushing's disease who underwent transsphenoidal surgery between 1975 and 1990 were collected from 25 institutions throughout Europe. Data from 668 of 716 patients were suitable for statistical analyses. Surgical mortality was 1.9%, and major morbidity occurred in 97 patients (14.5%). Clinical and biochemical remission of Cushing's disease after surgery occurred in 510 cases (76.3%). Identification of the tumor by neuroradiological imaging or at operation with histopathological corroboration was associated with remission of hypercortisolism. Recurrence of the disease occurred in 65 (12.7%) of 510 patients in remission after surgery at a mean time of 39.3 months (range 6-104 months). The distribution of the recurrences did not show any apparent plateau or cluster throughout the follow-up period. Low postoperative steroid levels, absence of cortisol response to CRH, and the need for long-term glucocorticoid substitution therapy were all associated with a high probability of long-term remission.Our study demonstrates that transsphenoidal surgery is a safe and effective treatment for patients with Cushing's disease. However, after successful surgery there is a steady increase in the percentage of recurrences, which continues with time. Patients who after operation had hypoadrenocorticism and needed long-term glucocorticoid substitution therapy had the lowest risk of relapse.