垂体性库欣病经蝶手术治疗后的延迟缓解

Delayed remission of pituitary Cushing's disease after transsphenoidal surgery

目的探讨垂体性库欣病经蝶手术后延迟缓解的特征。方法回顾性分析119例垂体性库欣病病人的临床资料,均行经蝶手术。根据术后血、尿皮质醇水平分为即刻缓解组、延迟缓解组和不缓解组。结果即刻缓解组73例(61.4%),延迟缓解组30例(25.2%),不缓解组16例(13.4%)。免疫组织化学结果显示:促肾上腺皮质激素(ACTH)阳性的垂体腺瘤96例,ACTH阴性的垂体腺瘤12例,ACTH阳性的结节性增生3例。所有病人随访(38.0±21.2)个月,延迟缓解组病人在术后(29.9±40.6)d皮质醇水平下降到正常范围;随访期间复发5例,均为延迟缓解组病人。结论垂体性库欣病部分病人术后会出现延迟缓解,术后早期单纯根据血皮质醇水平判断是否缓解并不完全可靠,是否再次手术治疗需谨慎考虑。

Objective To explore the characteristics of delayed remission of pituitary Cushing＇s disease after transsphenoidal surgery. Methods Clinical data of 119 patients with pituitary Cushing＇s disease undergoing transsphenoidal surgery were analyzed retrospectively. The patients were divided into immediate remission （IR） group, delayed remission （DR） group and no remission （NR） group based on the postoperative serum and urinary cortisol levels. Results According to the postoperative remission conditions, there were 73 patients （61.4%） in IR group, 30 （25.2%） in DR group and 16 （13.4%） in NR group. The immunohistochemical staining showed that pituitary adenoma was positive for adrenocorticotropic hormone （ACTH） in 96 patients and negative in 12, and focal nodular hyperplasia was positive for ACTH in 3. All the patients were followed up for 38.0±21.2 months, the cortisol levels reduced to the normal range 29.9±40.6 d after surgery, and recurrence was seeia in 5 patients of DR group during follow-up period. Conclusions DR may occur in some patients with pituitary Cushing＇s disease after transsphenoidal surgery. The judgement of remission based on the postoperative cortisol level in early stage is not completely reliable, and reoperation is worthy of careful consideration.