垂体ACTH腺瘤切除术后早期内分泌未缓解的病例分析

Analysis of adrenocorticotropic hormone-secreting adenoma without early remission after transsphenoidal approach surgery

目的分析术后早期未缓解的垂体促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)腺瘤的诊治。方法回顾性分析266例垂体ACTH腺瘤病例资料,均经蝶窦入路手术,其中术后早期内分泌未缓解44例(16.5%)。44例中初发垂体ACTH腺瘤34例(77.3%),复发垂体ACTH腺瘤10例(22.7%);MRI明确显示肿瘤30例(68.2%),MRI阴性14例(31.8%);垂体微腺瘤42例(95.5%),垂体大腺瘤2例(4.5%)。结果术中所取组织经病理检查:垂体腺瘤25例(其中不典型垂体腺瘤3例),垂体增生6例,垂体前叶或后叶13例。术后随访12~36个月,延迟缓解3例,放疗29例(普通放疗25例,伽玛刀4例),拒绝治疗随访观察2例,术后死亡5例,失访5例。在放疗病人中,11例病人血皮质醇恢复正常,2例效果不佳改行双侧肾上腺切除术。结论对经蝶窦入路术后早期未缓解的垂体ACTH腺瘤,随访半年后仍未缓解者,应根据病情行个体化治疗。

Objective To analyze the diagnosis and treatment of adrenocorticotropic hormone （ACTH）-secreting adenoma （ACTH adenoma） without early postoperative remission. Methods The clinical data of 266 patients with ACTH adenoma by transsphenoidal surgery were analyzed retrospectively. There were 44 cases （16.5%） without early postoperative remission. There were primary ACTH adenoma in 34 patients （77.3%） and recurrent ACTH adenoma in 10 （22.7%）. Positive MRI was seen in 30 patients （68.2%） and negative in 14 （31.8%）. Pituitary microadenoma was found in 42 cases （95.5%） and pituitary macroadenoma in 2 （4.5%）. Results The pathological results were pituitary adenoma in 25 cases （including 3 cases of atypical pituitary adenoma）, pituitary hyperplasia in 6, anterior or posterior pituitary lobe in 13. All the patients were followed up for 12 to 36 months. The delayed remission was obtained in 3 patients, radiotherapy in 29 （including 25 cases of general radiotherapy, 4 of gamma knife）, refusing treatment and receiving follow-up observation occurred in 2, death in 5 and loss to follow up in 5. In the radiotherapy, 11 patients＇ blood cortisol levels returned to normal, 2 patients underwent adrenalectomy because of poor radiotherapy efficacy. Conclusions For patients with ACTH adenoma who have no remission after surgery via transsphenoidal approach and after 6-month-follow-up, the best treatment could be chosen according to the individual patient＇s condition.