柯兴病手术前后激素水平与预后的关系

Relationship Between Endocrinological Change and Outcome after Surgery for Gushing' s Disease

目的 观察柯兴病手术前后内分泌激素的改变及激素测定对预后的预测意义。方法 回顾性研究65例柯兴病患者术前、术后1周、术后3个月测定的血皮质醇(F)、尿F、血ACTH、卵泡刺激素(FSH)、黄体生成激素(LH)等激素的水平。结果 65例尿F均升高,在治愈组,术后血F较术前明显下降,术后3个月的测定值较术后1周明显降低。地塞米松抑制试验大小剂量均不抑制的患者预后差。柯兴病术后1周,FSH、LH、促甲状腺素(TSH)分泌下降的人数比例较术前明显升高。结论 血F、地塞米松抑制试验对柯兴病的预后有预测意义。手术能影响柯兴病的垂体前叶激素分泌。

Objective To investigate the endocrinological change and the predicting relapse factor after surgery for Cushing's disease. Methods We reviewed retrospectively 65 patients and documented the endocrinological changes at 1 week and 3 months postoperatively. Results All patients had elevated urinary free cortisol. Serum cortisol measurements after surgery were lower than before operation. Serum cortisol measurements at 3 months after surgery were lower than levels obtained within 1 week of surgery. The patients who did not have cortisol suppression with high - dose dexamethasone developed disease recurrence. The total gonadotrophin and TSH deficiency rates were higher within one week after surgery compared to preoperation. Conclusion The serum cortisol measurement and dexamethasone suppression test were helpful in predicting relapse after surgery for Cushing disease. It is obvious that pituitary hormorlal deficiency may develope following surgery.