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Factors predicting the outcomes of removal of corticotropinom in Cushing's disease

Abstract

Background. Cushing’s disease (CD) is the heavy disease of the hypothalamic-pituitary-adrenal axis. The cause of the disease is pituitary adenoma (corticotropinoma). Hypersecretion of ACTH by a pituitary adenoma leads to increased secretion of cortisol by the adrenal cortex and the development of total endogenous hypercortisolism. The gold standard treatment for this disease is surgical removal of corticotropinoma. However, adenomectomy is not effective in all cases and approximately 20% of cases after the radical treatment fails to achieve remission of the disease and then comes the relapse.


Aims. The aim of our work was to evaluate the factors influencing the result of adenomectomy in patients with the Cushing’s disease and identification of recurrence predictors.


Materials and methods. The study included 84 patients (80 women and 4 men), aged 18 to 58 years with a Cushing’s disease (CD) before and after the transnasal adenomectomy. The observation period from 3 to 15 years, starting in 2001 (average 9.0 years). There was a retrospective evaluation of clinical and hormonal (ACTH and cortisol) factors before surgery and 1–3 days and 8–13 days after surgery.


Results. Remission of the disease developed in 54 (64.3%) of the 84 patients with CD after transnasal adenomectomy. Surgical treatment was not effective in 30 patients (35.7%), and they had a repeat adenomectomy. According MRI of the brain among patients with remission of the disease was more frequently found pituitary microadenomas (54%), compared with patients in whom operation was not effective, and MRI were more frequent in macroadenomas (63%). All patients with CD regardless of the outcome of neurosurgical operations was observed a significant decrease of cortisol and ACTH in the early postoperative period.


Conclusions. Factors of efficiency of adenomectomy and long-term remission in patients with CD is the levels of morning cortisol less than 100 nmol/l and ACTH of less than 10,0 pg/ml in the early postoperative period (1–13 days). The presence of adrenal insufficiency after adenomectomy is a predictor of the effectiveness of the operation, but does not exclude the likelihood of relapse.

About the Authors

Evgenia I. Marova

Endogrinology Research Centre


Russian Federation

MD, PhD, Professor



Galina S. Kolesnikova

Endogrinology Research Centre


Russian Federation

PhD



Svetlana D. Arapova

Endogrinology Research Centre


Russian Federation

MD, PhD



Aleksandr U. Grigorjev

Endogrinology Research Centre


Russian Federation

MD, PhD



Anastasia M. Lapshina

Endogrinology Research Centre


Russian Federation

MD, PhD



Galina A. Melnichenko

Endogrinology Research Centre


Russian Federation

MD, PhD



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Supplementary files

1. Рис. 1. Экспрессия АКТГ в клетках кортикотропиномы. а – фрагмент базофильно-клеточной кортикотропиномы. Окраска гематоксилином и эозином, Ч20; б – непрямая иммунопероксидазная реакция с антителами к АКТГ в клетках кортикотропиномы. Ч20.
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2. Таблица 1. Содержание гормонов в биологических жидкостях до операции
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3. Таблица 2. Содержание гормонов в биологических жидкостях через 1–3 и 8–13 дней после операции
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4. Рис. 2. Распределение больных БИК в зависимости от размера аденомы гипофиза.
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5. Рис. 3. Концентрация кортизола и АКТГ до и после операции у пациентов с ремиссией заболевания (1-я группа) и без ремиссии (2-я группа).
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6. Таблица 3. Процент снижения концентраций кортизола и АКТГ в ранние сроки после операции
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7. Рис. 4. Содержание кортизола и АКТГ у больных подгрупп 1а и 1б в ранние сроки после операции.
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8. Таблица 4. Содержание гормонов в биологических жидкостях через 1–3 и 8–13 дней после операции
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9. Рис. 5. Распределение пациентов 1-й группы в зависимости от последующего рецидива и объема аденомы гипофиза.
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For citations:


Marova E.I., Kolesnikova G.S., Arapova S.D., Grigorjev A.U., Lapshina A.M., Melnichenko G.A. Factors predicting the outcomes of removal of corticotropinom in Cushing's disease. Endocrine Surgery. 2016;10(4):20-30. (In Russ.)

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