| Analysis of influencing factors of remission in patients with recurrent Cushing's disease after reoperation |
| Received:March 31, 2021 Revised:May 29, 2021 Click here to download the full text |
| Citation of this paper:ZHENG Shu-ying,SUN Yü-hao,WANG Bao-feng,SUN Qing-fang,BIAN Liu-guan.Analysis of influencing factors of remission in patients with recurrent Cushing's disease after reoperation[J].Chinese Journal of Clinical Medicine,2021,28(4):640-645 |
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| Author Name | Affiliation | E-mail | | ZHENG Shu-ying | Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China | | | SUN Yü-hao | Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China | | | WANG Bao-feng | Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China | | | SUN Qing-fang | Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China | | | BIAN Liu-guan | Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China | blg11118@rjh.com.cn |
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| Abstract:Objective: To analyze the remission rate of patients with recurrent Cushing's disease (CD) and its related factors.Methods: Clinical data of 22 patients with recurrent CD who underwent a second transsphenoidal surgery from Jan. 2003 to Dec. 2018 were retrospectively analyzed. Patients were followed up for over 6 months. Biochemical indexes, bilateral inferior petrosal sinus sampling (BIPSS) results, and MRI results before the second surgery were analyzed. Postoperative serum cortisol, 24-hour urinary free cortisol (UFC) levels, and postoperative pathology were evaluated. Postoperative remission was defined as postoperative serum cortisol less than 5 μg/L or UFC within the normal range. The correlations between preoperative MRI results, adreno-cortico-tropic-hormone (ACTH) level, UFC level, tumor size, and other factors and remission after the second operation were statistically analyzed.Results: Totally, 16(72.7%) patients achieved remission after the second surgery, with a mean follow-up of 64.5 months. All the 22 patients had obvious imaging evidence before the first operation, among whom 8 cases (36.4%) had no obvious imaging evidence of recurrence before the second operation. Of the 14 patients with MRI showing pituitary adenomas, 10 (71.4%) were in remission after reoperation, and 6 of the 8 patients with negative MRI also benefited from reoperation. The disease control rate after reoperation in patients with microadenoma (75.0%,15/20) was better than that in patients with macroadenoma (50.0%,1/2), but there was no statistically significant difference. The levels of ACTH and UFC in the remission patients before the second operation were lower than those in the non-remission group, but the differences were not statistically significant. Patients with pathologic evidence of ACTH-positive adenoma after the second surgery had a higher remission rate (86.7% vs 42.9%, P<0.05). And older age at the time of recurrence was not an unfavorable factor for the outcome of the surgery.Conclusions: Reoperation is a considerable option for patients with recurrent CD after initial surgery. However, further studies with longer follow-up periods and more cases are needed to confirm the long-term effects of reoperation, and other related factors need to increase the number of cases for further screening. |
| keywords:Cushing's disease recurrence pituitary adenoma reoperation |
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