CUSHİNG HASTALIĞINDA ENDOSKOPİK TRANSSFENOİDAL CERRAHİ DENEYİMLERİMİZ: 48 HASTADA SONUÇLARIMIZ VE KOMPLİKASYON ORANLARIMIZ
Öz
Amaç: Çalışmamızın amacı kliniğimizde endoskopik transsfenoidal cerrahi (ETC) yöntemle opere edilen Cushing hastalarının cerrahi sonuçları, nüks ve remisyon oranları ile komplikasyon oranlarını değerlendirmektir. Gereç ve Yöntemler: Kliniğimizde Ocak 2005 – Ocak 2019 tarihleri arasında, ETC yöntemle opere edilen ve histopatolojik olarak ACTH salgılayan hipofiz adenomu tespit edilen olgular retrospektif olarak incelendi ve 48 hasta çalışmamıza dahil edildi. Steroid şemsiyesi altında opere edilen hastaların glukokortikoid replasmanı fizyolojik doza inildiğinde 24 saat ilaçsız iken bazal kortizol seviyesi ve klinik bulguları değerlendirildi. Hastalar steroid replasman süreleri, ilk 3. ay, 1. yıl ve son kontroldeki serum sabah kortizol ölçümleri ve 1 mg deksametazon supresyon testleri; ilk 24 saat içinde, 3. ay, 1. yıl kontrollerinde kontrastlı Manyetik Rezonans görüntülemeleri ile değerlendirildi. Bulgular: Toplamda 48 hasta kliniğimizde ETC ile opere edilmiş olup bu hastaların 38’inde (%79,1) post-operatif ilk 12 aylık dönemde remisyon sağlandığı görüldü. Ortalama olarak 72 ay süreyle takip ettiğimiz bu hastalardan 11 (%22,9) tanesinde Cushing hastalığının nüks ettiği saptandı. Sonuç olarak uzun dönem takiplerimizde remisyonda kalan hasta sayısının 27 (%56,3) olduğu gözlenmiştir. Sonuç: Cushing hastalığı tedavi edildiği takdirde morbidite ve mortalite riski belirgin azalmaktadır. Cushing hastalığının seçkin tedavisi cerrahidir. Daha iyi bir görüş açısı ve parasellar bölgelere ulaşabilme imkânı sağlaması, daha az komplikasyon oranlarına sahip olması gibi nedenlerden dolayı ETC Cushing hastalığı tedavisinde etkin ve güvenli bir yöntemdir.
Anahtar Kelimeler
Kaynakça
- 1. Cushing, H. The Basophil Adenomas of the Pituitary Body and Their Clinical Manifestations (Pituitary Basophilism). J Neurosurg 1964;21(4);318-47. [CrossRef] google scholar
- 2. Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet 2006;367(9522):1605-17. [CrossRef] google scholar
- 3. Sherlock M, Ayuk J, Tomlinson JW, Toogood AA, Aragon-Alonso A, Sheppard MC, et al. Mortality in patients with pituitary disease. Endocr Rev 2010;31(3):301-42. [CrossRef] google scholar
- 4. Etxabe J, Vazquez JA. Morbidity and mortality in Cushing’s disease: An epidemiological approach. Clin Endocrinol (Oxf) 1994;40(4):479-84. [CrossRef] google scholar
- 5. Swearingen B, Biller BMK, Barker FG, Katznelson L, Grinspoon S, Klibanski A, et al. Long-term mortality after transsphenoidal surgery for Cushing disease. Ann Intern Med 1999;130(10):821-4. [CrossRef] google scholar
- 6. Lindholm J, Juul S, J0rgensen JOL, Astrup J, Bjerre P, Feldt-Rasmussen U, et al. Incidence and late prognosis of Cushing’s syndrome: A population-based study. J Clin Endocrinol Metab 2001;86(1):117-23. [CrossRef] google scholar
- 7. Hammer GD, Tyrrell JB, Lamborn KR, Applebury CB, Hannegan ET, Bell S, et al. Transsphenoidal microsurgery for Cushing’s disease: Initial outcome and long-term results. J Clin Endocrinol Metab 2004;89(12):6348-57. [CrossRef] google scholar
- 8. Dekkers OM, Biermasz NR, Pereira AM, Roelfsema F, van Aken MO, Voormolen JHC, et al. Mortality in patients treated for Cushing’s disease is increased, compared with patients treated for nonfunctioning pituitary macroadenoma. J Clin Endocrinol Metab 2007;92(3):976-81. [CrossRef] google scholar
- 9. Lomas J, Anderson GM, Domnick-Pierre K, Vayda E, Enkin MW. A Survey of Results with Transsphenoidal Surgery in Cushing’s Disease. N Engl J Med 1989;321(19):1306-11. [CrossRef] google scholar
- 10. Nieman LK, Biller BMK, Findling JW, Newell-Price J, Savage MO, Stewart PM et al. The diagnosis of Cushing’s syndrome: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008;93(5):1526-40. [CrossRef] google scholar
- 11. Giraldi FP, Moro M, Cavagnini F. Gender-related differences in the presentation and course of Cushing’s disease. J Clin Endocrinol Metab 2003;88(4):1554-8. [CrossRef] google scholar
- 12. Chaidarun SS, Alexander JM. A Tumor-Specific Truncated Estrogen Receptor Splice Variant Enhances Estrogen-Stimulated Gene Expression. Mol Endocrinol 1998;12(9):1355-66. [CrossRef] google scholar
- 13. Broersen LHA, Biermasz NR, van Furth WR, de Vries F, Verstegen MJT, Dekkers OM et al. Endoscopic vs. microscopic transsphenoidal surgery for Cushing’s disease: a systematic review and meta-analysis. Pituitary 2018;21(5):524-34. [CrossRef] google scholar
OUR EXPERIENCE OF ENDOSCOPIC TRANSSPHENOIDAL SURGERY FOR CUSHING’S DISEASE: OUTCOMES AND COMPLICATION RATES IN 48 PATIENTS
Öz
Objective: This study aimed to analyze the results of patients who underwent the transsphenoidal endoscopic approach for Cushing’s disease in our department and to determine the surgical outcomes, recurrence and complication rates. Materials and Methods: A single-center retrospective study was performed on 48 patients who underwent endoscopic transsphenoidal surgery for Cushing’s disease in our department between January 2005 and January 2019. Patients who underwent endoscopic transsphenoidal surgery received perioperative supraphysiological glucocorticoid therapy. Patients were evaluated for clinical features and basal cortisol levels without medication use in the last 24 hours when glucocorticoid therapy was reduced to a physiological dose. Patients were also evaluated with steroid replacement durations; the 3rd month, the first year and the last examination blood cortisol levels, 1mg dexametazon suppression test; MRI imaging post-operative in the first 24 hours, the 3rd month and the first year. Results: A total of 48 patients underwent transsphenoidal endoscopic approach. Moreover, 38 patients (79.1%) had biochemical remission 1 year postoperatively. The mean follow-up of duration was 72 months. An additional recurrence of Cushing’s disease was detected in 11 patients (22.9%). Consequently, in our long-term results 27 patients (56.3%) remained in remission. Conclusions: The mortality and morbidity rates of Cushing’s disease are significantly decreased with treatment. Surgery is the first line treatment method for Cushing’s disease. Transsphenoidal endoscopic surgery is a safe and effective treatment method for Cushing’s disease with benefits such as better visualization, providing the opportunity to access parasellar regions, and lower complication rates.
Anahtar Kelimeler
Kaynakça
- 1. Cushing, H. The Basophil Adenomas of the Pituitary Body and Their Clinical Manifestations (Pituitary Basophilism). J Neurosurg 1964;21(4);318-47. [CrossRef] google scholar
- 2. Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet 2006;367(9522):1605-17. [CrossRef] google scholar
- 3. Sherlock M, Ayuk J, Tomlinson JW, Toogood AA, Aragon-Alonso A, Sheppard MC, et al. Mortality in patients with pituitary disease. Endocr Rev 2010;31(3):301-42. [CrossRef] google scholar
- 4. Etxabe J, Vazquez JA. Morbidity and mortality in Cushing’s disease: An epidemiological approach. Clin Endocrinol (Oxf) 1994;40(4):479-84. [CrossRef] google scholar
- 5. Swearingen B, Biller BMK, Barker FG, Katznelson L, Grinspoon S, Klibanski A, et al. Long-term mortality after transsphenoidal surgery for Cushing disease. Ann Intern Med 1999;130(10):821-4. [CrossRef] google scholar
- 6. Lindholm J, Juul S, J0rgensen JOL, Astrup J, Bjerre P, Feldt-Rasmussen U, et al. Incidence and late prognosis of Cushing’s syndrome: A population-based study. J Clin Endocrinol Metab 2001;86(1):117-23. [CrossRef] google scholar
- 7. Hammer GD, Tyrrell JB, Lamborn KR, Applebury CB, Hannegan ET, Bell S, et al. Transsphenoidal microsurgery for Cushing’s disease: Initial outcome and long-term results. J Clin Endocrinol Metab 2004;89(12):6348-57. [CrossRef] google scholar
- 8. Dekkers OM, Biermasz NR, Pereira AM, Roelfsema F, van Aken MO, Voormolen JHC, et al. Mortality in patients treated for Cushing’s disease is increased, compared with patients treated for nonfunctioning pituitary macroadenoma. J Clin Endocrinol Metab 2007;92(3):976-81. [CrossRef] google scholar
- 9. Lomas J, Anderson GM, Domnick-Pierre K, Vayda E, Enkin MW. A Survey of Results with Transsphenoidal Surgery in Cushing’s Disease. N Engl J Med 1989;321(19):1306-11. [CrossRef] google scholar
- 10. Nieman LK, Biller BMK, Findling JW, Newell-Price J, Savage MO, Stewart PM et al. The diagnosis of Cushing’s syndrome: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008;93(5):1526-40. [CrossRef] google scholar
- 11. Giraldi FP, Moro M, Cavagnini F. Gender-related differences in the presentation and course of Cushing’s disease. J Clin Endocrinol Metab 2003;88(4):1554-8. [CrossRef] google scholar
- 12. Chaidarun SS, Alexander JM. A Tumor-Specific Truncated Estrogen Receptor Splice Variant Enhances Estrogen-Stimulated Gene Expression. Mol Endocrinol 1998;12(9):1355-66. [CrossRef] google scholar
- 13. Broersen LHA, Biermasz NR, van Furth WR, de Vries F, Verstegen MJT, Dekkers OM et al. Endoscopic vs. microscopic transsphenoidal surgery for Cushing’s disease: a systematic review and meta-analysis. Pituitary 2018;21(5):524-34. [CrossRef] google scholar
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | ARAŞTIRMA |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Ekim 2022 |
| Gönderilme Tarihi | 1 Nisan 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 85 Sayı: 4 |
Kaynak Göster
Contact information and address
Addressi: İ.Ü. İstanbul Tıp Fakültesi Dekanlığı, Turgut Özal Cad. 34093 Çapa, Fatih, İstanbul, TÜRKİYE
Email: itfdergisi@istanbul.edu.tr
Phone: +90 212 414 21 61