大剂量地塞米松抑制试验阴性的库欣病患者的经蝶手术治疗  

Surgical treatment for Cushing′s disease with negative results in high dose dexamethasone suppression tests

作　　者：倪泓阳 秦凯捷 孙青芳[1] 卞留贯[1] Ni Hongyang;Qin Kaijie;Sun Qingfang;Bian Liuguan(Shanghai Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院神经外科,上海200025

出　　处：《中华医学杂志》2019年第19期1499-1501,共3页National Medical Journal of China

摘　　要：目的研究总结大剂量地塞米松抑制试验(HDDST)阴性的库欣病患者的手术指征及经蝶手术疗效。方法回顾性总结2015年1月至2017年12月间在上海交通大学医学院附属瑞金医院神经外科接受经蝶手术治疗的HDDST阴性的库欣病患者共18例,其中男5例,女13例,年龄(41±14)岁。结果所有病例术前评估均行双侧岩下窦采血(BIPSS)明确垂体性促肾上腺皮质激素(ACTH)分泌,有经蝶窦手术指征。术后内分泌缓解比例为17/18。缓解病例术后随访1~3年均未见肿瘤复发。术后病理学证实垂体ACTH腺瘤15例,其中包括1例未缓解病例。故本组18例HDDST阴性患者均证实为库欣病。结论单纯通过HDDST结果无法直接排除库欣病。对于HDDST阴性的ACTH依赖性库欣综合征患者,应进一步行BIPSS检查,如结果提示垂体性病变则有手术指征。术后内分泌缓解情况以及病理学诊断可为确诊库欣病提供最终依据。Objective To analyze the indication and the outcome of trans-sphenoidal surgery (TSS) in Cushing′s disease (CD) with negative high dose dexamethasone suppression tests (HDDST) results. Methods Eighteen cases of ACTH-dependent Cushing′s syndrome (CS) with negative HDDST results in the Department of Neurosurgery in Shanghai Ruijin Hospital from January 2015 to December 2017 were retrospectively reviewed. All patients underwent TSS. There were 5 males and 13 females, with an average age of (41±14) years. Results All patients underwent bilateral inferior petrosal sinus sampling (BIPSS) before the surgery and got evidence of pituitary origin of ACTH secretion. They were thus indicated for TSS. Immediate post-operative remission was achieved in ratio 17/18. There were no recurrences within a flow-up of 1 to 3 years. Pituitary ACTH secreting adenomas were pathologically confirmed in 15 cases, including the one who did not achieve post-operative remission. Thus, all 18 patients with negative HDDST results can finally be confirmed as CD. Conclusions HDDST alone is not sufficient to eliminate CD. For patients with ACTH-dependent CS with negative HDDST results, BIPSS should be further performed. The fact of post-operative remission and the pathological confirm of ACTH secreting pituitary adenoma may add final evidence to the diagnosis of CD.

关 键 词：地塞米松抑制试验 库欣病 经蝶手术 

分 类 号：R699.3[医药卫生—泌尿科学]