Evaluating the efficiency of surgical treatment of ACTH-dependent Cushing’s syndrome in the early and late postoperative period

Abstract

Background. Adrenocorticotropic hormone-dependent Cushing’s syndrome (ACTH-dependent CS) is a form of endogenous CS caused by abnormal production of ACTH, in 80 % of cases — due to ACTH oversecretion by a pituitary adenoma (Cushing’s disease), and in 20 % of cases — as a result of ectopic ACTH secretion by an extrapituitary tumor or, very rarely, due to a tumor secreting both ACTH and corticotropin-releasing hormone. The purpose of our study was to evaluate the efficiency of the treatment for ACTH-dependent CS in the postoperative period. Materials and methods. Under supervision, there were 234 patients, out of them 160 women and 74 men aged 26.38 ± 3.40 years. The set of researches included clinical, biochemical, hormonal studies and also magnetic resonance imaging. Results. Transnasal transsphenoidal adenomectomies were performed initially for 200 patients, out of them for the second time — in 34 persons. The significance of differences was certain between such parameters, as a number of patients in the period of remission and number of relapses after transnasal transsphenoidal adenomectomy, level of free plasma cortisol and glycemia in the period of remission. After analyzing the data on the remissions and relapses, the correlation between free plasma cortisol level in the early postoperative period after transnasal transsphenoidal adenomectomy and the incidence of relapses was selectively studied in patients. Conclusions. The most significant, informing prognostic marker of tumor relapse is the level of plasma cortisol in the early postoperative period.

Keywords

• ACTH-dependent Cushing’s syndrome
• surgical treatment