垂体细胞增生所致库欣病术后复发的诊断和处理

目的讨论垂体细胞增生所致库欣病经蝶术后复发的诊断和处理。方法根据临床症状,内分泌学检查和蝶鞍区MRI检查,5例病人被诊断为垂体ACTH腺瘤而行经蝶手术,术后病理为垂体细胞增生。术后1例症状无改善,4例症状改善3～11个月后复发皮质醇增高为降低皮质醇例行垂体放疗和肾上腺切除术,。2,3例行肾上腺切除术。在肾上腺切除的例中例症状32再次复发复查,MRI发现垂体腺瘤并再次经蝶手术,术后病理为垂体腺瘤。结果随诊1～5年,行二次经蝶手术的2例病人皮质醇降至正常行垂体放疗和肾上腺切除术者因垂体功能低下用强的松替代治疗结论当垂体细胞增生病人术后症状复发影像学。检查发现垂体肿瘤时应再次经蝶手术没有发现垂体腺瘤时可行肾上腺切除和垂体放疗。

Diagnosis and Treatment of Postoperative Recurrent Cushing Disease Induced by Pituitary Corticotrope Hyperplasia

Objective To discuss the diagnosis and management of recurrent Cushing disease induced by pituitary corticotrope hyperplasia. Methods Five patients had undergone transsphenoidal surgery for the pituitary ACTH cell adenomas diagnosed according to the clinical manifestations, endorcrinological examination and MRI. The pituitary corticotrope hyperplasia was diagnosed by pathological examination. One patient did not improve in clinical symptom after the operation. Cushing syndrome was postoperatively improved in the 4 patients, but recurred and plasma and urinary steroid levels increased from 3 to 11 months after the operation. Of the 5 patients, 2 received adrenolectomy and pituitary radiotherapy and 3 adrenolectomy. The transsphenoidal surgery were reperformed on 2 patients of this 3 cases receiving adrenolectomy becaus MRI showed pituitary adenomas, which were confirmed by the pathological examination. Results The follow-up from 1 to 5 years showed that the clinical symptoms disappeared and endocrinological examination was normal in 2 patients undergoing transsphenoid re-operation, the glucocorticoid substitution therapy was used in 3 patients with hypofuction of pituitary gland. Conclusions The repeated transsphenoidal surgery shoud be performed in the patients in whom MRI showed pituitary adenomas, and the pituitary radiotherapy and adrenalectomy should be selected in the patients in whom MRI did not show pituitary adenoma when the clinical symptoms recurred after the operation in the patients with pituitary corticotrope hyperplasia.