Analysis Of Plasma Cortisol Levels After Operation And Gamma Knife Treatment For Pituitary ACTH Adenoma

BackgroundPituitary adrenocorticotropin adenoma is one of the high incidence of pituitary adenomas.It is believed that it is closely related to the monoclonal,gene expression and signal transduction of pituitary ACTH cells..The excessive secretion of ACTH caused the proliferation and hyperfunction of adrenal cortex cells,and increased the content of cortisol in blood.Cortisol can affect multiple organs and systems throughout the body,resulting in abnormal metabolism of nutrients in the body.Large tumors can cause and occupy even the surrounding nerve,blood vessels and other structures.Its clinical diagnosis is mainly based on typical clinical manifestations,combined with endocrinology and imaging examination,but final diagnosis depends on pathological examination of tumor tissues.The treatment of pituitary ACTH adenomas mainly includes surgical treatment,radiotherapy and drug therapy.The final aim is to relieve the endocrine abnormalities in the body and the occupying effect of the tumor.At present,with the further understanding of the microscopic department of neurosurgery and the development of neuroendoscopy,it has achieved the ideal excision of most pituitary adenomas through the transsphenoidal approach,and surgical treatment has become the first choice for the treatment of pituitary ACTH adenomas.Radiotherapy,as an important means of tumor therapy,is widely used in the treatment of pituitary adenomas.With the development of stereotactic technology and radiology,gamma knife has been widely used in the treatment of pituitary adenomas,and its curative effect has also been widely recognized.Compared with conventional radiotherapy,it can alleviate the endocrine abnormalities and limit the growth of the tumor,and reduce the damage to the surrounding normal tissues and alleviate the adverse reactions.Medication can only relieve clinical symptoms and can not serve as a radical cure for tumor.It is mainly used for patients who can not be operated on,and the hormone levels are not significantly relieved after surgery or gamma knife treatment.At present,there are many studies on the comparison of different treatment methods for pituitary ACTH adenomas,but there are few studies on the dynamic changes and comparison of the levels of cortisol after different methods of treatment.The purpose of this study was to compare the dynamic changes of the plasma cortisol levels before and after the treatment as well as the differences between operation and gamma knife treatment.And study the effectiveness of different treatments on the relief of plasma cortisol levels in patients with pituitary ACTH adenomas,to provide reference for clinical work.ObjectiveTo compare and analyze the changes in plasma cortisol levels after surgical treatment and gamma knife treatment of pituitary adrenocorticotropin adenoma,and explore the effective treatment of pituitary adrenocorticotropin adenoma.MethodThe clinical data of 107 cases of pituitary adrenocorticotropin adenoma treated by microscopical,endoscopic transsphenoidal surgery and gamma knife were analyzed retrospectively in the First Affiliated Hospital of Zhengzhou University from January 2011 to October 2016.The difference in plasma cortisol levels before and after treatment were compared between transsphenoidal surgery and gamma knife treatment.Results1.The plasma cortisol level was lower than that before operation at 1 weeks after operation,and the difference was statistically significant(P<0.05).There was no significant difference between the levels of cortisol at 1 month,3 months,6 months,12 months,18 months after operation and that at 1 weeks after operation(P>0.05).2.The plasma cortisol level was significantly lower at 6 months after the gamma knife treatment than that before the treatment(P<0.05).The plasma cortisol level decreased significantly at 12 months after treatment than that at 6 months after treatment(P<0.05).There was no significant difference between the levels of cortisol at 18 months after treatment and 12 months after treatment(P>0.05).3.The plasma level of cortisol at 1 week,1 month,3 months,6 months,12 months,18 months after operation were lower than that of the same period after the gamma knife treatment,the difference was statistically significant(P<0.05).Conclusions1.Endoscopic transsphenoidal surgery or microscopically transsphenoidal surgery can effectively reduce the plasma level of cortisol in adrenocorticotropin adenoma,which can be used as the first choice for the treatment of adrenocorticotropin adenoma.2.Gama knife can effectively reduce the plasma level of cortisol in adrenocorticotropin adenoma,the effect is slow and weak.It can be used as the second treatment of adrenocorticotropin adenoma.