Clinical Study Of Transsphenoidal Pituitary Adenoma Resection For Cushing’’s Disease(CD)

Research backgroundCushing’s disease(CD)is a series of clinical symptoms caused by excessive cortisol secretion caused by ACTH-dependent pituitary adenoma.[1-2].In the 1930 s,Kuxin’s disease was first proposed in Harvey Cushing’s book,and then known by the medical community.Cushing’s disease has its complicated clinical symptoms,with varying degrees of severity.Excessive cortisol may directly or indirectly induce vascular injury,which may lead to atherosclerosis in these patients.Therefore,the high cardiovascular risk of these patients is associated with complications of the disease,including central obesity,hypertension,impairment of glucose tolerance or diabetes,abnormal lipid patterns and abnormal coagulation processes.[3-4]In the actual clinical practice,the treatment of Cushing’s disease is very complicated.[5]Various studies have shown that surgical treatment is still the first choice for Cushing’s disease.Even in the hands of skilled neurosurgeons,the cure rate of Cushing’s disease is not ideal,and the recurrence rate is high.[2,6-8]Currently there are other treatments for Cushing’s disease,such as drug therapy and radiotherapy,but this chronic and destructive disease is progressing over a long period of time.Because patients after treatment need lifelong hormone replacement therapy(usually not ideal)and mortality increases significantly,radiotherapy takes a long time,Nelson’s syndrome and hypophyseal dysfunction,no treatment has been proven to be completely satisfactory.[9-10]Additional medication may be used for patients undergoing surgery(especially those with diabetes,hypertension and significant coagulation abnormalities),as well as for those who persist or relapse after unsuccessful surgery.To sum up,the treatment of Cushing’s disease is very complex and challenging for us,but for the treatment of Cushing’s disease,surgical treatment still has obvious advantages.Research objectiveThis study summarized 31 cases of Cushing’s disease treated by transsphenoidal pituitary adenoma excision in our hospital from 2014 to 2019.The relationship between transsphenoidal pituitary adenoma excision and sex,age,characteristics of pituitary adenoma,surgical operation and neurosurgeon(e.g.experience and knowledge of tumors)was analyzed.The clinical study of transsphenoidal pituitary adenoma resection for Cushing’s disease was carried out.Research methodSPSS 23.0(SPSS,Chicago,IL,USA)was used to analyze the statistical data.The difference was significant when p < 0.05.Quantitative results are expressed as median(range,minimum-maximum).Wilcoxon test was used to compare body weight and BMI before and after remission.Thereby,the effect of transsphenoidal pituitary adenoma resection for Cushing’s disease was analyzed.Research findingsFrom 2014 to 2019,31 cases of Cushing’s disease were treated by transsphenoidal pituitary adenoma resection(25 females and 6 males,median age 35 years,age range 18-71 years).The diagnosis of Cushing’s disease is based on patient’s history,characteristic clinical manifestations and laboratory data.In 31 patients,the tumors were visualized on MR images of sellar region before the first operation.Of the 31 patients,9 had macroadenomas and 22 had microadenomas.Eighteen patients(58.1%)had hypertension,15 patients(48.4%)had dyslipidemia,and six patients(19.4%)had type 2 diabetes.The median follow-up period was 18 months.Twenty-four patients(77.4%)achieved remission after transsphenoidal surgery,while seven patients(22.6%)failed to achieve remission.One patient did not receive re-treatment,and six patients failed to achieve remission were treated with second-line treatment(e.g.second surgery,drug therapy and radiotherapy),of which four patients were remitted.28 patients(90.3%)achieved cumulative remission after all treatments.The patients with Cushing’s disease should be managed in a multi-disciplinary and multi-directional way.In our hospital,77.4% of patients have achieved remission after transsphenoidal surgery.Comprehensive treatment,including radiotherapy and drug therapy,can alleviate biochemical symptoms in 90.3% of patients.ConclusionTranssphenoidal pituitary adenoma resection is effective for Cushing’s disease and can be used again if the disease persists or recurs.Tumor size is an important factor in the successful treatment of Cushing’s disease.The remission rate of microadenoma is higher than that of large adenoma.The treatment of Cushing’s disease is relatively complex,requiring comprehensive treatment such as surgery,radiotherapy and drugs.However,Cushing’s disease has the possibility of recurrence after operation,and patients should be followed up closely for a long time.