Diagnostic And Therapeutic Analysis Of 32 Cases Of Cushing’s Disease

Cushing’s disease is a neuroendocrine disease that results from the excessive secretion of adrenocorticotropic hormone, leading to persistent hypercortisolism. The major clinical manifestation is Cushing’s syndrome,which is characterized by moon face, buffalo hump, central obesity,purple striae, hypertension, edema, fatigue and so forth. In addition, the growing pituitary adenoma will compress optic nerves, which could result in decreased visual acuity and visual field defect. This disease can often be accompanied by metabolic disorders, diabetes, etc. Its onset is insidious and early diagnosis is difficult. Therefore, indepth studies of the clinic features,diagnostic key points and therapeutic methods of Cushing’s disease are very valuable clinically.Objective:To analyze the diagnostic and therapeutic methods and improve the level of clinical diagnosis and treatment, so as to provide reference for the clinical practice in the future.Methods:A total of 32 cases of patients with Cushing’s disease admitted to the First Hospital of Jilin University during January 2013 to June 2015 are analyzed retrospectively. All patients were diagnosed as Cushing’s disease and their laboratory examinations and imaging data are complete.All patients were treated by transsphenoidal pituitary adenoma resection.The remission standard of Cushing’s disease: 24 hour urinary free cortisol is less than 961nmol; low dose dexamethasone suppression test can inhibit;clinical symptoms are significantly ameliorated or eliminated. The surgical treatment is evaluated by comparing the preoperative and postoperative 24 h UFC, plasma ACTH, plasma cortisol, clinical symptoms, as well as preoperative and postoperative blood pressure, fasting glucose and plasma potassium among those with hypertension, high fast glucose or low plasma potassium.Results:Among the 32 patients in this study, 9 patients are male and 23 patients are female. The eldest was 58 years old and the youngest was 19 years old, with an average ages of 36.8, and the follow-up time is 6 months to 2 years. After the operation, 24 h UFC,plasma ACTH, plasma cortisol and clinical symptoms were all significantly alleviated, coupled with the significant decrease of systolic and diastolic blood pressure in patients with preoperative hypertension as well as the obvious decrease of fasting glucose in patients with preoperative high fasting glucose, and the significant increase of plasma potassium in patients with preoperative low plasma potassium. After 6 months follow-up, 32 patients’ preoperative fatigue almost disappeared after operations, and other symptoms were also obviously alleviated. 10 patients were relieved from central obesity in21 patients. The headache, decreased visual acuity, visual field defect and menstrual disorder were also significantly improved. Laboratory reexaminations of 24 h UFC showed that all patients’ results were normal except2 patient’s, and reexaminations of MRI revealed that except 2 case of recurrence, there is no obvious abnormalities.Conclusions:The surgical treatment, especially transsphenoidal pituitary adenoma resection, is the first choice for the treatment of Cushing’s disease,not only because the levels of 24 h UFC, plasma ACTH and plasma cortisol can be well controlled after operations, but also because the concurrent symptoms of hypertension, high fasting glucose and low plasma potassium could be significantly ameliorate. Additionally, patients’ postoperative conditions were stable, without serious complications, while the trauma is minute and the recovery is quick. Radiotherapy or drug therapy are supposed to be provided for those patients who are not completely cured by operations. If the tumor can not be completely resected, then the radiotherapy is an important complementary treatment. It is significant to individualize the treatment of Cushing’s disease.