CUSHİNG HASTALIĞINDA ENDOSKOPİK TRANSSFENOİDAL CERRAHİ DENEYİMLERİMİZ: 48 HASTADA SONUÇLARIMIZ VE KOMPLİKASYON ORANLARIMIZ

Amaç: Çalışmamızın amacı kliniğimizde endoskopik transsfenoidal cerrahi (ETC) yöntemle opere edilen Cushing hastalarının cerrahi sonuçları, nüks ve remisyon oranları ile komplikasyon oranlarını değerlendirmektir. Gereç ve Yöntemler: Kliniğimizde Ocak 2005 – Ocak 2019 tarihleri arasında, ETC yöntemle opere edilen ve histopatolojik olarak ACTH salgılayan hipofiz adenomu tespit edilen olgular retrospektif olarak incelendi ve 48 hasta çalışmamıza dahil edildi. Steroid şemsiyesi altında opere edilen hastaların glukokortikoid replasmanı fizyolojik doza inildiğinde 24 saat ilaçsız iken bazal kortizol seviyesi ve klinik bulguları değerlendirildi. Hastalar steroid replasman süreleri, ilk 3. ay, 1. yıl ve son kontroldeki serum sabah kortizol ölçümleri ve 1 mg deksametazon supresyon testleri; ilk 24 saat içinde, 3. ay, 1. yıl kontrollerinde kontrastlı Manyetik Rezonans görüntülemeleri ile değerlendirildi. Bulgular: Toplamda 48 hasta kliniğimizde ETC ile opere edilmiş olup bu hastaların 38’inde (%79,1) post-operatif ilk 12 aylık dönemde remisyon sağlandığı görüldü. Ortalama olarak 72 ay süreyle takip ettiğimiz bu hastalardan 11 (%22,9) tanesinde Cushing hastalığının nüks ettiği saptandı. Sonuç olarak uzun dönem takiplerimizde remisyonda kalan hasta sayısının 27 (%56,3) olduğu gözlenmiştir. Sonuç: Cushing hastalığı tedavi edildiği takdirde morbidite ve mortalite riski belirgin azalmaktadır. Cushing hastalığının seçkin tedavisi cerrahidir. Daha iyi bir görüş açısı ve parasellar bölgelere ulaşabilme imkânı sağlaması, daha az komplikasyon oranlarına sahip olması gibi nedenlerden dolayı ETC Cushing hastalığı tedavisinde etkin ve güvenli bir yöntemdir.

Anahtar Kelimeler:

Cushing, Cerrahi, Endoskopik, Transsfenoidal

OUR EXPERIENCE OF ENDOSCOPIC TRANSSPHENOIDAL SURGERY FOR CUSHING’S DISEASE: OUTCOMES AND COMPLICATION RATES IN 48 PATIENTS

Objective: This study aimed to analyze the results of patients who underwent the transsphenoidal endoscopic approach for Cushing’s disease in our department and to determine the surgical outcomes, recurrence and complication rates. Materials and Methods: A single-center retrospective study was performed on 48 patients who underwent endoscopic transsphenoidal surgery for Cushing’s disease in our department between January 2005 and January 2019. Patients who underwent endoscopic transsphenoidal surgery received perioperative supraphysiological glucocorticoid therapy. Patients were evaluated for clinical features and basal cortisol levels without medication use in the last 24 hours when glucocorticoid therapy was reduced to a physiological dose. Patients were also evaluated with steroid replacement durations; the 3rd month, the first year and the last examination blood cortisol levels, 1mg dexametazon suppression test; MRI imaging post-operative in the first 24 hours, the 3rd month and the first year. Results: A total of 48 patients underwent transsphenoidal endoscopic approach. Moreover, 38 patients (79.1%) had biochemical remission 1 year postoperatively. The mean follow-up of duration was 72 months. An additional recurrence of Cushing’s disease was detected in 11 patients (22.9%). Consequently, in our long-term results 27 patients (56.3%) remained in remission. Conclusions: The mortality and morbidity rates of Cushing’s disease are significantly decreased with treatment. Surgery is the first line treatment method for Cushing’s disease. Transsphenoidal endoscopic surgery is a safe and effective treatment method for Cushing’s disease with benefits such as better visualization, providing the opportunity to access parasellar regions, and lower complication rates.

Keywords:

Cushing, Surgery, Endoscopic, Transsphenoidal,

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