Cushing Hastalığında Nüksü Öngören Faktörler

GİRİŞ ve AMAÇ: Cushing Hastalığının nüks oranı yüksektir; bu nedenle, nüksü öngören klinik özellikler, yüksek riskli hastaları belirlemek için tanımlanmalıdır. Bu faktörler hastalığın yönetimini ve izlem sıklığını etkileyebilir. Nüks etmiş CH (RD) ve uzun sürekli remisyon (SR) sağlanmış hastaların klinik özelliklerini karşılaştırarak hastalık nüksünü öngören klinik faktörleri belirlemeyi amaçladık YÖNTEM ve GEREÇLER: Cerrahi tedavi uygulanan 85 CH olan hasta retrospektif olarak değerlendirildi. Preoperatif tanı testleri ve postoperatif hastalık aktivitesi kaydedildi. Hipofiz tümör boyutu, invazyonu, p53 ve Ki-67 immünhistokimyasal boyama verileri ile postoperatif kortizol aksı geridönüş zamanı değerlendirildi. BULGULAR: Çalışmaya 16 RD ve 54 SR hastası alındı. Preoperatif ACTH düzeyleri RD grubunda daha yüksekti. RD hastalarında preoperatif adenom boyutu ve kavernöz sinüs invazyonu ile Ki-67 indeksi SR grubuna göre daha yüksekti. RD'li 11 hastada (% 69) hızlı kortizol aksı geridönüşü görülürken SR grubunda sadece 6 hastada (% 11) vardı. TARTIŞMA ve SONUÇ: Preoperatif ACTH yüksekliği, atmış tümör boyutu, kavernöz sinüs invazyonu ve yüksek Ki-67 indeksi, Cushing hastalığında nüksü öngörebilir faktörlerdir. Bununla birlikte, hızlı kortizol aksı geridönüşü de nüks ile ilişkili bulunmuştur.

Predicting Factors of Recurrence in Patients with Cushing's Disease

INTRODUCTION: Cushing's Disease (CD) has high recurrence rate therefore clinical features predicting recurrence should be defined to discriminate patients with high risk. These factors can effect management and follow-up frequency. We aimed to compare the clinical features of the patients with recurrent CD (RD) and sustained remission (SR) in order to determine clinical factors that might predict disease recurrence. METHODS: Surgically treated 85 patients with CD were evaluated retrospectively. Preoperative diagnostic tests and postoperative disease activity were noted. Pituitary tumor size, invasiveness and features such as p53 and Ki-67 immunohistochemical staining data also postoperative cortisol axis recovery time were evaluated.. RESULTS: 16 RD and 54 SR patients were enrolled to the study. Preoperative ACTH but not cortisol levels were higher in RD group. RD patients had higher preoperative adenoma size and cavernous sinus invasion rate and Ki-67 index than SR group. Eleven (69%) patients with RD had early recovery time while 6 (11%) patients in SR group DISCUSSION and CONCLUSION: Higher preoperative ACTH levels, tumor size, cavernous sinus invasion and Ki-67 immunostaining would predict recurrence in CD. Additionally, rapid recovery of cortisol axis was found to be related with recurrence.

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