부산대학교 도서관

Purpose: Clinical consequences of the endoscopic endonasal approach (EEA) for Cushing Diseases (CD) were investigated in a single-center series based on definitions and assessments of recurrence and remission. Materials and methods: 825 patients were evaluated, including 64 patients with CD who underwent EEA at Ankara University Neurosurgery Department and were evaluated retrospectively between 2014 and 2021. Postoperative next-morning cortisol and adrenocorticotrophic hormone (ACTH) values were used to assess postoperative endocrinological remission. Results: Twenty-two patients had macroadenoma, and 40 had microadenoma. In 2 patients, no lesions were detected in the sellar region, and a magnetic resonance imaging (-) CD diagnosis was done. Regardless of remission, the effect of the duration of glucocorticoid use after surgery on recurrence made examined. Glucocorticoid therapy was given in 46 patients (71%) after pituitary surgery. No recurrence was observed in 20 patients whose treatment was longer than one year. In 12 patients, the glucocorticoid therapy duration ranged from 6 months to 12 months, and four patients showed recurrence. The glucocorticoid therapy duration of >6 months predicted that recurrence would not occur (p Conclusion: The sustainability of hypocortisolemia is essential in the treatment of CD. The mainstay of CD treatment is appropriate postoperative follow-up and administration of the necessary medical and surgical interventions. Glucocorticoid therapy duration> six months after surgery predicts that recurrence will not occur. Long-term glucocorticoid therapy after surgery suggests surgical success. Key words: Cushing disease, endonasal endoscopic approach, recurrence, remission. Kilinc MC, Kahilogullari G, Alpergin BC, Hasimoglu S, Bahcecioglu AB, Beton S, Meco C, Unlu MA. Evaluation of factors that affect remission and recurrence after endonasal endoscopic approach in Cushing disease. Pam Med J 2023;16:446-453. Amac: Bu calismada, Cushing Hastaligi (CH) icin endoskopik endonazal yaklasimin (EEY) klinik sonuclari, remisyon ve nuks tanimlari ve degerlendirmelerine dayali olarak tek merkezli bir seride arastirildi. Gerec ve yontem: Ankara Universitesi Ibni Sina Hastanesi Norosirurji Anabilim Dali'nda 2014-2021 yillari arasinda EEY uygulanan 825 hasta arasinda CH'ligi tanisi alan 64 hastanin verileri retrospektif olarak degerlendirildi. Postoperatif ertesi sabah kortizol ve adrenokortikotropik hormon (ACTH) degerleri postoperatif endokrinolojik remisyonu degerlendirmek icin kullanildi. Bulgular: Yirmi iki hastada makroadenom ve 40 hastada mikroadenom saptandi. 2 hastada sellar bolgede lezyon saptanmadi, manyetik rezonans goruntuleme (-) CH tanisi kondu. Kirk hasta kadin, 12 hasta erkekti. Remisyondan bagimsiz olarak ameliyat sonrasi glukokortikoid kullanim suresinin nuks uzerine etkisi incelendi. Hipofiz cerrahisi sonrasi 46 hastaya (%71) glukokortikoid tedavisi verildi. Tedavi suresi 1 yildan uzun olan 20 hastada nuks gozlenmedi. 12 hastada glukokortikoid tedavi suresi 6 ay ile 1 yil arasinda degismekteydi ve 4 hastada nuks goruldu. 6 aydan uzun glukokortikoid tedavi suresinin nuksun olmayacagini saptadigi ongoruldu (p Sonuc: Hipokortizoleminin surdurulebilirligi CH tedavisinde onemlidir. Ameliyattan sonra 6 aydan fazla glukokortikoid tedavi suresi, nuksun olmayacagini ongormede yardimcidir. CH tedavisinin temel dayanagi uygun postoperatif takip ve gerekli medikal ve cerrahi girisimlerin uygulanmasidir. Anahtar kelimeler: Cushing hastaligi, endoskopik endonazal yaklasim, rekurrens, remisyon. Kilinc MC, Kahilogullari G, Alpergin BC, Hasimoglu S, Bahcecioglu AB, Beton S, Meco C, Unlu MA. Cushing hastaliginda endonazal endoskopik yaklasim sonrasi remisyon ve nuks'e etki eden faktorlerin degerlendirilmesi. Pam Tip Derg 2023;16:446-453.
Introduction Cushing disease (CD) is the consequence of hypercortisolism that occurs in a pituitary corticotroph adenoma that releases adrenocorticotropic hormone (ACTH), and CH is a prevalent cause of endogenous Cushing [...]