medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-21-2-152-161medsovet-6648Research ArticleИсследованиеResearchПрогнозирование результатов транссфеноидальной эндоскопической аденомэктомии у пациентов с болезнью Иценко – КушингаPrediction of the transsphenoidal endoscopic adenomectomy results in patients with cushing’s diseasehttps://orcid.org/0000-0003-1337-1719КурицынаН. В.KuritsynaN. V.

Курицына Наталья Валерьевна - кандидат медицинских наук, врач-эндокринолог, старший научный сотрудник научно-исследовательской лаборатории нейроэндокринных опухолей Центра персонализированной медицины.

197341, Санкт-Петербург, ул. Аккуратова, д. 2.

Natalya V. Kuritsyna - Cand. Sci. (Med.), Endocrinologist, Senior Research Associate, Research Laboratory of Neuroendocrine Tumors, Research Centre of Personalized Oncology, Almazov National Medical Research Centre.

2, Akkuratov St., St Petersburg, 197341.

nvgussaova@mail.ruhttps://orcid.org/0000-0003-4013-4831ЦойУ. А.TsoyU. A.

Цой Ульяна Александровна - кандидат медицинских наук, заведующая научно-исследовательской лабораторией нейроэндокринных опухолей Центра персонализированной медицины.

197341, Санкт-Петербург, ул. Аккуратова, д. 2.

Uliana A. Tsoy - Cand. Sci. (Med.), Head of Research Laboratory of Neuroendocrine Tumors, Research Centre of Personalized Oncology, Almazov National Medical Research Centre.

2, Akkuratov St., St Petersburg, 197341.

utsoy@mail.ruhttps://orcid.org/0000-0001-6803-9954ЧеребиллоВ. Ю.CherebilloV. Yu.

Черебилло Владислав Юрьевич - доктор медицинских наук, заслуженный врач России, врач-нейрохирург, отделение нейрохирургии №6.

197341, Санкт-Петербург, ул. Аккуратова, д. 2.

Vladislav Yu. Cherebillo - Dr. Sci. (Med.), Honored Physician of Russia, Neurosurgeon, Neurosurgery Department No. 6, Almazov National Medical Research Centre.

2, Akkuratov St., St Petersburg, 197341.

cherebillo@mail.ruhttps://orcid.org/0000-0002-9966-2965ПальцевА. A.PaltsevA. A.

Пальцев Артем Александрович – кандидат медицинских наук, врач-нейрохирург, заведующий отделением нейрохирургии №6.

197341, Санкт-Петербург, ул. Аккуратова, д. 2.

Artem A. Paltsev - Cand. Sci. (Med.), Neurosurgeon, Head of Neurosurgery Department No. 6, Almazov National Medical Research Centre.

2, Akkuratov St., St Petersburg, 197341.

artem.paltsev@gmail.comhttps://orcid.org/0000-0001-6587-4313ЦиберкинА. А.TsiberkinA. I.

Циберкин Александр Иванович - врач-эндокринолог, младший научный сотрудник научно-исследовательской лаборатории нейро-эндокринологии Института эндокринологии.

197341, Санкт-Петербург, ул. Аккуратова, д. 2.

Alexandr I. Tsiberkin - Endocrinologist, Junior Research Associate, Research Laboratory of Neuroendocrine Tumors, Institute of Endocrinology, Almazov National Medical Research Centre.

2, Akkuratov St., St Petersburg, 197341.

tsibern1@gmail.comhttps://orcid.org/0000-0003-0042-7680ГриневаЕ. Н.GrinevaE. N.

Гринева Елена Николаевна – доктор медицинских наук, профессор, главный научный сотрудник научно-исследовательской лаборатории нейроэндокринных опухолей Центра персонализированной медицины, директор Института эндокринологии.

197341, Санкт-Петербург, ул. Аккуратова, д. 2.

Elena N. Grineva - Dr. Sci. (Med.), Professor, Lead Research Associate, Research Laboratory of Neuroendocrine Tumors, Research Centre of Personalized Oncology, Director of Institute of Endocrinology, Almazov National Medical Research Centre.

2, Akkuratov St., St Petersburg, 197341.

grineva_e@mail.ruНаучный медицинский исследовательский центр имени В.А. АлмазоваРоссияAlmazov National Medical Research CentreRussian Federation202109012022021-2152161Copyright © Курицына Н.В., Цой У.А., Черебилло В.Ю., Пальцев А.A., Циберкин А.А., Гринева Е.Н., 20222022Курицына Н.В., Цой У.А., Черебилло В.Ю., Пальцев А.A., Циберкин А.А., Гринева Е.Н.Kuritsyna N.V., Tsoy U.A., Cherebillo V.Y., Paltsev A.A., Tsiberkin A.I., Grineva E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6648Введение

Введение. Транссфеноидальная аденомэктомия (ТСА) является методом выбора в лечении болезни Иценко – Кушинга (БИК), однако ремиссии гиперкортицизма удается достичь не у всех пациентов. Поиск предикторов ремиссии БИК после ТСА является одной из актуальных проблем эндокринологии.

Цель исследования

Цель исследования. Изучить данные предоперационного и послеоперационного обследования пациентов с БИК для выявления предикторов ремиссии гиперкортицизма после ТСА.

Материалы и методы

Материалы и методы. В исследование включили 101 пациента с БИК, которым была выполнена ТСА. Через год после операции пациенты были обследованы и разделены на две группы: с ремиссией БИК и ее отсутствием. В обеих группах сопоставили результаты магнитно-резонансной томографии гипофиза с контрастированием, предоперационного большого дексаметазонового теста, а также показатели кортизола сыворотки утром на 2–3-е сут. после операции.

Результаты

Результаты. Спустя год после ТСА ремиссия БИК была подтверждена у 63 пациентов (62,4%), у 38 пациентов (37,6%) сохранялся гиперкортицизм. Благоприятными предикторами ремиссии заболевания оказались: размер аденомы > 3 мм при отсутствии ее инвазивного роста по данным МРТ гипофиза с контрастированием (специфичность 82,4%, чувствительность 82,8%), подавление уровня кортизола сыворотки ≥ 74% в предоперационном БДТ (специфичность 81,5%, чувствительность 86,3%), уровень кортизола сыворотки утром на 2–3-е сут. после операции ≤ 388 нмоль/л (специфичность 79,3%, чувствительность 97,4%).

Выводы

Выводы. В качестве предикторов ремиссии БИК могут быть использованы данные МРТ гипофиза с контрастированием, результаты предоперационного БДТ и уровня кортизола сыворотки утром на 2–3-е сут. после операции.

Introduction

Introduction. Transsphenoidal adenomectomy (TSA) is the method of choice in the treatment of Cushing’s disease (CD), but remission of hypercorticism cannot be achieved in all patients. The search for predictors of CD remission after TSA remains to be an important challenge in the endocrinology today.

Aim

Aim. To study the preoperative and postoperative data of patients with CD to identify the predictors of hypercorticism remission after TSA.

Materials and methods

Materials and methods. 101 patients with confirmed CD after TSA were included. One year after operation all patients were examined for the presence of hypercorticism remission and divided into two groups: with CD remission and its absence. In both groups’ preoperative pituitary magnetic resonance imaging (MRI) data, the results of preoperative high dose dexamethasone suppression test (HDDST) and the results of serum cortisol collected in the morning 2–3 days after surgery were compared.

Results

Results. One year after TSA, CD remission was confirmed in 63 patients (62.4%), whereas in 38 patients (37.6%) hypercortisolism persisted. Favorable predictors of CD remission were: the adenoma size > 3 mm without the invasive growth according to pituitary MRI (specificity 82.4%, sensitivity 82.8%), serum cortisol suppression ≥ 74% in preoperative HDDST (specificity 81.5%, sensitivity 86.3%), morning serum cortisol level in 2–3 days after surgery ≤ 388 nmol/l (specificity 79.3%, sensitivity 97.4%).

Conclusions

Conclusions. Pituitary MRI data, the results of preoperative HDDST and morning serum cortisol in the 2–3 days after surgery can be used as predictors of CD remission.

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The authors declare that there are no conflicts of interest present.