ABSTRACT
No disponible
Subject(s)
Humans , Brain Abscess/diagnosis , Pituitary Diseases/diagnosis , Risk FactorsSubject(s)
Abscess , Pituitary Diseases , Abscess/diagnosis , Abscess/drug therapy , Adult , Female , Humans , Middle Aged , Pituitary Diseases/diagnosis , Pituitary Diseases/drug therapyABSTRACT
En el manejo de la enfermedad de Cushing (EC) no existe un consenso sobre los criterios de remisión ni sobre la definición de recurrencia en la literatura, por lo que las seriesno son comparables. Se ha descrito que la tasa de recurrencia en la EC oscila entre 5-25% en el seguimiento a largo plazo. Dentro de los factores pronósticos de remisión a largo plazo podemos diferenciar: 1) factores dependientes del adenoma (agresividad, tamaño, identificación preoperatoria por técnicas de imagen); 2) factores dependientes de la cirugía, donde destaca por su importancia la experiencia del neurocirujano; 3) factores clínicos, siendo la dependencia del tratamiento glucocorticoideo y su duración los más demostrados; y 4) factores bioquímicos. Dentro de estos últimos queda bien documentado en la literatura que un nadir indetectable de cortisol, al menos inferior a 2 mcg/dL, en el postoperatorio predice la remisión de la enfermedad pero, incluso en estos casos, no puede excluirse la recidiva, lo que obliga al seguimiento de por vida en estos pacientes. Presentamos los resultados preliminares de los primeros 20 pacientes intervenidos en el Hospital Universitario de la Ribera utilizando el nadir de cortisol inferior a 2 mcg/dL
There is no consensus on the remission criteria for Cushing's disease or on the definition of disease recurrence after transsphenoidal surgery, and comparison of the different published series is therefore difficult. A long-term recurrence rate of Cushing's disease ranging from 2%-25% has been reported. Predictors of long-term remission reported include: 1) adenoma-related factors (aggressiveness, size, preoperative identification in MRI), 2) surgery-related factors, mainly neurosurgeon experience, 3) clinical factors, of which dependence on and duration of glucocorticoid treatment are most important, and 4) biochemical factors. Among the latter, low postoperative cortisol levels, less than 2 mcg/dL predict for disease remission. However, even when undetectable plasma cortisol levels are present, long-term recurrence may still occur and lifetime follow-up is required. We report the preliminary results of the first 20 patients with Cushing's disease operated on at our hospital using nadir cortisol levels less than 2 mcg/dl as remission criterion
Subject(s)
Humans , Pituitary ACTH Hypersecretion/surgery , Sphenoid Sinus/surgery , Hydrocortisone/blood , Treatment Outcome , RecurrenceABSTRACT
There is no consensus on the remission criteria for Cushing's disease or on the definition of disease recurrence after transsphenoidal surgery, and comparison of the different published series is therefore difficult. A long-term recurrence rate of Cushing's disease ranging from 2%-25% has been reported. Predictors of long-term remission reported include: 1) adenoma-related factors (aggressiveness, size, preoperative identification in MRI), 2) surgery-related factors, mainly neurosurgeon experience, 3) clinical factors, of which dependence on and duration of glucocorticoid treatment are most important, and 4) biochemical factors. Among the latter, low postoperative cortisol levels, less than 2 mcg/dL predict for disease remission. However, even when undetectable plasma cortisol levels are present, long-term recurrence may still occur and lifetime follow-up is required. We report the preliminary results of the first 20 patients with Cushing's disease operated on at our hospital using nadir cortisol levels less than 2 mcg/dl as remission criterion.
