Abstract：
OBJECTIVE: Our aim was to characterise a cohort of patients with Cushing\'s disease (CD) who did not present pituitary adenoma in magnetic resonance imaging (MRI), needing a catheterisation of the inferior petrosal sinus (CIPS), and to study the pathological findings of the pituitary gland in these subjects after transsphenoidal surgery in order to establish the aetiology of CD. Furthermore, we evaluated possible differences in the features of the diagnosis between hyperplasia and adenoma.
METHODS: We included 16 subjects. 17 CIPS were done. Hormonal parameters were measured using standard methods. A microscopic histochemical study following standard procedures and immunohistochemical analysis was performed. The diagnostic criteria for adenoma and hyperplasia were based on the WHO classification.
RESULTS: One patient was excluded for presenting an ACTH-producing bronchial neuroendocrine tumour. The 15 subjects with CD have a positive CIPS test indicating hypophyseal ACTH production. After transsphenoidal surgery, 12 patients showed a microadenoma and three (20%) a corticotroph cell hyperplasia. We found four recurrences after the transsphenoidal surgery (26%), with a mean time for recurrence of 105 months. We found that recurrence was more frequent in subjects with hyperplasia, and in those subjects with lower right/left ACTH ratio.
CONCLUSIONS: Our study, which was focused on patients with CD with no pituitary adenoma detected by MRI and a positive CRH test after CIPS, has found that 20% showed corticotroph cell hyperplasia as the cause of CD. Right/left ACTH ratio after CIPS was useful to differentiate adenoma from hyperplasia. This finding may have important prognostic and treatment implications. More studies are necessary to confirm our result.
METHODS: We included 16 subjects. 17 CIPS were done. Hormonal parameters were measured using standard methods. A microscopic histochemical study following standard procedures and immunohistochemical analysis was performed. The diagnostic criteria for adenoma and hyperplasia were based on the WHO classification.
RESULTS: One patient was excluded for presenting an ACTH-producing bronchial neuroendocrine tumour. The 15 subjects with CD have a positive CIPS test indicating hypophyseal ACTH production. After transsphenoidal surgery, 12 patients showed a microadenoma and three (20%) a corticotroph cell hyperplasia. We found four recurrences after the transsphenoidal surgery (26%), with a mean time for recurrence of 105 months. We found that recurrence was more frequent in subjects with hyperplasia, and in those subjects with lower right/left ACTH ratio.
CONCLUSIONS: Our study, which was focused on patients with CD with no pituitary adenoma detected by MRI and a positive CRH test after CIPS, has found that 20% showed corticotroph cell hyperplasia as the cause of CD. Right/left ACTH ratio after CIPS was useful to differentiate adenoma from hyperplasia. This finding may have important prognostic and treatment implications. More studies are necessary to confirm our result.
摘要：
目的：我们的目的是描述一组库欣病（CD）患者的特征，这些患者在磁共振成像（MRI）中没有出现垂体腺瘤，需要对岩下窦（CIPS）进行导管插入，并研究经蝶窦手术后这些受试者垂体的病理发现，以确定CD的病因。此外，我们评估了增生和腺瘤诊断特征的可能差异.
方法：我们纳入了16名受试者。完成17CIPS。使用标准方法测量激素参数。按照标准程序和免疫组织化学分析进行显微镜组织化学研究。腺瘤和增生的诊断标准基于WHO分类。
结果：一名患者因出现产生ACTH的支气管神经内分泌肿瘤而被排除。15名CD患者的CIPS测试为阳性，表明垂体ACTH产生。经蝶窦手术后,12例患者显示出微腺瘤和3例（20％）促肾上腺皮质激素细胞增生。我们发现4例经蝶窦手术后复发（26%），平均复发时间为105个月。我们发现增生患者的复发更为频繁，以及右/左ACTH比值较低的受试者。
结论：我们的研究，重点是MRI未检测到垂体腺瘤的CD患者，CIPS后CRH测试阳性，已发现20％的促肾上腺皮质激素细胞增生是CD的原因。CIPS后右/左ACTH比值有助于区分腺瘤和增生。这一发现可能具有重要的预后和治疗意义。需要更多的研究来证实我们的结果。
方法：我们纳入了16名受试者。完成17CIPS。使用标准方法测量激素参数。按照标准程序和免疫组织化学分析进行显微镜组织化学研究。腺瘤和增生的诊断标准基于WHO分类。
结果：一名患者因出现产生ACTH的支气管神经内分泌肿瘤而被排除。15名CD患者的CIPS测试为阳性，表明垂体ACTH产生。经蝶窦手术后,12例患者显示出微腺瘤和3例（20％）促肾上腺皮质激素细胞增生。我们发现4例经蝶窦手术后复发（26%），平均复发时间为105个月。我们发现增生患者的复发更为频繁，以及右/左ACTH比值较低的受试者。
结论：我们的研究，重点是MRI未检测到垂体腺瘤的CD患者，CIPS后CRH测试阳性，已发现20％的促肾上腺皮质激素细胞增生是CD的原因。CIPS后右/左ACTH比值有助于区分腺瘤和增生。这一发现可能具有重要的预后和治疗意义。需要更多的研究来证实我们的结果。
