目的：确定与库欣病（CD）手术缓解相关的术前因素。
方法：确定了2014-2021年在我们中心随访的所有ACTH依赖性库欣综合征患者（n=40）。包括由同一神经外科医生（n=32）进行经蝶入路手术的CD诊断患者。手术缓解定义为术后血浆皮质醇<1.8μg/dl和正常或低尿游离皮质醇（UFC）。
结果：63％（n=20）是女性，诊断时的平均年龄为42.3±17.9岁。六个病人有大型腺瘤,17例有微腺瘤，在其他9名患者中，MRI未发现垂体损伤.先前在另一个中心对7名患者进行了手术。手术缓解率达到75%(n=24)。只有3名患者出现复发。术前人口统计学(年龄，性别,合并症)或荷尔蒙(UFC，ACTH,深夜唾液皮质醇水平）特征和手术缓解的可能性。与更大的缓解机会相关的唯一变量是MRI上腺瘤的术前可视化（OR8.3，P=0.02）。还观察到，既往有垂体手术史的患者获得缓解的趋势较低，虽然没有达到统计学意义(OR0.17,P=0.09)。
结论：根据我们的经验，75%的CD患者干预后取得生化医治。在那些在干预前观察到腺瘤的患者中，手术缓解的频率高达八倍。但没有确定其他术前治愈的预测因素。
OBJECTIVE: Identify presurgical factors associated with surgical remission in Cushing\'s disease (CD).
METHODS: All the patients with ACTH-dependent Cushing\'s Syndrome in follow-up at our centre between 2014-2021 (n=40) were identified. Those patients with CD diagnosis who underwent transsphenoidal surgery by the same neurosurgeon (n=32) were included. Surgical remission was defined as plasma cortisol <1.8μg/dl and normal or low urinary free cortisol (UFC) after surgery.
RESULTS: Sixty-three per cent (n=20) were women, and the mean age at diagnosis was 42.3±17.9 years. Six patients had macroadenomas, 17 had microadenomas, and in the other 9 patients, no pituitary lesion was identified on the MRI. Seven patients were previously operated on in another centre. Surgical remission was achieved in 75% (n=24). Only three patients experienced recurrence. No association between pre-surgical demographic (age, sex, comorbidities) or hormonal (UFC, ACTH, late-night salivary cortisol levels) characteristics and the probability of surgical remission was observed. The only variable associated with a greater chance of remission was the presurgical visualisation of the adenoma on MRI (OR 8.3, P=0.02). It was also observed that patients with a history of a previous pituitary surgery had a lower tendency to achieve remission, although statistical significance was not reached (OR 0.17, P=0.09).
CONCLUSIONS: In our experience, 75% of patients with CD achieved biochemical cure after the intervention. Surgical remission was up to eight times more frequent in those patients in whom the adenoma was visualised before the intervention, but no other presurgical predictive factors of cure were identified.
