目的:库欣病(CD)患者手术成功后出现短暂性中枢肾上腺功能不全(CAI)。然而,报道的下丘脑-垂体-肾上腺(HPA)轴的恢复时间各不相同,影响HPA轴恢复时间的相关因素尚未得到广泛研究。本研究旨在分析生化缓解的CD术后患者CAI持续时间,探讨影响HPA轴恢复的因素。
方法:回顾性分析2014-2020年华山医院诊断CD的病历。根据标准,140例生化缓解和术后定期随访的患者被纳入这项回顾性队列研究。人口统计细节,收集并分析基线和每次随访(2年内)时的临床和生化信息.
结果:总体而言,103例患者(73.6%)在2年内从一过性CAI中恢复,中位恢复时间为12个月[95%置信区间(CI):10-14]。年龄较年轻,基线时午夜ACTH明显较低,而在2年随访时,HPA恢复患者的TT3和FT3水平明显高于持续CAI患者(p<0.05)。在持续CAI组中,更多的患者接受了部分垂体切除术。诊断时TT3是HPA轴恢复的独立相关因素,即使在调整了性别之后,年龄,持续时间,手术史,肿瘤最大直径,手术策略,和术后最低点血清皮质醇水平(p=0.04,OR:6.03,95%CI:1.085,22.508)。在2年随访时HPA轴未恢复的患者中,23例(62%)CAI患者除HPA轴外还伴有多发性垂体轴功能障碍,包括甲状腺功能减退,性腺功能减退,或中心性尿崩症。
结论:73.6%的CD患者手术成功后2年内HPA轴恢复,中位恢复时间为12个月。诊断时TT3水平是CD患者术后HPA轴恢复的独立相关因素。此外,2年随访时合并其他垂体功能减退的患者HPA轴无法恢复的可能性很高.
Patients with Cushing\'s disease (CD) experienced transient central adrenal insufficiency (CAI) after successful surgery. However, the reported recovery time of hypothalamic-pituitary-adrenal (HPA) axis varied and the related factors which could affect recovery time of HPA axis had not been extensively studied. This study aimed to analyze the duration of CAI and explore the factors affecting HPA axis recovery in post-operative CD patients with biochemical remission.
Medical records of diagnosis with CD in Huashan Hospital were reviewed between 2014 and 2020. 140 patients with biochemical remission and regular follow-up after surgery were enrolled in this retrospective cohort study according to the criteria. Demographic details, clinical and biochemical information at baseline and each follow-up (within 2 years) were collected and analyzed.
Overall, 103 patients (73.6%) recovered from transient CAI within 2 years follow-up and the median recovery time was 12 months [95% confidence intervals (CI): 10-14]. The age was younger and midnight ACTH at baseline was significantly lower, while the TT3 and FT3 levels were significantly higher in patients with recovered HPA compared to patients with persistent CAI at 2-year follow-up (p < 0.05). In persistent CAI group, more patients underwent partial hypophysectomy. TT3 at diagnosis was an independent related factor of the recovery of HPA axis, even after adjusting for gender, age, duration, surgical history, maximum tumor diameter, surgical strategy, and postoperative nadir serum cortisol level (p = 0.04, OR: 6.03, 95% CI: 1.085, 22.508). Among patients with unrecovered HPA axis at 2-year follow-up, 23 CAI patients (62%) were accompanied by multiple pituitary axis dysfunction besides HPA axis, including hypothyroidism, hypogonadism, or central diabetes insipidus.
HPA axis recovered in 73.6% of CD patients within 2 years after successful surgery, and the median recovery time was 12 months. TT3 level at diagnosis was an independent related factor of postoperative recovery of HPA axis in CD patients. Moreover, patients coexisted with other hypopituitarism at 2-year follow-up had a high probability of unrecovered HPA axis.