Journals / İstanbul Üniversitesi İstanbul Tıp Fakültesi Mecmuası / 1999 / Cilt: 62 - Sayı: 3
Cushing's syndrome: Clinical and laboratory evaluation and the results of therapy in forty-five patients
- Pages
- 237–242
- DOI
- —
Abstract
In this study 45 patients with Cushing's syndrome (41 female, 4 male; mean age: 34± 12.3 years) who were to our clinic between the years 1983 and 1998 were retrospectively evaluated for clinical and laboratory features and modes of treatment. Cushing's disease was diagnosed in 31patients (69%), surrenal adenoma in 11 patients (24.4%) and surrenal carcinoma in 3 patients (6.6%). Centripedal obesity, hypertension, moon facies, hirsutism, stria were freguent findings. No significant difference in the basal cortisol levels between patients with Cushing's disease and patients with surrenal tumors was observed. Sensivity and specivity of the high dose dexamethasone suppression test in distinguishing Cushing's disease was found to be 81% and 100%, respectively. All of the patients with surrenal tumors were not suppressed with high dose dexamethasone suppression test. Sellar CT and/or MR accurately identified the tumor in 58% of these patients. Recurrence was observed in 3 (14%) out of 21 patients with Cushing's disease treated by transsphenoidal adenomectomy. Recurrence were diagnosed 1.5, 3 and 6 years after the operation in these 3 patients. In our series bilateral surrenalectomy plus pituitary irradiation achieved the highest remission rate (100%) in Cushing's disease. In 2 out of 4 patients (50%) treated by left adrenalectomy associated with pituitary irradiation, recurrence was observed. Panhypopituitarism due to tumor apoplexy was observed in one patients with a diagnosing of Cushing's disease. All of the patients with adrenal adenoma, the tumor was accurately localised before the operation. The appropriate operative procedure resulted in remission in all of the patients. One patient with adrenal carcinoma died within six months after unilateral adrenalectomy despite continued medical treatment with mitotane. Bilateral adrenalectomy plus pituitary irradiation achieved the highest remission rates. However, the better remission rates are recently achieved with pituitary surgery in our series.
Özet
Bu çalışmada kliniğimizde 1983-1998 yıllara arasında takip ve tedavi edilen Cushing sendromlu 45 hasta (41 kadın, 4 erkek; yaş ortalaması 34 ± 12.3 yıl) klinik ve laboratuar özellikleri ve tedavi yöntemleri açısından retrospektif olarak değerlendirildi. Otuz bir (%69) olguda Cushing hastalığı,11 olguda (%24.4) sürrenal adenomu ve 3 olguda (%6.6) sürrenal karsinomu saptandı. Hastalarda en sık rastlanan klinik özellikleri sentripedal obesite, hipertansiyon, aydede yüzü, tüylenme artışı ve stria olduğu görüldü. Cushing hastalığı ile sürrenal kaynaklı Cushing hastalığı ile sürrenal kaynaklı Cushing sendromu karşılaştırıldığında bazal kortizol seviyeleri arasında iki grup arasında anlamlı bir fark saptanmadı. Sekiz mg'lık deksametazon supresyon testinin (DST) Cushing hastalığını ayırt etmedeki sensitivitesi % 81, spesifitesi % 100 olarak bulundu. Sürrenal tümörlü hiç bir olguda 8 mg'lık DST ile supresyon sağlanamadı. İki hasta grubu arasındaki fark istatistiksel olarak anlamlıydı (p