Kocaeli Med J. 2017; 6(3): 7-12

Predicting factors of recurrence in patients with Cushing's Disease

Alev Selek
Department Of Endocrinology, Kocaeli University Faculty Of Medicine

INTRODUCTION: Introduction: Cushing's Disease (CD) has high recurrence rate therefore clinical features predicting recurrence should be defined to discriminate patients with high risk. These factors can effect management and follow-up frequency.
Aim: We aimed to compare the clinical features of the patients with recurrent CD (RD) and sustained remission (SR) in order to determine clinical factors that might predict disease recurrence.

METHODS: Surgically treated 85 patients with CD were evaluated retrospectively. Preoperative diagnostic tests and postoperative disease activity were noted. Pituitary tumor size, invasiveness and features such as p53 and Ki-67 immunohistochemical staining data also postoperative cortisol axis recovery time were evaluated.
RESULTS: 16 RD and 54 SR patients were enrolled to the study. Preoperative ACTH but not cortisol levels were higher in RD group. RD patients had higher preoperative adenoma size and cavernous sinus invasion rate and Ki-67 index than SR group. Eleven (69%) patients with RD had early recovery time while 6 (11%) patients in SR group.
DISCUSSION AND CONCLUSION: Higher preoperative ACTH levels, tumor size, cavernous sinus invasion and Ki-67 immunostaining would predict recurrence in CD. Additionally, rapid recovery of cortisol axis was found to be related with recurrence.

Keywords: Cushing's Disease, recurrent Cushing's Disease, HPA axis recovery time

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Cushing hastalýðýnda nüksü öngören faktörler

Alev Selek
Kocaeli Üniversitesi Týp Fakültesi, Endokrinoloji Bd

GÝRÝÞ ve AMAÇ: Giriþ: Cushing Hastalýðýnýn nüks oraný yüksektir; bu nedenle, nüksü öngören klinik özellikler, yüksek riskli hastalarý belirlemek için tanýmlanmalýdýr. Bu faktörler hastalýðýn yönetimini ve izlem sýklýðýný etkileyebilir.
Amaç: Nüks etmiþ CH (RD) ve uzun sürekli remisyon (SR) saðlanmýþ hastalarýn klinik özelliklerini karþýlaþtýrarak hastalýk nüksünü öngören klinik faktörleri belirlemeyi amaçladýk.

YÖNTEM ve GEREÇLER: Cerrahi tedavi uygulanan 85 CH olan hasta retrospektif olarak deðerlendirildi. Preoperatif taný testleri ve postoperatif hastalýk aktivitesi kaydedildi. Hipofiz tümör boyutu, invazyonu, p53 ve Ki-67 immünhistokimyasal boyama verileri ile postoperatif kortizol aksý geridönüþ zamaný deðerlendirildi.
BULGULAR: Çalýþmaya 16 RD ve 54 SR hastasý alýndý. Preoperatif ACTH düzeyleri RD grubunda daha yüksekti. RD hastalarýnda preoperatif adenom boyutu ve kavernöz sinüs invazyonu ile Ki-67 indeksi SR grubuna göre daha yüksekti. RD'li 11 hastada (% 69) hýzlý kortizol aksý geridönüþü görülürken SR grubunda sadece 6 hastada (% 11) vardý.
TARTIÞMA ve SONUÇ: Preoperatif ACTH yüksekliði, atmýþ tümör boyutu, kavernöz sinüs invazyonu ve yüksek Ki-67 indeksi, Cushing hastalýðýnda nüksü öngörebilir faktörlerdir. Bununla birlikte, hýzlý kortizol aksý geridönüþü de nüks ile iliþkili bulunmuþtur.

Anahtar Kelimeler: Cushing Hastalýðý, Nüks Cushing Hastalýðý, HPA aks geri gönüþ zamaný

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