S-Space College of Medicine/School of Medicine (의과대학/대학원) Neurosurgery (신경외과학전공) Journal Papers (저널논문_신경외과학전공)
성인 쿠싱병의 치료성적과 예후인자
Treatment Outcome and Prognostic Factors of Cushing's Disease in Adults
- 박철기; 황승균; 곽호신; 유헌; 정영섭; 백선하; 김동규; 정희원; 김성연; 홍승관
- Issue Date
- Journal of Korean Neurosurgical Society
- J Korean Neurosurg Soc 29(10):1316-1321,2000
- Objectives：The authors analyzed the surgical series of Cushing’s disease to evaluate the proper treatment policy
and to verify the possible prognostic factors.
Material and Methods：Of 50 patients diagnosed as Cushing’s disease and operated at Department of Neurosurgery
of our institute between 1988 and 1999, 48 patients with available medical records were analyzed retrospectively.
Mean follow-up period was 48 months(3 to 109 months). Preoperative diagnosis was made after evaluating the
patients with multiple-stage endocrinological studies and 31 selective patients were evaluated with inferior petrosal
sinus sampling(IPSS). Magnetic resonance imaging(MRI) and/or high resolution computerized tomography(CT)
was done in all patients. A total of 51 transsphenoidal adenomectomy(TSA) were performed including 3 revision for
initial surgical failure cases. Remission was decided on the basis of both endocrinological criteria and clinical status.
Radiation and/or ketoconazole therapy were applied to failed cases. For the verification of prognostic factors, the
authors evaluated the statistical significance of multiple variables over remission rate by chi-square test.
Result：Sensitivity of IPSS for central localization was 93.5% which was better than that of MRI(87.5%). But for
lateralization, it was 72.4% for IPSS versus MRI 90.5%. Success rate of TSA was 82%(42/51) and recurrence rate was
9%(4/48). When including adjuvant treatments for surgically failed cases, overall success rate was 89.6% and all of 3
reoperated cases(TSA) due to recurrence were successful. Significant complication occurred in 7.8%(4/51) after
TSA including hypopituitarism, diabetes insipidus, and visual loss. Non-existence of tumor in MRI and prolonged
symptom duration(>3 years) were significant prognostic factors.
Conclusion：TSA can be considered as initial treatment for Cushing’s disease. In surgically failed cases, multiple
treatment modality may improve the overall outcome and repeated TSA for recurrent cases seem to provide similar
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