neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2020-22-1-39-48neurosurgery-833Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTИсходы нейрохирургического лечения пациентов с невизуализируемой аденомой и микроаденомой гипофиза при болезни Иценко–КушингаOutcomes of neurosurgical treatment of patients with non-visualized adenoma and microadenoma of the pituitary gland and with Cushing’s diseasehttps://orcid.org/0000-0002-6109-7550ИващенкоО. В.IvashchenkoO. V.

117036 Москва, ул. Дмитрия Ульянова, 11

 

11 Dmitriya Ulyanova St., Moscow 117036

leviv@rambler.ruhttps://orcid.org/0000-0002-9575-4520ГригорьевА. Ю.GrigorievA. Yu.

117036 Москва, ул. Дмитрия Ульянова, 11

11 Dmitriya Ulyanova St., Moscow 117036

https://orcid.org/0000-0001-9718-6099АзизянВ. Н.AzizyanV. N.

117036 Москва, ул. Дмитрия Ульянова, 11

11 Dmitriya Ulyanova St., Moscow 117036

https://orcid.org/0000-0002-9459-6428НадеждинаЕ. Ю.NadezhdinaE. Yu.

117036 Москва, ул. Дмитрия Ульянова, 11

11 Dmitriya Ulyanova St., Moscow 117036

https://orcid.org/0000-0002-6733-0958РеброваО. Ю.RebrovaO. Yu.

117997 Москва, ул. Островитянова, 1; 101000 Москва, ул. Мясницкая, 20

1 Ostrovitianovа St., Moscow 117997; 20 Myasnitskaya St., Moscow 101000

https://orcid.org/0000-0003-4353-6705ЛапшинаА. М.LapshinaA. M.

117036 Москва, ул. Дмитрия Ульянова, 11

11 Dmitriya Ulyanova St., Moscow 117036

https://orcid.org/0000-0002-4266-2171КолесниковаГ. С.KolesnikovaG. S.

117036 Москва, ул. Дмитрия Ульянова, 11

11 Dmitriya Ulyanova St., Moscow 117036

ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава РоссииРоссияNational Medical Research Center of Endocrinology, Ministry of Health of RussiaRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава России; ФГАОУ ВО «Национальный исследовательский университет “Высшая школа экономики”»РоссияN.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia; National Research University “Higher School of Economics”Russian Federation2020110420202213948Copyright © Иващенко О.В., Григорьев А.Ю., Азизян В.Н., Надеждина Е.Ю., Реброва О.Ю., Лапшина А.М., Колесникова Г.С., 20202020Иващенко О.В., Григорьев А.Ю., Азизян В.Н., Надеждина Е.Ю., Реброва О.Ю., Лапшина А.М., Колесникова Г.С.Ivashchenko O.V., Grigoriev A.Y., Azizyan V.N., Nadezhdina E.Y., Rebrova O.Y., Lapshina A.M., Kolesnikova G.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/833

Цель исследования – сравнить до- и интраоперационные характеристики, а также результаты нейрохирургического лечения пациентов с невизуализируемой аденомой и микроаденомой гипофиза при болезни Иценко–Кушинга.

Материалы и методы

Материалы и методы. Проведен анализ результатов транссфеноидальной аденомэктомии у 102 пациентов с невизуализируемой аденомой и 360 пациентов с микроаденомой гипофиза и подтвержденной болезнью Иценко–Кушинга. Гипофизарный генез эндогенного АКТГ-зависимого гиперкортицизма у 182 пациентов был доказан путем селективного забора крови из нижних каменистых синусов cо стимуляцией десмопрессином. В исследование вошло 369 женщин и 93 мужчины в возрасте от 16 до 64 лет. Все пациенты были оперированы с использованием трансназального доступа и эндоскопических технологий.

Результаты

Результаты. Среди пациентов с невизуализируемой аденомой преобладали мужчины (p = 0,005), у них чаще встречался тяжелый гиперкортицизм (p = 0,021). В этой группе статистически значимо чаще наблюдался инвазивный рост (53 % против 39 %) (р = 0,017), что, в свою очередь, привело к выбору более агрессивной интраоперационной тактики (р <0,001) и более частому развитию гипотиреоза (11 % против 4 %) (р = 0,028) в раннем послеоперационном периоде. Ранняя послеоперационная ремиссия зарегистрирована у 73 (72 %) из 102 пациентов с невизуализируемой аденомой и у 314 (87 %) из 360 пациентов с микроаденомой (р <0,001).

Заключение

Заключение. Ранние результаты первичной транссфеноидальной аденомэктомии у пациентов с невизуализируемой аденомой гипофиза статистически значимо хуже, чем у пациентов с микроаденомой, выявленной при магнитно-резонансной томографии (1,5 Тл), что, вероятнее всего, объясняется более часто встречающимся у них инвазивным ростом, который обусловливает увеличение объема оперативного вмешательства и возможное усиление послеоперационного гипопитуитаризма.

The study objective is to compare pre- and intraoperative characteristics, and the results of neurosurgical treatment in patients with Cushing’s disease, non-visualized adenoma and microadenoma of the pituitary gland.

Materials and methods

Materials and methods. The results of transsphenoidal adenomectomy were analyzed in 102 patients with non-visualized corticotropinomas and 360 patients with microcorticotropinomas. The pituitary genesis of endogenous ACTH-dependent hypercorticism in 182 patients was proved by the results of selective blood sampling from inferior petrosal sinus with stimulation desmopressin. The study included 369 women and 93 men aged 16 to 64 years. All patients were operated by transnasal approach using endoscopic techniques.

Results

Results. The group with non-visualized adenoma was dominated by men (p = 0.005) and patients with severe hypercorticism (p = 0.021). When comparing intraoperative characteristics in this group, invasive growth was statistically significantly more frequent (53 % vs 39 %) (p = 0.017), which in turn led to more aggressive intraoperative tactics (p <0.001) and more frequent development of hypothyroidism (11 % vs 4 %) (p = 0.028) in the early postoperative period. Early postoperative remission occurred in 73 (72 %) of 102 patients with non-visualized adenoma and in 314 (87 %) of 360 patients with microadenoma (p <0.001).

Conclusion

Conclusion. Early results of primary transsphenoidal adenomectomy in patients with non-visualized pituitary adenoma were significantly worse in comparison with patients with microadenoma detected by 1.5 T magnetic resonance imaging, which have more frequently invasive growth, what leads to an increase in the volume of surgery and a possible increase in postoperative hypopituitarism.

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The authors declare that there are no conflicts of interest present.