MRI未见异常的库欣病的诊断和处理

:100730MRIMRI36MRI,1Nelson,3531,5360154,11536ACTH27,ACTH4,5,67%,19%MRI,,;ACTHMRIDiagnosisandmanagementofCushingpsdiseasewithnormalMRfindingXINGBing,RENZuyuan,SUChangbao,etal.Dept.ofNeurosurgery,PekingUnionMedicalCollegeHospital,Beijing100730,ChinaAbstractObjectiveTodiscussthediagnosisandmanagmentalprincipleofCushingpsdiseasewithnormalMRfinding.MethodsClinicaldataof36casesofCushingpsdiseasewithnormalMRfindingwereanalyzedretro2spectively.BesidesoneNelsonsyndromecase,theother35patientshadtypicalclinicalmanifestationsofhypercorti2coidism.EndocrinologicalassessmentsupportedthediagnosisofCushingpsdiseasein31,theother5caseshadatypi2calendocrinedata.Allpatientsweretreatedbytranssphenoidalpituitaryexploration.Thefollow2upperiodrangedfromhalfayearto4years(average115yrs).ResultsPathologicalexaminationconfirmedpituitaryACTHadenomain27,pituitaryACTHcellhyperplasiain4,noevidenceofadenomaorhyperplasiain5cases.Combinedwithen2docrinologicalresultsandclinicalfeatures,thecurativeandremissiveratiowas67%and19%respectivelyinourstudy.ConclusionsForpatientsofCushingpsdiseasewithnormalMRfinding,transsphenoidalpituitaryexplorationcouldbeusedifthepatienthavetypitalclinicalandendocrinologicalfeatures.PatientswithatypicalendocrinedatahaverelativesurgicalindicationsoifectopicACTHsecretingadenomacouldbeexcluded.KeywordsCushingpsdiseaseNormalMRIfindingTranssphenoidalsurgery,()ACTH,MRI1995200036MRI1.:7,29;1248,3113;214,3142.:1Nelson,35,30,6;16,7,36,4;6,24;1-,21,5;290320029185ChinJNeurosurg,September2002,Vol118,No15©1995-2005TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.3.:(F)24(UFCP24hr)ACTH,UFCP24hr100g34,100g2;F35,1;UFCP24hr100g31;5,,ACTHACTH17,19,1,ACTH560pgPml,UFCP24hrF,Nelson106MRI(Toshiba115T,T1T23mm),(4),9;4;MRI(Dy2namicMRI,DMRI)B()CT,7,4,ACTH4.:,6;21,9013018cm,0147cmHEACTH27,ACTH4,5(5,)5,ACTH4,16,23,14,7,21,101015mgP,6(1)100mgP,,624UFC80g,81100g,50%,50%,75%(27P36)ACTH,23,4ACTH4,1,1,25,2,3,67%,19%0154,115,MRI(),,,MRIACTH86%[1],MRI:T1[2],59%[3]MRI,:(1)MRI3mm,MRI;(2)MRI,T1MRI;(3),MRI,13%46%[4,5],34%,12%;,[5],MRI01320029185ChinJNeurosurg,September2002,Vol118,No15©1995-2005TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.MRI,,DMRI,,DMRI[1],,,,ACTH[6]MRI,MRI89%[7],MRI,,,,,,,,:;;,,,5,ACTH,,,[6],,,,[6],UFCP24hr,,,,MRI,90148%[8],MRI,,,MRIMRI,80%ACTH,0147cm,45mm[9],,,,,MRI;ACTH,,5,80%(4P5),MRI,,,,,,Knappe24,7018%[10]MRI,,,Nelson,,Nelson,MRI,[11],MRI,,1TabarinA,LaurentF,CatargiB,etal.ComparativeevaluationofconventionalanddynamicmagneticresonanceimagingofthepituitaryglandforthediagnosisofCushingpsdisease.ClinEndocrinol,1998,49:2932300.2ColomboN,VignatiL,ScialfaG.MRofcorticotropin2secretingpituit2arymicroadenomas.AmJNeuroradiol,1994,15:159121595.3BuchfelderM,NistorR,FahlbuschR,etal.TheaccuracyofCTandMRevaluationofthesellaturcicafordetectionofadrenocorticotropichor2mone2secretingadenomasinCushingdisease.AJNR,1993,14:118321190.4HallWA,LucianoMG,DoppmanJL,etal.Pituitarymagneticeso2nanceimaginginnormalhumanvolunteers:occultadenomasinthegen2eralpopulation.AnnInternMed,1994,120:8172820.5AhmadiH,LarssonEM,JinkinsJR.NormalpituitaryglandcoronalMRimagingofinfundibulartilt.Radiology,1990,177:3892392.6BochicchioD,LosaM,BuchfelderM,etal.FactorsinfluencingtheimmediateandlateoutcomeofCushingpsdiseasetreatedbytranssphenoi2dalsurgery:aretrospectivestudybytheEuropeanCushingpsdiseasesur2veygroup.JClinEndocrinol&Metab,1995,80:311423120.7LudeckeDK.TransnasalmicrosurgeryofCushingpsdisease1990over2viewincludingpersonalexperienceswith256patients.PathResPract,11320029185ChinJNeurosurg,September2002,Vol118,No15©1995-2005TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.1991,187:6082612.8,,,.ACTHCushing.,1989,5:225.9LacroixA.Cushingpsdisease:thechallengeoftumorsize.PresseMed,1997,26:426.10KnappeUJ,LudeckeDK.Persistentandrecurrenthypercortisolismaf2tertranssphenoidalsurgeryforCushingpsdisease.ActaNeurochirSuppl,1996,65:3124.11,,,.Nelson.,2001,17:426.(:2001209211:2002205227)(NO.96Z008),:836500,();()36(SHI),18(CVA2LH450,)0137101421(CVDI),01371421CT,CVDI24CV2DI,,,4833,35,CV2DI,()(13d)(414d)(15d);,()(13d)(4d)CVDI(CVS)8P182P18(P0105):14(1401922195cm3),3(9518314197cm3),1442%(P0105)1:2212%(4P18),5516%(10P18)(P0105);:3819%(7P18),6617%(12P18),,,:SHI,,,:414,,78,39147%,8CV2DICVS,85CVDICVS28CT,312CVS,1CVS,CVS,CT,CVDI,,,,CVS10,6,4CVDICVS,,,CVDI,SHI,,,(:2001205210:2001210219)21320029185ChinJNeurosurg,September2002,Vol118,No15©1995-2005TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.