Болезнь Иценко–кушинга – От Истории К Настоящему

Григорьев, А.Ю.; России, Фгбу «Нмиц эндокринологии» Минздрава; Иващенко, О.В.; Азизян, В.Н.; Надеждина, Е.Ю.; Арапова, С.Д.; Марова, Е.И.

doi:10.14341/conf22-25.09.21-246

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“…Эффективность перечисленных методов лечения различна, но следует признать, что большинство клиницистов придерживается той точки зрения, что методом выбора служит хирургическое лечение с применением как эндоскопических, так и микрохирургических методик удаления опухоли. Имеются данные, что при сравнении микрохирургического и эндоскопического подхода при лечении акромегалии эффективность каждого примерно одинаковая и составляет 68 % [6]. Цель оперативного лечения -нормализация уровней СТГ и инсулиноподобного фактора роста 1 (ИФР-1) за счет тотального удаления опухоли, а при невозможности радикального удаления -за счет уменьшения ее массы [7][8][9][10].…”

Section: Introductionunclassified

Intraoperative characteristics of somatotropinomas

Senko

Крылов

Dashyan

et al. 2023

Nejrohirurgiâ (Mosk.)

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Background. Acromegaly is a rare disease associated with insulin‑like growth factor 1 hyperproduction due to the presence of pituitary adenoma in the patient. The first‑line treatment of such patients is surgical removal of the formation in order to normalize hormonal status. The main predictors of the ineffectiveness of surgical treatment and relapse of the disease are large tumor size, tumor invasion into the cavernous sinus, and high preoperative levels of growth hormone, as well as Ki‑6 % expression. The search for additional risk factors for disease recurrence, which according to various sources is approximately 30 % after primary surgical treatment, is an urgent task for researchers. In our work, we studied the intraoperative characteristics of the tumor, size of pituitary adenomas according to preoperative magnetic resonance imaging of the brain, degree of invasion of the tumor into the cavernous sinus according to the Knosp classification and compared them with disease outcomes after a year of follow‑up after surgical treatment.Aim. To identify new markers of aggressive progression of pituitary tumors.Materials and methods. A retrospective analysis of medical documentation, protocols of operations of 90 patients aged between 19 and 73 years with the diagnosis of growth hormone‑secreting pituitary adenoma was performed. The dia gnosis was confirmed based on clinical picture, laboratory and instrumental examination methods. All patients underwent endoscopic transsphenoidal removal of pituitary adenoma by one surgeon in one medical institution between 2017 and 2019.Results. Intraoperative characteristics of the tumor, such as the color of the solid component, density, degree of vascularization were compared with the results of laboratory and instrumental data, as well as the results of surgical treatment after a year of follow‑up.Conclusion. Such intraoperative characteristics of growth hormone‑secreting pituitary adenomas as the purplish‑gray color of the solid component, high vascularization, as well as dense‑elastic consistency of the tumor, can be considered high risk factors for continued tumor growth in the first 6 months after surgical treatment or relapse of the disease during a year of follow‑up.

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