Endoskopik transsfenoidal yaklaşımla ameliyat edilen ACTH salgılayan adenomlarda remisyonun değerlendirilmesi

MEHMET KORKMAZ

Endoskopik transsfenoidal yaklaşımla ameliyat edilen ACTH salgılayan adenomlarda remisyonun değerlendirilmesi

Thesis Type: Expertise In Medicine

Institution Of The Thesis: Kocaeli University, Tıp Fakültesi, Cerrahi Tıp Bilimleri, Turkey

Approval Date: 2010

Thesis Language: Turkish

Student: MEHMET KORKMAZ

Principal Supervisor (For Co-Supervisor Theses): İHSAN ANIK

Open Archive Collection: AVESIS Open Access Collection

Abstract:

Objective: The aim of this study is to analyze the relation between early and late post-operative cortisol values with remisson and to assess the other factors on remission.Materials\ Method: Twenty patients with Cushing Disease, underwent surgery between the years 2005-2009, were included. All of the patients underwent surgery through the endoscopic endonasal transsphenodial approach. Mean follow-up period was 29,7 months.Results: Of the cases, 16 (80%) were female and 4 (20%) were male and the mean age was 36,5 years. Among these 14 (70%) were microadenoma and 6 (30%) were macroadenoma. Caverneous sinus invasion was observed in 4 (20%) of the cases. Total resection was achieved in 18 (90%) of the patients, and 2 patients (10%) were reoperated due to residual tumor.Discussion: Remission criteria were accepted as the regression of the symptoms of Cushing disease and/or reaching to normal cortizol values in UFC levels and decreasing the basal cortisol levels to 1,8 microgr/dl via 1 mg suppression test. Remisson and the other factors that play role on remisson are compared with literature. In addition to the the cortisol values measured by dexamethazon suppression test which is considered to be the most important factor in the follow-up, basal cortisol levels are also correlate with remission in the long term. Parallel to the literature, we observed that macroadenom and cavernous sinus invasion have an effect on remission.Conclusion: All patients were operated via endoscopic transsphenodial approach. In 16 patients remission criteria?s were achieved about 80%. This ratio is parallel with the literature. Even we found out that basal cortisol values taken in postoperative long term period as a remission follow-up criteria, studies in a longer period with increased number of patients are required.Key words: ACTH Secreting pituitary adenomas, The Cushing Disease, endoscope, transphenodial approach, cavernous sinus invasion