Journal of Korean Neurosurgical Society
- 제29권10호
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- Pages.1316-1321
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- 2000
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- 2005-3711(pISSN)
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- 1598-7876(eISSN)
성인 쿠싱병의 치료성적과 예후인자
Treatment Outcome and Prognostic Factors of Cushing's Disease in Adults
- 박철기 (서울대학교 의과대학 신경외과학교실) ;
- 황승균 (서울대학교 의과대학 신경외과학교실) ;
- 곽호신 (서울대학교 의과대학 신경외과학교실) ;
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유헌
(인제대학교 서울백병원 신경외과학교실) ;
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정영섭
(서울대학교 의과대학 신경외과학교실) ;
-
백선하
(서울대학교 의과대학 신경외과학교실) ;
- 김동규 (서울대학교 의과대학 신경외과학교실) ;
- 정희원 (서울대학교 의과대학 신경외과학교실) ;
- 김성연 (서울대학교 의과대학 내과학교실) ;
- 홍승관 (강원대학교 의과대학 신경외과학교실)
- Park, Chul-Kee (Department of Neurosurgery, Seoul National University College of Medicine) ;
- Hwang, Sung Kyun (Department of Neurosurgery, Seoul National University College of Medicine) ;
- Gwak, Ho-Shin (Department of Neurosurgery, Seoul National University College of Medicine) ;
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Yoo, Heon
(Department of Neurosurgery, Inje University Seoul Paik Hospital) ;
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Chung, Young Seob
(Department of Neurosurgery, Seoul National University College of Medicine) ;
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Paek, Sun Ha
(Department of Neurosurgery, Seoul National University College of Medicine) ;
- Kim, Dong Gyu (Department of Neurosurgery, Seoul National University College of Medicine) ;
- Jung, Hee-Won (Department of Neurosurgery, Seoul National University College of Medicine) ;
- Kim, Seong Yeon (Department of Internal Medicine, Seoul National University College of Medicine) ;
- Hong, Seung Kuan (Department of Neurosurgery, Kangwon National University College of Medicine)
- 투고 : 2000.03.09
- 심사 : 2000.07.25
- 발행 : 2000.10.28
초록
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 success.