The recovery time of hypothalamic-pituitary-adrenal axis after curative surgery in Cushing's disease and its related factor.

Humans Hypothalamo-Hypophyseal System Pituitary ACTH Hypersecretion / surgery Retrospective Studies Pituitary-Adrenal System Hypopituitarism Adrenal Insufficiency Hypothalamic Diseases Hydrocortisone
Central adrenal insufficiency Cushing’s disease Hypothalamic-pituitary-adrenal axis Recovery Total triiodothyronine

Journal

Endocrine
ISSN: 1559-0100
Titre abrégé: Endocrine
Pays: United States
ID NLM: 9434444

Informations de publication

Date de publication:
08 2023
Historique:
received: 03 11 2022
accepted: 17 05 2023
medline: 28 6 2023
pubmed: 7 6 2023
entrez: 7 6 2023
Statut: ppublish

Résumé

Patients with Cushing's disease (CD) experienced transient central adrenal insufficiency (CAI) after successful surgery. However, the reported recovery time of hypothalamic-pituitary-adrenal (HPA) axis varied and the related factors which could affect recovery time of HPA axis had not been extensively studied. This study aimed to analyze the duration of CAI and explore the factors affecting HPA axis recovery in post-operative CD patients with biochemical remission. Medical records of diagnosis with CD in Huashan Hospital were reviewed between 2014 and 2020. 140 patients with biochemical remission and regular follow-up after surgery were enrolled in this retrospective cohort study according to the criteria. Demographic details, clinical and biochemical information at baseline and each follow-up (within 2 years) were collected and analyzed. Overall, 103 patients (73.6%) recovered from transient CAI within 2 years follow-up and the median recovery time was 12 months [95% confidence intervals (CI): 10-14]. The age was younger and midnight ACTH at baseline was significantly lower, while the TT3 and FT3 levels were significantly higher in patients with recovered HPA compared to patients with persistent CAI at 2-year follow-up (p < 0.05). In persistent CAI group, more patients underwent partial hypophysectomy. TT3 at diagnosis was an independent related factor of the recovery of HPA axis, even after adjusting for gender, age, duration, surgical history, maximum tumor diameter, surgical strategy, and postoperative nadir serum cortisol level (p = 0.04, OR: 6.03, 95% CI: 1.085, 22.508). Among patients with unrecovered HPA axis at 2-year follow-up, 23 CAI patients (62%) were accompanied by multiple pituitary axis dysfunction besides HPA axis, including hypothyroidism, hypogonadism, or central diabetes insipidus. HPA axis recovered in 73.6% of CD patients within 2 years after successful surgery, and the median recovery time was 12 months. TT3 level at diagnosis was an independent related factor of postoperative recovery of HPA axis in CD patients. Moreover, patients coexisted with other hypopituitarism at 2-year follow-up had a high probability of unrecovered HPA axis.

Identifiants

DOI: 10.1007/s12020-023-03405-8 PMID: 37284972
pubmed: 37284972
doi: 10.1007/s12020-023-03405-8
pii: 10.1007/s12020-023-03405-8
doi:

Substances chimiques

Hydrocortisone WI4X0X7BPJ

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

349-356

Informations de copyright

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Références

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Auteurs

Qiaoli Cui (Q)

Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.

Xiaoyu Liu (X)

School of Life Sciences, Fudan University, Shanghai, 200438, China.
College of Life Sciences, Inner Mongolia University, Hohhot, 010021, Inner Mongolia, China.

Quanya Sun (Q)

Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.

Wanwan Sun (W)

Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.

Hangping Zheng (H)

Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.

Min He (M)

Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.

Zhaoyun Zhang (Z)

Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.

Zengyi Ma (Z)

Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.

Ming Shen (M)

Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.

Xuefei Shou (X)

Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.

Yao Zhao (Y)

Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.

Yiming Li (Y)

Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.

Yongfei Wang (Y)

Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.

Hongying Ye (H)

Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China. janeyhy@163.com.

Shuo Zhang (S)

Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China. zhangshuo@huashan.org.cn.
ORCID: 0000-0002-7446-0435

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questionsmedicales.fr › Système nerveux › Système neuroendocrinien › Axe hypothalamohypophysaire › The recovery time of...
questionsmedicales.fr › Maladies endocriniennes › Maladies de l'hypophyse › Hyperpituitarisme › Hypersécrétion hypophysaire d'ACTH › The recovery time of...
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questionsmedicales.fr › Système endocrine › Glandes endocrines › Axe hypophyso-surrénalien › The recovery time of...
questionsmedicales.fr › Maladies endocriniennes › Maladies de l'hypophyse › Hypopituitarisme › The recovery time of...
questionsmedicales.fr › Maladies endocriniennes › Maladies des surrénales › Insuffisance surrénale › The recovery time of...
questionsmedicales.fr › Maladies du système nerveux › Maladies du système nerveux central › Encéphalopathies › Maladies hypothalamiques › The recovery time of...
questionsmedicales.fr › Hormones corticosurrénaliennes › Hydroxycorticostéroïdes › 17-Hydroxycorticostéroïdes › Hydrocortisone › The recovery time of...