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目的 探讨MRI未见异常的库欣病的诊断和处理原则。方法 回顾性分析 36例MRI未见异常的库欣病的临床资料 ,除 1例Nelson综合征外 ,其余 35例均有典型的皮质醇增多症的表现。内分泌学检查符合库欣病 31例 ,不典型 5例。 36例均行经蝶窦垂体探查术。随访时间 0 5～ 4年 ,平均 1 5年。结果 36例中病理为垂体ACTH腺瘤 2 7例 ,垂体ACTH细胞增生 4例 ,未见肿瘤或增生 5例。结合内分泌检查及临床表现 ,全组治愈率为 6 7% ,缓解率为 19%。结论 对于MRI未见异常的库欣病 ,如果临床和内分泌学典型 ,可行经蝶窦垂体探查术 ;对内分泌学检查不典型而临床排除异位ACTH腺瘤的患者有手术探查的相对适应证。
Objective To investigate the principles of diagnosis and management of Cushing’s disease without MRI abnormalities. Methods Retrospective analysis of 36 cases of Cushing’s disease without abnormal clinical data, in addition to a case of Nelson syndrome, the remaining 35 cases have a typical performance of cortisol hypersecretion. Endocrinological examination in line with Cushing’s disease in 31 cases, atypical in 5 cases. 36 cases were performed transsphenoidal pituitary exploration. Follow-up time 0 5 ~ 4 years, an average of 15 years. Results The pathology of 36 cases was pituitary ACTH adenoma 27 cases, pituitary ACTH cell hyperplasia 4 cases, no tumor or hyperplasia in 5 cases. Combined with endocrine examination and clinical manifestations, the overall cure rate was 67%, the response rate was 19%. Conclusions For Cushing’s disease without abnormal MRI, if the clinical and endocrinology is typical, transsphenoidal pituitary exploration is feasible. For patients with clinically excluded ectopic ACTH adenocarcinoma who have not endocrinologic examination, there are relative indications for surgical exploration.