الفهرس 
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Abstract
Cushing’s disease is caused by a pituitary tumour that secretes adrenocorticotropic hormone (ACTH) autonomously, leading to excess cortisol secretion from the adrenal glands. The condition is associated with increased morbidity and mortality that can be alleviated by treatments that result in sustained endocrine remission. Endonasal transsphenoidal pituitary surgery (ETSS) remains the mainstay of treatment for Cushing’s disease but requires considerable neurosurgical expertise and experience in order to optimize patient outcomes. Up to 90% of patients with microadenomas (tumour below 1 cm in largest diameter) and 65% of patients with macroadenomas (tumour at or above 1 cm in greatest diameter) achieve endocrine remission after ETSS by an experienced surgeon.
If Cushing’s disease is not effectively treated, it is associated with hypertension, diabetes, obesity, osteoporosis, vascular disease, and shortened life span. Successful surgical removal of a Cushing’s disease -associated ACTH-secreting pituitary adenoma results in immediate biochemical remission and preservation of pituitary function. Early diagnosis of Cushing’s disease by clinical findings, endocrinological assessment, and imaging investigation is critical for effective surgical management. Therefore the aim of this research article was to establish and evaluate the outcomes the endonasal transsphenoidal endoscopic management of Adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas among patients admitted to neurosurgery unit, department of surgery, Minia university hospital Minia University, El-Minia, Egypt.
This study was conducted on twenty patients with Cushing’s disease due to pituitary adenomas. They were admitted and operated in Neurosurgery Unit, Department of Surgery, Minia University hospital, Minia University, El-Minia, Egypt in the period from January 2015 to July 2021.
The patients were subjected to preoperative and postoperative clinical, laboratory, endocrinological, and radiological examinations. Histopathological examination of the resected pituitary tumors was also done postoperatively. They were followed up for one year following surgical intervention to evaluate remission and relapse rate.
Sixteen of the twenty patients with Cushing’s disease due to pituitary adenomas involved in the present study were females and four were males. The preoperative clinical examination of the twenty patients involved in this study revealed that 80% of them had Cushinoid features which included striae rubra, centripetal obesity, supraclavicular fat, moon face and buffalo hump, while 20% of them had no Cushinoid features. It was also found that 65%, 75%, 75% and 20% of them had impaired glucose tolerance, hypertension, proximal myopathy and visual field defect respectively. Postoperatively, 5%, 15%, 15%, 25%, 10% of them had Cushinoid features, impaired glucose tolerance, hypertension, proximal myopathy and visual field defect respectively. The preoperative and postoperative laboratory investigations of blood HbA1c, urine cortisol, serum am. cortisol and ACTH showed that their concentrations were significantly increased preoperatively and they were statistically significantly decreased postoperatively. On the other hand, the levels of serum TSH and free T4 were not comparable preoperatively and postoperatively. The BMI of the studied Cushinoid patients showed significant improvement after surgical operation (24.69 ± 5.51 vs. 32.90 ± 1.86). No statistically significant alterations were found in the serum prolactin level and electrolytes in the studied Cushinoid patients preoperatively and postoperatively. The MRI radiological examinations revealed that 80% of the studied Cushinoid patients had microadenomas while 20% had macroadenomas. The histopathological examination confirmed the clinical and laboratory diagnoses. The postoperative complications were 10% CSF leakage, 20% Diabetes inspidus and 25% panhypopituitarism. The postoperative one follow up revealed 90% remission and 10% relapse.