| Objective:The objective of this research is to collect and retrospectively analyze ACTH-dependent Cushing’s syndrome patients clinical data, summarize the clinical and therapeutic features of subtypes of the disease, evaluate the therapeutic effect, and raise the level of clinician awareness and treatment of the disease.Methods:67copies of complete medical records of the surgical treatments of ACTH-dependent Cushing’s syndrome patients from January2003to December2013in the First Affiliated Hospital of Guangxi Medical University were collected, and according to their sub-pathology, divided into the adrenal adenoma group (52cases) and the adrenal cortical nodular hyperplasia group (15cases), and retrospective statistical description and inference were conducted with the application of SPSS22, based on general information on the two groups of patients (sex, age, body type, admission blood pressure, duration, ipsilateral, clinical manifestations), laboratory examinations the results (admission electrolytes, glucose, lipids, and serum cortisol rhythm,24-hour urinary free cortisol, ACTH and rhythm, urinary B-adrenal CT), surgical cases (when surgery, surgical, blood transfusion, the amount of bleeding, the total drainage volume, tumor size), postoperative conditions (after electrolyte, discharge pressure, gross specimens, pathology constitutes postoperative hospital stay, total hospitalization days), hormone replacement therapy, and other sources of literature.Results:1. the female proportion of adenomas (83%) is larger compared with that of hyperplasia (53%)(P=0.030);.2. The average age of adenoma group (30.2±9.4years old) is lower than the proliferation group (44.3±11.6years)(P=0.011), high incidence from20to40years old in the adenoma group, and from30to50years old in the hyperplasia group;3. BMI of adenoma group (24.36±3.45kg/m2) is higher compared with that of hyperplasia group (22.40±2.76kg/m2)(P=0.048);4. the course of adenoma group (1to72months,21months on average) is shorter than that of hyperplasia (6to120months,37months on average)(P=0.013);5. single side illnesses are demonstrated in all patients of adenoma group, about1.3:1, bilateral illnesses in most patients of hyperplasia mostly bilateral disease (80%);6. The incidence of moon-shaped face (P=0.038), central obesity (P=0.020), skin purple lines (P=0.037), body vellus hair (P=0.039) of adenoma group is higher than that of those of hyperplasia.7. The total cholesterol of adenoma group (6.23±1.50mmol/L) is more than that of hyperplasia group (5.33±0.98mmol/L)(P=0.035).8.8am blood Cor of adenoma group (766.51±221.47nmol/L) is higher than that of hyperplasia group (599.87±161.16nmol/L)(P=0.013),8am of ACTH adenoma group (6.75±4.20pg/ml) lower than that of hyperplasia group (8.10±2.13pg/ml)(P=0.041);.9. Postsurgical average hospital stay of adenoma group (11±4.3days) is longer than that of hyperplasia group (7±2.8days)(P=0.009), total hospital stay on average of adenoma group (28±7.1days) longer than that of hyperplasia group (21±5.3days)(P=0.001).10. There is no statistically significant difference between the admission blood pressure, electrolytes, glucose, B-detection rate, adrenal CT detection rate, operative time, surgical approach, intraoperative blood transfusion rate, blood loss, postoperative drainage, postoperative electrolyte, and discharge blood pressure of the two groups.Conclusion:1. The research data indicates that, in ACTH non-dependent CS, adenomatous CS women of childbearing ages demonstrate unilaterally high incidence with a typical CS-based and short duration, while proliferative CS middle-aged subjects demonstrate bilaterally high incidence with non-specific performance-based and long duration.2. CS adenoma type always needs postsurgical hormone replacement therapy, with high dosage, slow reduction, long period of use, and slow recovery. Proliferative CS surgery, depending on specific cases:1) can spare hormone replacement therapy;2) conducts hormone replacement therapy, with low dosage, fast reduction, short period of use, and fast recovery. |
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