Research On The Relationship Between Pituitary Adrenocorticotropic Adenoma And Immune System Function

BackgroundPituitary adenoma is one of the most common intracranial tumors, the incidence rate ranks third of all the primary intracranial tumors. Among the people aged over 20, pituitary adenoma is the most common cause of sellar region lesions with a proportion of as high as 10% of all intracranial tumors. Cushing’s disease, or pituitary ACTH dependent Cushing’s syndrome, is a rare disease responsible for increased morbidity and mortality, accounting for 13.1% of all primary pituitary adenomas. Although the majority of Cushing’s disease are benign tumors, patients with Cushing’s disease had much greater chances to suffer from various kinds of infections as well as several examples of severe infections, especially opportunistic infections when they were in hospital, which differed from most of the benign tumors. Besides, pituitary occupies the center of the NEI network based on the Neuro-Endocrine-Immune network theory, the cortisol which ACTH secreting pituitary adenomas promote has extensively and profoundly affect on the immune system, so the immune system of patients with Cushing’s disease is influenced by multiple factors from both the tumors and the endocrine system. Through the study of the immune function of patients with ACTH adenoma, it helps to explore the potential mechanism of adenoma’s development, guide the clinical management of perioperative patients, and reduce the incidence of infections especially the severe ones.ObjectiveResearch and analysis on the immune functions of patients with pituitary ACTH adenoma; Investigate the potential immune mechanisms of the occurrence, development and recurrence of the ACTH-secreting pituitary adenoma. To explore the effect of surgeries on the immune system of patients with ACTH adenoma; To guide the clinical perioperative management and reduce the infection incidence.MethodsImmunological aspects:lymphocyte subsets were tested by flow cytometry before and after the operations. IgG、IgA、IgM were examined to evaluate humoral immunity function, besides, C3、C4、IL6、IL10 were tested as the supplements.Endocrinal aspects:samples of PF/24h-UFC/ACTH from ACTH adenoma patients1. Statistical work on the immune items to get a portrait of immune system of the patients with ACTH adenoma.2. Compare pre-operative immune items between pituitary ACTH secreting adenoma and non-functional pituitary adenoma to confirm the unique of pituitary ACTH secreting adenoma in immune system among pituitary adenomas.3. Compare pre-operative and post-operative immune items in both the pituitary ACTH secreting adenoma group and the Non-functional group to evaluate the effects of operations in immune function4. Pair the immune items with the endocrine items so that we can explore the relationship between them5. Organize and analysis the infection cases of patients with pituitary ACTH secreting adenoma to find some useful items to guide clinical managementResults1. Compared with the heathy people of the same age, patients with pituitary ACTH secreting adenoma had a much lower level of both Naive T cell and 45RA+CD4+T cell in count and percentage, but suffered a much higher level of both CD38+CD8+T cell and DR+CD8+T cell in count and percentage.2. ACTH secreting adenoma differs greatly from non-functional pituitary adenoma in immune function3. Surgeries can promote the immune function for the patient of pituitary ACTH secreting adenoma in the short run4. Endocrine system does have lots of connections with the Immune system of pituitary ACTH secreting adenoma5. Patients with pituitary ACTH secreting adenoma suffered a much higher incidence of infections, CD8+CD38+T% and CD4 count can be a good guidance for the prevention of infections in some wayConclusionsPituitary ACTH secreting adenoma is a kind of unique pituitary adenoma in immune, which is characterized by a deep inhibition of Naive CD4+T cell and an extremely promoted activated CD8+ subset. Patients of pituitary ACTH secreting adenoma are prone to get infected during the perioperative period as the immune system is inhibited. The immune state of pituitary ACTH secreting adenoma is closely related with patient’s endocrine system function level, operations can relieve immune suppression, and immune monitoring will do a lot of good to clinical management during the perioperative period.