Эндогенный гиперкортизолизм: достижения и перспективы в диагностике и лечении
- 作者: Maistrenko N.1, Romashchenko P.1, Cherebillo V.2, Dovganyuk V.1
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隶属关系:
- Military Medical Academy named after S.M. Kirov
- Pavlov State Medical University of the Ministry of Health of the Russian Federation
- 期: 卷 23, 编号 3 (2021)
- 页面: 9-16
- 栏目: Clinical trials
- URL: https://journals.rcsi.science/1682-7392/article/view/73193
- DOI: https://doi.org/10.17816/brmma73193
- ID: 73193
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详细
The results of examination and treatment of 647 patients with endogenous hypercortisolism were studied: pituitary corticotropinoma was detected in 494 (76.4%) patients, corticosteroma and pre — corticosteroma of the adrenal gland — in 142 (21.9%), bilateral macro-nodular hyperplasia of the adrenal glands of primary adrenal origin-in 11 (1.7%). Differential diagnosis of clinical forms of endogenous hypercortisolism was based on the assessment of the level of adrenocorticotropic hormone and cortisol, both in peripheral blood, and with selective bilateral blood sampling from the adrenal veins and lower stony sinuses, and the study of the nature of samples with 8 mg of dexamethasone. Topical diagnostics consisted in assessing the state of the adrenal glands and pituitary gland during computed tomography and magnetic resonance imaging with the use of contrast agents, and the use of special software 3D-Volume Rendering Technique allowed optimizing tactical and technical approaches to performing surgical interventions. Of the operated patients with adrenocorticotropic hormone dependent endogenous hypercortisolism, total removal according to the control magnetic resonance imaging was achieved in 92.3% of cases, subtotal — in 7.7%. However, hormonal remission was achieved only in 82.4% of cases. All patients with corticosteroma and pre-corticosteroma of the adrenal gland underwent adrenalectomy: in 6 patients by open method, in 136 patients by endovideosurgical method (in 11 patients by laparoscopic method, in 124 patients by retroperitoneoscopic method, and in 1 patient by thoracoscopic transdiaphragmatic adrenalectomy). In all patients, the operation led to recovery. Patients with benign macronodular hyperplasia of the adrenal glands needed conservative treatment with steroidogenesis blockers. Indications for surgical treatment in the volume of unilateral adrenalectomy occurred only in 2 patients.
作者简介
Nicolay Maistrenko
Military Medical Academy named after S.M. Kirov
Email: nik.m.47@mail.ru
ORCID iD: 0000-0002-1405-7660
SPIN 代码: 2571-9603
doctor of medical sciences, professor
俄罗斯联邦, Saint PetersburgPavel Romashchenko
Military Medical Academy named after S.M. Kirov
Email: romashchenko@rambler.ru
ORCID iD: 0000-0001-8918-1730
SPIN 代码: 3850-1792
doctor of medical sciences, professor
俄罗斯联邦, Saint PetersburgVsevolod Cherebillo
Pavlov State Medical University of the Ministry of Health of the Russian Federation
Email: cherebillo@mail.ru
ORCID iD: 0000-0001-6803-9954
SPIN 代码: 2887-6943
doctor of medical sciences, professor
俄罗斯联邦, Saint PetersburgVitaly Dovganyuk
Military Medical Academy named after S.M. Kirov
编辑信件的主要联系方式.
Email: vit.dov65@rambler.ru
ORCID iD: 0000-0002-0038-795X
SPIN 代码: 2713-3684
doctor of medical sciences, associate professor
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