[en] Background and purpose. - Cushing's disease is characterized by an overproduction of ACTH inducing an hypersecretion of corticosteroids. We assessed the non-corticotrophic pituitary functions before and after microsurgical resection of the corticotrophic adenoma. Methods. - We reviewed retrospectively a series of 98 patients (19 males, 79 females) undergoing transsphenoidal surgery between 1974 and 2001. Prolactin levels, somatrotrophic, gonadotrophic and thyroidotrophic functions were assessed and compared before and after resection of the adenoma. Results. - Before surgery, we observed an elevation of prolactin and a reduction of the GH, TSH, LH and FSH levels. These modifications were not linked to the volume of the adenoma but depended on the systemic effect of the hypercorticism or on local paracrine mechanisms. Selective adenomectomy usually restored altered corticotrophic and also, unlike (partial or total) hypophysectomy, the non-corticotrophic functions. Conclusions. - Non-corticotrophic functions are often altered in Cushing's disease but can be restored after selective adenomectomy. [fr] Buts de l'étude. - La maladie de Cushing se caractérise par une hypersécrétion d'ACTH d'origine hypophysaire. Les autres fonctions hypophysaires peuvent également être altérées. Méthode. - Nous avons revu une série de 98 patients (19 hommes, 79 femmes) opérés par voie transsphénoïdale entre 1974 et 2001. Les taux de PRL, de GH, de TSH, de LH et FSH ainsi que la réponse aux libérines correspondantes ont été mesurés. Résultats. - Avant chirurgie, nous avons observé une élévation du taux de PRL, une diminution du taux de GH, de TSH, de LH et FSH ainsi qu'une réduction de leur réponse aux libérines correspondantes. Les modifications sont les plus marquées pour les fonctions somatotrope et gonadotrope. Les mécanismes physiopathologiques sont probablement multiples, souvent sans rapport avec une compression ou une destruction du tissu hypophysaire normal en raison du volume le plus souvent réduit de la tumeur, mais plutôt par les effets systémiques de l'hypercorticisme ou peut-être par des effets locaux paracrines. Alors que l'hypophysectomie (partielle ou complète) ne permet habituellement pas de restaurer une situation normale, l'adénomectomie sélective permet par contre de conserver les fonctions préservées ou conduit à restaurer les fonctions corticotropes et non corticotropes. Conclusions. - Les fonctions hypophysaires non corticotropes souvent altérées dans la maladie de Cushing peuvent être normalisées par l'adénomectomie sélective.
Disciplines :
Neurology Surgery Endocrinology, metabolism & nutrition
Author, co-author :
Martin, Didier ; Université de Liège - ULiège > Département des sciences cliniques > Neurochirurgie
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