Endocrine Abstracts

Introduction: Long term remission of CD is achieved in 65–83% after neurosurgery, while the remaining cases have recurrence or continued tumor growth. This paper deals with the problem of CD prognostic factors after neurosurgery.

Design: ACTH and cortisol blood levels, free cortisol in daily urine, MRI, histology (hemotaxiline–eosine staining) and immunohistochemistry (with antibodies to the pituitary tropic hormones, Ki-67, CD31 and VEGF) of the removed corticotropinomas tissue were compared between two groups of patients with CD (totally 46): 31 (67.4%) patients in remission (first group) and 15 patients (32.6%) without CD remission (second group) after neurosurgery, who were observed on the average for 2 years.

Results: ACTH and cortisol blood levels didn`t differ between two groups of patients before neurosurgical treatment (P=0.9 and P=0.8 respectively). The content of free cortisol in the daily urine before treatment was significantly higher in patients from the second group (P=0.0006). Volume and topography of corticotropinomas on MRI also didn’t differ in patients from both groups (P=0.8 and P=0.9 respectively). After pituitary adenomectomy in 30 (96.8%) patients from the first group developed clinical and laboratorial signs of adrenal insufficiency, whereas only 5 (10.9%) patients from the second group were diagnosed with adrenal insufficiency. Histologically the incidence of basophilic-cell tumors (P=0.4), mitosis (P=0.9), necrosis (P=0.5), hemorrhage (P=0.7), stromal edema (P=0.9), angiomatosis (P=0.6) and anterior pituitary hyperplasia (P=0.5) didn’t differ in the corticotropinomas of patients from the both groups. Significant difference of frequency of mono-(P=0.8), bi-(P=0.8), and polihormonal (P=0.4) adenomas in patients from the both groups is not found. Labeling index of Ki-67 in corticotropinomas in patients without CD remission was significantly higher than in adenomas of patients with remission (P=0.02). Significant differences of CD31 (P=0.3) and VEGF (P=0.7) expression in the tumors of patients from both groups did not find.

Conclusion: Such factors as the level of free cortisol in the daily urine, the absence of adrenal insufficiency after neurosurgery, increased labeling index of Ki-67 may be considered as poor prognostic factors of CD after neurosurgery.