Endocrine Abstracts

It is known that disoaders of the hypothalamic-pituitary-adrenal system and excess glucocorticoids in Cushing’s disease (CD) can significantly affect various organs and systems, in particular, the secretion of pituitary hormones. However, in the literature there is practically no work on the assessment of the state of tropic hormones and hormones of the peripheral glands in the early postoperative period after transsphenoidal adenomectomy. The aim of this study was to assess the effect of transsphenoidal adenomectomy on the state of pituitary function before and in the early postoperative period in patients with Cushing’s disease. The our study included 434 patients with active stage of Cushing’s disease {374 women (age 38.0 (23–55) years) and 60 men (age 32 (19–51) years}. The duration of the observation from 2001 to 2017. The state of pituitary function was analyzed in patients with CD before and directly in the early postoperative period (average follow-up period from 4 to 14 days) on the basis of hormonal parameters in peripheral blood in the morning (GH, prolactin, TTH, fr T₄, LH, FSH, estradiol, testosterone). The content of ACTH and cortisol in the blood was determined two times a day: in the morning and in the evening, and the average daily content of these hormones was calculated. In addition, to confirm the diagnosis of CD, a study of free cortisol levels in saliva (in the evening) and daily urine was conducted. It was shown that the number of patients with simultaneous reduction of all tropic hormones was minimal – only 22 (4.7%). Different combinations of hormone reduction were found in other patients. The most common decrease in blood levels of prolactin (66.2%) and TSH (53.0%). The most rare decrease in gonadotropins: LH-36.7% and FSH – (21.2%). This mosaic in the lower level of tropic hormones, which may be explained by the fact that often the cells of the pituitary tumors have a mixed activity, and most often in conjunction with an ACTH produce prolactin. Thus, the rehabilitation of patients with CD after transnasal adenomectomy is a complex multicomponent process characterized by a complex approach to therapy and requires regular monitoring of all the tropic functions of the pituitary gland.