Endocrine Abstracts

Transsphenoidal pituitary surgery is the method of choice in the treatment of ACTH-DCS, although to date, according to a number of researchers, the method is not ideal. Despite the achievement of immediate postoperative remission in 69-98% of cases, with an increase in the duration of follow-up after TSS from 5 to 10 years, an increase in the frequency of relapses from 15 to 66% is observed. In this regard, we analyzed cases of ACTH DCS subjected to TSS for 2003-2021, included in the national register. Thus, according to the registry data, over a 18-year period, 222 patients with ACTH DCS were under dynamic observation, of which 128(57.6%). The remaining 94(42.4%) patients were on medication - 54 cases (24.4%), adrenalectomy - 36 (16.2%), including 3 patients (1.3%) in combination with RT, on radiation therapy -4 patients (1.8%). Every year, there are 2-3 cases of relapse, which aggravate both the course and outcome of the disease. In view of this, the this stage of our research was the search and analysis of possible causes of the development of relapses of the disease in ACTH-DCS. The analysis revealed that a total of 53 (41.4%) patients out of 128 treated with TSS developed a relapse in the period 2003-2021. Of these women, the overwhelming majority - 48 (90%) and 5 men (10%). The mean age of the patients was 34.3±0.26 years. The average duration of the remission period was 3.25±0.04 years. Due to the development of recurrence and failure to achieve in 33 cases (62.3%), repeated TSS was performed in 11 patients, radiation therapy in 5 and adrenalectomy in 15 patients, which caused the development of pituitary complications in the form of diabetes insipidus in 2 (3.7 %) and panhypopituitarism in 2 (3.7%). Thus, in a cohort of 53 (42.9%) patients with ACTH-DCS, who developed a relapse of the disease after TSS, they were aged 34.3±0.16, consisted mainly of females (90%), were characterized by microadenomas (88.6%), insufficient decrease in ACTH and cortisol levels in the early postoperative period (by 1.5 and 1.7 times, respectively), persistence of arterial hypertension (26.4%), impaired BMD (63.4%), 26.3%), the presence of central diabetes insipidus (3.7%) and panhypopituitarism (3.7%). As the results of the analysis show, the very state of remission in patients with ACTH-DCS is unstable and, for various reasons, they may develop a relapse, the frequency of which increases with an increase in the observation period.