DEVELOPING MODELS TO PREDICT PERSISTENT DISEASE AFTER PITUITARY ADENOMA SURGERY

гона. Уровень ГИП во время ОГТТ существенно не отличался от контрольной группы. Уровень ГПП-1 и ГПП-2 был значительно выше по сравнению с контрольной группой (p=0,017 и p<0,001 соответственно) с пиками на 30-й минуте. Уровень грелина также был значительно выше по сравнению с контрольной группой (р=0,013). Выводы. Уровень инкретинов может выступать в качестве возможного маркера специфических нарушений углеводного обмена у пациентов с болезнью Иценко—Кушинга и предположительно может помочь в дифференциальной диагностике стероидного диабета и сахарного диабета 2-го типа. Необходимы дальнейшие исследования для подтверждения данных предположений. КЛЮЧЕВЫЕ СЛОВА Incretins, carbohydrate metabolism, Cushing disease, secondary hyperglycaemia.

Introduction.Pituitary adenomas are the most frequent intracranial tumors of the central nervous system.Except for prolactinomas, surgery is the treatment of choice.
Aim -to assess the percentage of patients with persistent disease after surgery and to identify independent predictors of persistent disease.
Material and methods.Ambispective multicenter observational study.Data were collected from The Molecular Registry of Pituitary Adenomas (REMAH).Univariate and multivariate analysis were performed in 128 patients with histologically confi rmed adenomas who underwent transsphenoidal surgery between 2009 and 2015 in hospitals from Madrid, with at least one month of follow-up.
Results.During follow-up, persistent disease was observed in 50.8% of patients (radiological 30.7%, biochemical 2.4%, both 14.2%), especially in nonfunctioning tumors.Factors signifi cantly associated with persistent disease in the univariate analysis were age, male gender, previous hypopituitarism, large tumor diameter and microscopic transsphenoidal surgery (p<0.05).Independent predictors of persistent disease in multivariate analysis were: patients over 76 years old, a greater tumor diameter, multiple hypopituitarism and microscopic transsphenoidal surgery (p<0.05).

Conclusion.
Age, tumor size, previous hypopituitarism and the type of surgical technique were independent predictors of persistent disease.These factors could be useful for clinicians in the follow-up of patients to better establish monitoring and treatment algorithms.Introduction.Neurosurgery, which is the treatment of choice of non-functioning pituitary adenomas (NFPA), is often incurative.It usually leaves tumour residue that can regrow in the future.There is no established management for the postoperative period of NFPA, however, some data suggest that somatostatin analogues (SSA) can be eff ective, especially regarding somatostatin receptors (SSTR) presence in NFPA.SSTR scintigraphy and immunohistochemistry are used to assess SSTR expression in NFPA.

KEYWORDS
Aim -to analyse the outcome of SSA treatment in NFPA and to correlate it with the results of SSTR scintigraphy and immunohistochemistry.
Material and methods.Twenty six NFPA patients after incomplete neurosurgery with positive results of scintigraphy and immunohistochemistry were included in the study.All patients were treated with octreotide LAR 20mg intramuscular every 4 weeks.The tumour size was evaluated in control magnetic resonance imaging after 2 years of SSA therapy.
Results.Tumour size remained stable in the majority of NFPA.Adenoma size reduction was observed in 2 patients with strong expression of SSTR2 in both scintigraphy and immunohistochemistry. Increase of tumour size was noticed in 4 patients whose tumours were characterised not only by the presence of SSTR2 and SSTR5 but also by strong expression of SSTR1 in immunohistochemistry.
Conclusions.Only strong expression of SSTR2 can predict patients response to SSA treatment in NFPA.However, strong expression of SSTR1 observed in some of NFPA gives hope that introduction of new broad spectrum SSA like pasireotide would be more eff ective, especially in tumour shrinkage.KEYWORDS Somatostatin receptors, octreotide treatment, non-functioning pituitary adenomas.