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Predicting late recurrence in surgically treated patients with C ushing's disease
Author(s) -
Barbot Mattia,
Albiger Nora,
Koutroumpi Stavroula,
Ceccato Filippo,
Frigo Anna C.,
Manara Renzo,
Fassina Ambrogio,
Gardiman Marina P.,
Scanarini Massimo,
Mantero Franco,
Scaroni Carla
Publication year - 2013
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12133
Subject(s) - medicine , endocrinology , disease
Summary Objective Cushing's disease ( CD ) has an uncertain prognosis because patients achieving remission after transsphenoidal pituitary neurosurgery ( TSS ) may relapse. We aimed to identify factors predicting relapse, focusing on desmopressin ( DDAVP ) and corticotropin‐releasing hormone ( CRH ) tests after surgery. Materials and methods Fifty‐seven patients with CD (mean age 36 years) after TSS experienced remission (24 cases), late relapse ( LR ) (15 cases), or persistent disease (18 cases). Results The median time to relapse was 40 months. ACTH levels increased after both DDAVP and CRH stimulation, with a significantly higher response in the late recurrence group, showing this to be an indicator of increased risk of relapse. In the logistic regression model, a rise in ACTH >9 pg/ml after DDAVP and >36·7 pg/ml after CRH showed a sensitivity of 93% and 73%, respectively, a specificity of 82% and 76% in LR group. The area under the curve was 0·91 for DDAVP , 0·80 for CRH and 0·95 for DDAVP + CRH test, i.e. the combined tests performed better than each test alone, but not to a statistically significant degree. A response to both tests resulted in a positive predictive value ( PPV ) of 100%, while no response to either test in a negative predictive value ( NPV ) of 100%. Conclusions ACTH hyper‐responsiveness to DDAVP stimulation proved a valuable indicator of relapsing patients with high sensitivity and specificity; in selected cases when a clear high increment of ACTH level is not evident, the CRH test might be used as additional tool to confirm the risk of future relapses.