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Evaluation of C ushing's disease remission after transsphenoidal surgery based on early serum cortisol dynamics
Author(s) -
Costenaro Fabíola,
Rodrigues Ticiana C.,
Rollin Guilherme A. F.,
Ferreira Nelson P.,
Czepielewski Mauro A.
Publication year - 2014
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.12300
Subject(s) - medicine , endocrinology , hydrocortisone , disease
Objective To evaluate the ability of post‐transsphenoidal pituitary surgery ( TSS ) serum cortisol levels (s‐cortisol) to predict surgical remission and recurrence of C ushing's disease ( CD ). Design One hundred and three patients with CD from a tertiary referral centre were prospectively analysed over 6·0 ± 4·8 years of follow‐up. Twenty patients received perioperative glucocorticoids as routine care and had s‐cortisol measured 10–12 days after TSS ( P rotocol I ). Eighty‐six patients (91 surgeries) had s‐cortisol measured at 6, 12, 18, 24, 48 h, and 10–12 days after TSS , and received glucocorticoids only in case of adrenal insufficiency ( P rotocol II ). Main outcomes Remission [clinical signs and symptoms of adrenal insufficiency (or hypocortisolism) plus cortisol <3 μg/dl on the 1‐mg overnight test ( OT ) and/or normal free urinary cortisol] during follow‐up. Recurrence was defined as loss of remission criteria at least 1 year after TSS . Results The remission rate after first TSS was 80%; 8% had recurrence. An s‐cortisol nadir ≤3·5 μg/dl within 48 h after TSS had sensitivity of 73%, specificity and positive predictive value ( PPV ) of 100% and negative predictive value ( NPV ) of 60% and an s‐cortisol nadir ≤5·7 μg/dl within 10–12 days of TSS had specificity and PPV of 100% and sensitivity of 91% NPV of 78% for CD remission. Conclusion At hospital discharge, the s‐cortisol nadir within 48 h after TSS was already able to predict surgical remission for some patients, and the s‐cortisol nadir within 10–12 days of TSS was able to predict cohort‐wide surgical remission.