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Predicting late recurrence in surgically treated patients with Cushing's disease.
- Source :
-
Clinical endocrinology [Clin Endocrinol (Oxf)] 2013 Sep; Vol. 79 (3), pp. 394-401. Date of Electronic Publication: 2013 May 06. - Publication Year :
- 2013
-
Abstract
- 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.<br />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).<br />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%.<br />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.<br /> (© 2013 John Wiley & Sons Ltd.)
- Subjects :
- Adolescent
Adult
Aged
Area Under Curve
Computer Simulation
Female
Humans
Male
Middle Aged
Pituitary ACTH Hypersecretion pathology
Predictive Value of Tests
Prognosis
Recurrence
Remission Induction
Treatment Outcome
Young Adult
Corticotropin-Releasing Hormone blood
Deamino Arginine Vasopressin blood
Pituitary ACTH Hypersecretion diagnosis
Pituitary ACTH Hypersecretion surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1365-2265
- Volume :
- 79
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Clinical endocrinology
- Publication Type :
- Academic Journal
- Accession number :
- 23278711
- Full Text :
- https://doi.org/10.1111/cen.12133