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Low immediate postoperative serum-cortisol nadir predicts the short-term, but not long-term, remission after pituitary surgery for Cushing's disease
- Source :
- BMC Endocrine Disorders
- Publication Year :
- 2015
-
Abstract
- Background Cushing’s disease is an ACTH-producing pituitary adenoma, and the primary treatment is microscopic or endoscopic transsphenoidal selective adenectomy. The aims of the present study were to evaluate whether the early postoperative S-cortisol level can serve as a prognostic marker for short- and long-term remission, and retrospectively review our own short and long term results after surgery for Cushing’s disease. Methods This single centre, retrospective study consists of 19 consecutive patients with Cushing’s disease who underwent transsphenoidal surgery. S-cortisol was measured every 6 h after the operation without any glucocorticoid replacement. We have follow-up on all patients, with a mean follow-up of 68 months. Results At the three-month follow-up, 16 patients (84 %) were in remission; at 12 months, 18 (95 %) were in remission and at the final follow-up (mean 68 months), 13 (68 %) were in remission. Five-years recurrence rate was 26 %. The mean postoperative S-cortisol nadir was significantly lower in the group of patients in remission than in the non-remission group at 3 months, but there was no difference between those in long-term remission compared to those in long-term non-remission. The optimal cut-off value for classifying 3-month remission was 74 nmol/l. Conclusion We achieved a 95 % 1-year remission rate with transsphenoidal surgery for Cushing’s disease in this series of consecutive patients. However, the 5-year recurrence rate was 26 %, showing the need for regular clinical and biochemical controls in this patient group. The mean postoperative serum-cortisol nadir was significantly lower in patients in remission at 3 months compared to patients not in remission at 3 months, but a low postoperative S-cortisol did not predict long-term remission.
- Subjects :
- Adult
Male
medicine.medical_specialty
Pathology
Adolescent
Hydrocortisone
medicine.medical_treatment
Endocrinology, Diabetes and Metabolism
Pituitary Diseases
Endocrine remission
Young Adult
Postoperative Complications
Pituitary adenoma
Predictive Value of Tests
Recurrence
medicine
Humans
Pituitary ACTH Hypersecretion
Aged
Retrospective Studies
Transsphenoidal surgery
business.industry
Pituitary ACTH hypersecretion
Remission Induction
Retrospective cohort study
General Medicine
Cushing's disease
Middle Aged
Cushing’s disease
medicine.disease
Surgery
Clinical trial
Predictive value of tests
Female
business
Biomarkers
Cortisol measurement
medicine.drug
Follow-Up Studies
Research Article
Subjects
Details
- ISSN :
- 14726823
- Volume :
- 15
- Database :
- OpenAIRE
- Journal :
- BMC endocrine disorders
- Accession number :
- edsair.doi.dedup.....5eac87babb90dabbdd2454f1de038432