Evaluation of Cushing's disease remission after transsphenoidal surgery based on early serum cortisol dynamics
Article first published online: 4 SEP 2013
© 2013 John Wiley & Sons Ltd
Volume 80, Issue 3, pages 411–418, March 2014
How to Cite
Costenaro, F., Rodrigues, T. C., Rollin, G. A. F., Ferreira, N. P. and Czepielewski, M. A. (2014), Evaluation of Cushing's disease remission after transsphenoidal surgery based on early serum cortisol dynamics. Clinical Endocrinology, 80: 411–418. doi: 10.1111/cen.12300
- Issue published online: 23 JAN 2014
- Article first published online: 4 SEP 2013
- Accepted manuscript online: 29 JUL 2013 10:51AM EST
- Manuscript Accepted: 24 JUL 2013
- Manuscript Revised: 23 JUL 2013
- Manuscript Revised: 3 JUL 2013
- Manuscript Received: 15 MAY 2013
- CAPES (Coordenação de Aperfeiçoamento de Profissional de Nível Superior)
- FIPE (Fundo de Incentivo à Pesquisa do Hospital de Clínicas de Porto Alegre
To evaluate the ability of post-transsphenoidal pituitary surgery (TSS) serum cortisol levels (s-cortisol) to predict surgical remission and recurrence of Cushing's disease (CD).
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 (Protocol 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 (Protocol II).
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.
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.
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.