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Serum cortisol response to transsphenoidal surgery for Cushing disease
N E Simmons1, T D Alden, M O Thorner
1Division of Neurosurgery, University of Texas Health Sciences Center at San Antonio, 78229-3900, USA. simmonsn@uthscsa.edu
Journal of Neurosurgery
|July 17, 2001
Summary
Transsphenoidal surgery for Cushing disease can be assessed rapidly. Postoperative serum cortisol levels on day one help determine surgical remission, avoiding unnecessary steroid use.
Area of Science:
- Endocrinology
- Neurosurgery
- Surgical Outcomes
Background:
- Transsphenoidal surgery is the primary treatment for Cushing disease.
- Defining surgical cure and failure post-operatively remains challenging.
Purpose of the Study:
- To evaluate serum cortisol levels before and after transsphenoidal surgery.
- To identify patterns of cortisol decrease and optimal criteria for determining surgical remission.
Main Methods:
- Serum cortisol levels were measured in 27 patients pre- and post-transsphenoidal surgery.
- Cortisol levels were monitored for 8 months, with no exogenous steroids given until remission diagnosis.
- Divergent cortisol patterns were observed between initial remissions and failures.
Main Results:
- 81% of patients achieved surgical remission at follow-up.
- Postoperative day one cortisol levels differed significantly between remission and failure groups.
- Remission criteria: cortisol < 10 microg/dl and lower than preoperative midnight levels.
Conclusions:
- Exogenous steroid use is not required until remission is confirmed.
- A simple, rapid method for determining postoperative remission exists.
- Delayed remission is possible in a small subset of patients.
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