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Published on: September 15, 2017
Characterization of persistent and recurrent Cushing's disease
Nina K Sundaram1, Alessia Carluccio, Eliza B Geer
1Division of Endocrinology, Department of Medicine, Mount Sinai Medical Center, New York, NY, 10029, USA.
Pituitary
|August 31, 2013
Summary
Defining remission for Cushing's disease (CD) is complex, with ongoing debate about the best biochemical tests. Further research is needed to clarify subtle hypothalamic pituitary adrenal (HPA) axis abnormalities and their link to persistent morbidities.
Area of Science:
- Endocrinology
- Neurosurgery
- Internal Medicine
Background:
- Cushing's disease (CD) recurrence poses challenges in patient management.
- Current guidelines for defining CD remission, persistence, and recurrence lack universal consensus.
- Biochemical markers for assessing remission, such as serum cortisol, urinary free cortisol, dexamethasone suppression tests, and salivary cortisol, show variability in interpretation.
Purpose of the Study:
- To review current definitions of Cushing's disease remission, persistence, and recurrence.
- To highlight the debate surrounding the most effective biochemical methods and thresholds for defining remission.
- To explore the clinical significance of subtle hypothalamic pituitary adrenal (HPA) axis abnormalities in patients with apparent CD remission.
Main Methods:
- Review of existing literature on Cushing's disease remission criteria.
- Analysis of various biochemical tests used to define remission: serum cortisol, 24-hour urinary free cortisol, dexamethasone suppression tests, and midnight salivary free cortisol.
- Discussion of discrepancies between different biochemical markers in defining remission and recurrence.
Main Results:
- There is inconsistency among studies regarding the number and degree of abnormal test results required to define recurrence.
- The significance of discrepancies between different biochemical markers for assessing remission remains unclear.
- Subtle HPA axis abnormalities may represent distinct remission subtypes or early recurrence, warranting further investigation.
Conclusions:
- Further research is essential to establish standardized criteria for defining Cushing's disease remission and recurrence.
- Investigating subtle HPA axis abnormalities is crucial for differentiating remission subtypes from early recurrence.
- Understanding the association between HPA axis abnormalities and persistent CD morbidities is critical for comprehensive patient care.
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