Normalized Early Postoperative Cortisol and ACTH Values Predict Nonremission After Surgery for Cushing Disease

Area of Science:

• Endocrinology
• Neurosurgery
• Oncology

Background:

• Perioperative elevations in adrenocorticotropic hormone (ACTH) and cortisol levels after transsphenoidal surgery (TSS) for Cushing disease (CD) may indicate residual adenoma.
• Identifying patients with persistent disease post-TSS is crucial for timely management adjustments.

Purpose of the Study:

• To predict nonremission after TSS for CD using perioperative hormone levels.
• To evaluate the utility of normalized early postoperative values (NEPVs) for ACTH and cortisol in predicting disease recurrence.

Main Methods:

• Retrospective case-control study involving 257 patients undergoing 291 TSS procedures for CD.
• NEPVs calculated by subtracting preoperative post-corticotropin-releasing hormone (CRH) stimulation test levels from immediate postoperative levels.
• Logistic and Cox regression models used to assess prediction of early and medium-term nonremission, respectively.

Main Results:

• NEPVs for both cortisol and ACTH significantly predicted early nonremission (ORs 1.1 and 1.0, respectively).
• Area under the receiver operating characteristic curve (AUROC) for cortisol NEPV was 0.78 and for ACTH NEPV was 0.80.
• NEPVs for cortisol and ACTH also predicted medium-term nonremission (HRs 1.1 and 1.0, respectively).

Conclusions:

• Normalized early postoperative values of ACTH and cortisol are effective predictors of nonremission following TSS for CD.
• This hormonal assessment aids in identifying patients likely to experience persistent or recurrent disease.