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Predicting relapse after transsphenoidal surgery for Cushing's disease
G C Toms1, M I McCarthy, M J Niven
1Department of Endocrinology, Royal London Hospital, United Kingdom.
The Journal of Clinical Endocrinology and Metabolism
|February 1, 1993
Summary
Accurate assessment of Cushing
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Selective transsphenoidal surgery is effective for Cushing's syndrome.
- Defining surgical cure versus improvement remains challenging.
- Optimal timing for assessing surgical success post-transsphenoidal surgery is not well-established.
Purpose of the Study:
- To determine the optimal timing for serum cortisol assessment after transsphenoidal surgery for Cushing's disease.
- To correlate early postoperative serum cortisol levels with long-term remission status.
Main Methods:
- Eleven patients with Cushing's disease underwent transsphenoidal surgery for corticotroph adenomas.
- Serum cortisol levels were measured at 5-14 days and 6-12 weeks postoperatively.
- Hypothalamic-pituitary axis recovery and long-term remission were assessed using specific tests.
Main Results:
- All patients achieved initial clinical resolution.
- Four patients later showed biochemical recurrence.
- Serum cortisol levels at 6-12 weeks were lower than early postoperative levels and better predicted long-term remission.
Conclusions:
- Serum cortisol measurements at 6-12 weeks post-transsphenoidal surgery are more indicative of long-term remission in Cushing's disease.
- Cortisol levels below 35 nmol/L at 6-12 weeks suggest a favorable surgical outcome.
- This timing aids in distinguishing cure from improvement after pituitary surgery.