Delayed remission after transsphenoidal surgery in patients with Cushing's disease.

Abstract

BACKGROUND:

Transsphenoidal surgery (TSS) is the treatment of choice for Cushing's disease (CD). Postoperative hypercortisolemia mandates further therapy.

OBJECTIVE:

The aim of the study was to characterize patients without immediate postoperative remission who have a delayed decrease to normal or low cortisol levels without further therapy.

DESIGN AND SETTING:

A retrospective case series was conducted at three tertiary care centers.

PATIENTS AND INTERVENTION:

We reviewed the records of 620 patients (512 females, 108 males; mean age, 38 +/- 13 yr) who underwent transsphenoidal pituitary surgery for CD between 1982 and 2007.

RESULTS:

Outcomes were classified into the following three groups based upon the postoperative pattern of cortisol testing: group IC (immediate control) included 437 of the 620 patients (70.5%) with hypocortisolism and/or cortisol normalization throughout the postoperative follow-up; group NC (no control) included 148 of 620 patients (23.9%) with persistent hypercortisolism; and group DC (delayed control) included 35 of 620 patients (5.6%) who had early elevated or normal UFC levels and developed a delayed and persistent cortisol decrease after an average of 38 +/- 50 postoperative days. The total rate of recurrence was 13% at a median follow-up time of 66 months after TSS; the cumulative rate of recurrence at 4.5 yr was significantly higher in group DC vs. group IC (43 vs. 14%; P = 0.02).

CONCLUSIONS:

Hormonal assessment in the immediate postoperative period after TSS for CD may be misleading because delayed remission can occur in a subset of patients. Expectant management and retesting may spare some patients from unnecessary further treatment. Optimal timing to determine the need for further therapy after TSS remains to be determined.

• Authors: Elena Valassi, Beverly M K Biller, Brooke Swearingen, Francesca Pecori Giraldi, Marco Losa, Pietro Mortini, Douglas Hayden, Francesco Cavagnini, Anne Klibanski
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 95 Issue 2 Pg. 601-10 (Feb 2010) ISSN: 1945-7197 [Electronic] United States
• PMID: 20080848 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenocorticotropic Hormone
• Hydrocortisone

Topics

• Adrenocorticotropic Hormone (blood)
• Adult
• Female
• Humans
• Hydrocortisone (urine)
• Male
• Middle Aged
• Pituitary ACTH Hypersecretion (metabolism, surgery)
• Retrospective Studies
• Time Factors