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:Wereviewed 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.
| Original language | English |
|---|---|
| Pages (from-to) | 601-610 |
| Number of pages | 10 |
| Journal | Journal of Clinical Endocrinology and Metabolism |
| Volume | 95 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Feb 2010 |
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ASJC Scopus subject areas
- Biochemistry
- Clinical Biochemistry
- Endocrinology
- Biochemistry, medical
- Endocrinology, Diabetes and Metabolism
Cite this
Delayed remission after transsphenoidal surgery in patients with cushing's disease. / Valassi, Elena; Biller, B. M K; Swearingen, Brooke; Giraldi, Francesca Pecori; Losa, Marco; Mortini, Pietro; Hayden, Douglas; Cavagnini, Francesco; Klibanski, Anne.
In: Journal of Clinical Endocrinology and Metabolism, Vol. 95, No. 2, 02.2010, p. 601-610.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Delayed remission after transsphenoidal surgery in patients with cushing's disease
AU - Valassi, Elena
AU - Biller, B. M K
AU - Swearingen, Brooke
AU - Giraldi, Francesca Pecori
AU - Losa, Marco
AU - Mortini, Pietro
AU - Hayden, Douglas
AU - Cavagnini, Francesco
AU - Klibanski, Anne
PY - 2010/2
Y1 - 2010/2
N2 - 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:Wereviewed 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.
AB - 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:Wereviewed 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.
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U2 - 10.1210/jc.2009-1672
DO - 10.1210/jc.2009-1672
M3 - Article
C2 - 20080848
AN - SCOPUS:76149118065
VL - 95
SP - 601
EP - 610
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
SN - 0021-972X
IS - 2
ER -