Normalized early post-operative cortisol and ACTH values predict nonremission after surgery for Cushing's disease.
Normalized early post-operative cortisol and ACTH values predict nonremission after surgery for Cushing's disease.
- 2017
Available online through MWHC library: 1999- June 2013, Available in print through MWHC library: 1999 - 2006
Conclusions: NEPV for cortisol and ACTH predict non-remission after TSS for CD. Context: Perioperative increases in adrenocorticotropic hormone (ACTH) and cortisol mimic corticotropin releasing hormone (CRH) stimulation testing. This phenomenon may help identify patients with residual adenoma after transsphenoidal surgery (TSS) for Cushing's disease (CD). Design: Retrospective case control study of patients treated at a single center from December 2003 till July 2016. Early and medium-term remission were assessed at 10 days and 11 months. Interventions: Normalized early post-operative values (NEPV) for cortisol and ACTH were calculated as immediate post-operative cortisol or ACTH minus preoperative post-CRH stimulation test levels. Main Outcome Measures: Prediction of early non-remission was evaluated using logistic regression. Prediction of medium-term remission was assessed using Cox regression. Predictive ability was quantified by areas under the receiver operating characteristic curve (AUROC). Objective: To predict non-remission after TSS for CD. Patients: 291 consecutive TSS cases from 257 patients with biochemical evidence of CD. Results: NEPV for cortisol and ACTH predicted early non-remission (adjusted OR 1.1, 95% CI 1.0 - 1.1, P = 0.016; and adjusted OR 1.0, 95% CI 1.0 - 1.0, P = 0.048 respectively). AUROC for NEPV cortisol was 0.78, 95% CI 0.61 - 0.95; and for NEPV ACTH was 0.80, 95% CI 0.61 - 0.98. NEPV for both cortisol and ACTH predicted medium-term non-remission (hazard ratios (HR) 1.1, 95% CI 1.0 - 1.1, P = 0.023; and HR 1.0, 95% CI 1.0 - 1.0, P = 0.025 respectively). Setting: Clinical Center.
English
0021-972X
*Adrenocorticotropic Hormone/bl [Blood]
*Hydrocortisone/bl [Blood]
*Pituitary ACTH Hypersecretion/su [Surgery]
Adult
Age Factors
Biomarkers/bl [Blood]
Female
Humans
Male
Pituitary ACTH Hypersecretion/bl [Blood]
Postoperative Period
Predictive Value of Tests
Prognosis
Reference Values
Remission Induction
Retrospective Studies
Sex Factors
MedStar Washington Hospital Center
Medicine/Endocrinology
Journal Article
Available online through MWHC library: 1999- June 2013, Available in print through MWHC library: 1999 - 2006
Conclusions: NEPV for cortisol and ACTH predict non-remission after TSS for CD. Context: Perioperative increases in adrenocorticotropic hormone (ACTH) and cortisol mimic corticotropin releasing hormone (CRH) stimulation testing. This phenomenon may help identify patients with residual adenoma after transsphenoidal surgery (TSS) for Cushing's disease (CD). Design: Retrospective case control study of patients treated at a single center from December 2003 till July 2016. Early and medium-term remission were assessed at 10 days and 11 months. Interventions: Normalized early post-operative values (NEPV) for cortisol and ACTH were calculated as immediate post-operative cortisol or ACTH minus preoperative post-CRH stimulation test levels. Main Outcome Measures: Prediction of early non-remission was evaluated using logistic regression. Prediction of medium-term remission was assessed using Cox regression. Predictive ability was quantified by areas under the receiver operating characteristic curve (AUROC). Objective: To predict non-remission after TSS for CD. Patients: 291 consecutive TSS cases from 257 patients with biochemical evidence of CD. Results: NEPV for cortisol and ACTH predicted early non-remission (adjusted OR 1.1, 95% CI 1.0 - 1.1, P = 0.016; and adjusted OR 1.0, 95% CI 1.0 - 1.0, P = 0.048 respectively). AUROC for NEPV cortisol was 0.78, 95% CI 0.61 - 0.95; and for NEPV ACTH was 0.80, 95% CI 0.61 - 0.98. NEPV for both cortisol and ACTH predicted medium-term non-remission (hazard ratios (HR) 1.1, 95% CI 1.0 - 1.1, P = 0.023; and HR 1.0, 95% CI 1.0 - 1.0, P = 0.025 respectively). Setting: Clinical Center.
English
0021-972X
*Adrenocorticotropic Hormone/bl [Blood]
*Hydrocortisone/bl [Blood]
*Pituitary ACTH Hypersecretion/su [Surgery]
Adult
Age Factors
Biomarkers/bl [Blood]
Female
Humans
Male
Pituitary ACTH Hypersecretion/bl [Blood]
Postoperative Period
Predictive Value of Tests
Prognosis
Reference Values
Remission Induction
Retrospective Studies
Sex Factors
MedStar Washington Hospital Center
Medicine/Endocrinology
Journal Article