Normalized early post-operative cortisol and ACTH values predict nonremission after surgery for Cushing's disease.

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Citation: Journal of Clinical Endocrinology & Metabolism. 102(7):2179-2187, 2017 Jul 01PMID: 28323961Institution: MedStar Washington Hospital CenterDepartment: Medicine/EndocrinologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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 FactorsYear: 2017Local holdings: Available online through MWHC library: 1999- June 2013, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0021-972X
Name of journal: The Journal of clinical endocrinology and metabolismAbstract: 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.All authors: Asuzu D, Benzo S, Beri A, Chatain GP, Chittiboina P, Hayes C, Keil M, Lodish M, Lonser RR, McGlotten R, Nieman L, Oldfield EH, Sharma ST, Stratakis CFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2017-05-06
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 28323961 Available 28323961

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.

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