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Earlier post-operative hypocortisolemia may predict durable remission from Cushing's Disease.

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Citation: European Journal of Endocrinology. 178(3):255-263, 2018 MarPMID: 29330227Institution: MedStar Washington Hospital CenterDepartment: Medicine/EndocrinologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *ACTH-Secreting Pituitary Adenoma/su [Surgery] | *Adenoma/su [Surgery] | *Hydrocortisone/bl [Blood] | *Neoplasm Recurrence, Local/ep [Epidemiology] | *Neurosurgical Procedures | *Pituitary ACTH Hypersecretion/su [Surgery] | Area Under Curve | Humans | Kaplan-Meier Estimate | Logistic Models | Neoplasm Recurrence, Local/bl [Blood] | Postoperative Period | Remission Induction | ROC Curve | Time FactorsYear: 2018 ISSN:

0804-4643

Name of journal: European journal of endocrinologyAbstract: CONCLUSIONS: In our cohort, early, profound hypocortisolemia could be used as a clinical prediction tool for durable remission. Achievement of hypocortisolemia <= 2 micro g/dL before 21 post-operative hours appeared accurately predict durable remission.CONTEXT: Achievement of hypocortisolemia following transsphenoidal surgery (TSS) for Cushing's disease (CD) is associated with successful adenoma resection. However, up to one third of these patients recur.METHODS: A retrospective review of of 257 patients who received 291 TSS procedures for CD at NIH, between 2003 and 2016. Early biochemical remission (serum cortisol nadir < 5 mug/dL), was confirmed with endocrinological and clinical follow up. Recurrence was detected by laboratory testing, clinical stigmata or medication-dependence during a median follow-up of 11 months.OBJECTIVE: We assessed whether delay in reaching post-operative cortisol nadir may delineate those at risk of recurrence for CD following TSS.RESULTS: Of the 268 unique admissions, remission was recorded in 241 instances. Recurrence was observed in 9% of these cases with cortisol nadir <= 5 mug/dL and 6% of cases with cortisol nadir <= 2 mug/dL. The timing of hypocortisolemia was critical in detecting late recurrences. Morning POD-1 cortisol < 3.3mug/dL was 100% sensitive in predicting durable remission and morning POD-3 cortisol >= 18.5mug/dL was 98.6% specific in predicting remote recurrence. AUROC analysis revealed that hypocortisolemia <= 5 micro g/dL before 15 hours (post-operative) had 95% sensitivity and an NPV of 0.98 for durable remission. Serum cortisol level <= 2 micro g/dL, when achieved before 21 hours, improved sensitivity to 100%.All authors: Asuzu D, Benzo S, Chatain G, Chittiboina P, Ironside N, Lodish M, Lonser R, Nieman L, Sharma S, Stratakis CFiscal year: FY2018Digital Object Identifier:

https://dx.doi.org/10.1530/EJE-17-0873

Date added to catalog: 2018-01-22

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	29330227	Available		29330227

CONCLUSIONS: In our cohort, early, profound hypocortisolemia could be used as a clinical prediction tool for durable remission. Achievement of hypocortisolemia <= 2 micro g/dL before 21 post-operative hours appeared accurately predict durable remission.

CONTEXT: Achievement of hypocortisolemia following transsphenoidal surgery (TSS) for Cushing's disease (CD) is associated with successful adenoma resection. However, up to one third of these patients recur.

METHODS: A retrospective review of of 257 patients who received 291 TSS procedures for CD at NIH, between 2003 and 2016. Early biochemical remission (serum cortisol nadir < 5 mug/dL), was confirmed with endocrinological and clinical follow up. Recurrence was detected by laboratory testing, clinical stigmata or medication-dependence during a median follow-up of 11 months.

OBJECTIVE: We assessed whether delay in reaching post-operative cortisol nadir may delineate those at risk of recurrence for CD following TSS.

RESULTS: Of the 268 unique admissions, remission was recorded in 241 instances. Recurrence was observed in 9% of these cases with cortisol nadir <= 5 mug/dL and 6% of cases with cortisol nadir <= 2 mug/dL. The timing of hypocortisolemia was critical in detecting late recurrences. Morning POD-1 cortisol < 3.3mug/dL was 100% sensitive in predicting durable remission and morning POD-3 cortisol >= 18.5mug/dL was 98.6% specific in predicting remote recurrence. AUROC analysis revealed that hypocortisolemia <= 5 micro g/dL before 15 hours (post-operative) had 95% sensitivity and an NPV of 0.98 for durable remission. Serum cortisol level <= 2 micro g/dL, when achieved before 21 hours, improved sensitivity to 100%.

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