TY  - BOOK
AU  - Sharma, Susmeeta
TI  - Earlier post-operative hypocortisolemia may predict durable remission from Cushing's Disease
SN  - 0804-4643
PY  - 2018///
KW  - *ACTH-Secreting Pituitary Adenoma/su [Surgery]
KW  - *Adenoma/su [Surgery]
KW  - *Hydrocortisone/bl [Blood]
KW  - *Neoplasm Recurrence, Local/ep [Epidemiology]
KW  - *Neurosurgical Procedures
KW  - *Pituitary ACTH Hypersecretion/su [Surgery]
KW  - Area Under Curve
KW  - Humans
KW  - Kaplan-Meier Estimate
KW  - Logistic Models
KW  - Neoplasm Recurrence, Local/bl [Blood]
KW  - Postoperative Period
KW  - Remission Induction
KW  - ROC Curve
KW  - Time Factors
KW  - MedStar Washington Hospital Center
KW  - Medicine/Endocrinology
KW  - Journal Article
N2  - 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%
UR  - https://dx.doi.org/10.1530/EJE-17-0873
ER  -