Low immediate postoperative serum-cortisol nadir predicts the short-term, but not long-term, remission after pituitary surgery for Cushing’s disease

BMC Endocrine Disorders

Research Article

Helene Halvorsen¹  Pål Rønning¹  Jon Ramm-Pettersen²  Jon Berg-Johnsen²  Eirik Helseth²  Jens Bollerslev³  Johan Arild Evang³  Per Kristian Hol⁴ 

[1] Department of Neurosurgery, Oslo University Hospital, Oslo, Norway;Department of Neurosurgery, Oslo University Hospital, Oslo, Norway;Faculty of Medicine, University of Oslo, Oslo, Norway;Faculty of Medicine, University of Oslo, Oslo, Norway;Section of Specialized Endocrinology, Medical Clinic B, Oslo University Hospital, Oslo, Norway;Faculty of Medicine, University of Oslo, Oslo, Norway;The Intervention Centre, Oslo University Hospital, Oslo, Norway;

关键词: Pituitary adenoma;    Cushing’s disease;    Transsphenoidal surgery;    Cortisol measurement;    Endocrine remission;   

DOI  :  10.1186/s12902-015-0055-9

 received in 2015-04-17, accepted in 2015-10-15,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundCushing’s disease is an ACTH-producing pituitary adenoma, and the primary treatment is microscopic or endoscopic transsphenoidal selective adenectomy. The aims of the present study were to evaluate whether the early postoperative S-cortisol level can serve as a prognostic marker for short- and long-term remission, and retrospectively review our own short and long term results after surgery for Cushing’s disease.MethodsThis single centre, retrospective study consists of 19 consecutive patients with Cushing’s disease who underwent transsphenoidal surgery. S-cortisol was measured every 6 h after the operation without any glucocorticoid replacement. We have follow-up on all patients, with a mean follow-up of 68 months.ResultsAt the three-month follow-up, 16 patients (84 %) were in remission; at 12 months, 18 (95 %) were in remission and at the final follow-up (mean 68 months), 13 (68 %) were in remission. Five-years recurrence rate was 26 %. The mean postoperative S-cortisol nadir was significantly lower in the group of patients in remission than in the non-remission group at 3 months, but there was no difference between those in long-term remission compared to those in long-term non-remission. The optimal cut-off value for classifying 3-month remission was 74 nmol/l.ConclusionWe achieved a 95 % 1-year remission rate with transsphenoidal surgery for Cushing’s disease in this series of consecutive patients. However, the 5-year recurrence rate was 26 %, showing the need for regular clinical and biochemical controls in this patient group. The mean postoperative serum-cortisol nadir was significantly lower in patients in remission at 3 months compared to patients not in remission at 3 months, but a low postoperative S-cortisol did not predict long-term remission.

【 授权许可】

CC BY   
© Ramm-Pettersen et al. 2015