The Prognostic Value of Perioperative Profiles of ACTH and Cortisol for Recurrence after Transsphenoidal Hypophysectomy in Dogs with Corticotroph Adenomas

Abstract

BackgroundTranssphenoidal hypophysectomy is an effective treatment for dogs with pituitary‐dependent hypercortisolism (PDH). However, long‐term recurrence of hypercortisolism is a well‐recognized problem, indicating the need for reliable prognostic indicators.ObjectivesThe aim of this study was to evaluate the prognostic value of perioperative plasma ACTH and cortisol concentrations for identifying recurrence of hypercortisolism after transsphenoidal hypophysectomy.AnimalsA total of 112 dogs with PDH that underwent transsphenoidal hypophysectomy met the inclusion criteria of the study.MethodsHormone concentrations were measured preoperatively and 1–5 hours after surgery. Both absolute hormone concentrations and postoperative concentrations normalized to preoperative concentrations were included in analyses. The prognostic value of hormone concentrations was studied with Cox's proportional hazard analysis.ResultsMedian follow‐up and disease‐free period were 1096 days and 896 days, respectively. Twenty‐eight percent of patients had recurrence, with a median disease‐free period of 588 days. Both absolute and normalized postoperative cortisol concentrations were significantly higher in dogs with recurrence than in dogs without recurrence. High ACTH 5 hours after surgery, high cortisol 1 and 4 hours after surgery, high normalized ACTH 3 hours after surgery, high normalized cortisol 4 hours after surgery and the random slope of cortisol were associated with a shorter disease‐free period.Conclusions and clinical importanceIndividual perioperative hormone curves provide valuable information about the risk of recurrence after hypophysectomy. However, because no single cutoff point could be identified, combination with other variables, such as the pituitary height/brain area (P/B) ratio, is still needed to obtain a good estimate of the risk for recurrence of hypercortisolism after hypophysectomy.

Cushing’s syndrome—an epidemiological study based on a canine population of 21,281 dogs

“…The median age at diagnosis of HC of 9.8 (± 2.5) yr was in agreement with the literature information that reported HC as a disease of middle-age and older dogs with a median value of approximately 9–11 yr (Jensen et al ., 1997; Barker et al ., 2005; Gallelli et al ., 2010; Burkhardt et al ., 2013; Fracassi et al ., 2015a; Van Rijn et al ., 2015; 2016; O’Neill et al ., 2016).…”

“…Dachshunds, Terriers, and Boxers have been identified to have a significantly higher risk of developing HC, and similar conclusions were reached by many other studies (Ling et al ., 1979; Jensen et al ., 1997; Bell et al ., 2006; Hanson et al ., 2007; Helm et al ., 2011; Rodriguez Piñeiro et al ., 2011; Burkhardt et al ., 2013; Fracassi et al ., 2015a; 2015b; Van Rijn et al ., 2015; 2016; O’Neill et al ., 2016). In the present study, this finding has been confirmed and reinforced.…”

Treating canine Cushing’s syndrome: Current options and future prospects

“…Factors that negatively influence the prognosis include a high pituitary height/brain area (P/B) value, old age, high preoperative circulating ACTH concentration, and high pre-and postoperative UCCRs (Hanson et al, 2007;van Rijn et al, 2015van Rijn et al, , 2016. Although a high P/B value is a negative prognostic indicator, hypophysectomy remains a good treatment option also for large pituitary tumors (Fracassi et al, 2014;van Rijn et al, 2016).…”

Transsphenoidal hypophysectomy as a treatment for Rathke's cleft cyst in a dog

“…In comparison, high basal plasma ACTH in a case of Cushing's disease before hypophysectomy should decrease to near zero values shortly after successful hypophysectomy (due to the short half-life of endogenous plasma ACTH), as can be seen in Figure 2. 18,19 However, very low UCCRs are consistent with complete removal of the corticotroph adenoma but are not evidence of complete removal of the pituitary gland.…”