Transsphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successfuI treatment

Trainer, Peter; Lawrie, Henrietta; Verhelst, Johan; Howlett, Trevor A.; Lowe, Donna; Grossman, Ashley; Savage, Martin O.; Afshar, F.; Besser, G. M.

doi:10.1111/j.1365-2265.1993.tb00975.x

Cited by 262 publications

(223 citation statements)

References 23 publications

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“…The best long-term outcome of transsphenoidal surgery appears to be in those patients who have unmeasurable plasma cortisol levels in the immediate postoperative period [7,9]. In this study, we showed that long-term remission may be possible with low or unmeasurable plasma cortisol levels postoperatively (<2 Cg/d1, 56 nmol/L).…”

Section: Discussionmentioning

confidence: 57%

“…Postoperative cure of Cushing's disease has been variously defined in terms of an undetectable or low normal serum Cortisol or urinary free IMAKI et al cortisol levels [7] . Trainer et al reported that patients with an undetectable serum cortisol (<50 nmol/L, 1.8 pg/dl) following surgery did not develop recurrent Cushing's disease [9] . Other parameters that have been used to predict cure following transsphenoidal surgery include basal plasma ACTH levels [l0], the response of plasma ACTH and cortisol to corticotropin-releasing hormone (CRH) [11][12][13][14], the dexamethasone suppression test [15], and postoperative hypocortisolism [16][17][18].…”

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confidence: 99%

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Postoperative Plasma Cortisol Levels Predict Long-Term Outcome in Patients with Cushing's Disease and Determine Which Patients Should be Treated with Pituitary Irradiation after Surgery.

et al. 2001

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Section: Discussionmentioning

confidence: 57%

mentioning

confidence: 99%

Postoperative Plasma Cortisol Levels Predict Long-Term Outcome in Patients with Cushing's Disease and Determine Which Patients Should be Treated with Pituitary Irradiation after Surgery.

et al. 2001

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“…Less strict criteria could result in higher rates of cure. Even adopting more stringent criteria, recurrence occurs in 5 to 15% of cases (1,25,(33)(34)(35)(38)(39)(40). In cured patients, glucocorticoid replacement therapy is mandatory during HPA recover.…”

Section: Factors Associated To Cure or Remission Rates In Cushing's Dmentioning

confidence: 99%

“…Postoperative serum cortisol is the major marker used to evaluate CD activity (25,26,33,34,36,47). Ideal time for serum collection does not follow any standard pattern and presents a wide variation between different centers (table 3).…”

Section: Serum Cortisolmentioning

confidence: 99%

Criteria of cure and remission in Cushing's disease: an update

Czepielewski

Rollin

Casagrande

et al. 2007

Arq Bras Endocrinol Metab

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We review the clinical and biochemical criteria used for evaluation of the transsphenoidal pituitary surgery results in the treatment of Cushing's disease (CD). Firstly, we discuss the pathophysiology of the hypothalamic-pituitary-adrenal axis in normal subjects and patients with CD. Considering the series published in the last 25 years, we observed a significant variation in the remission or cure criteria, including the choice of biochemical tests, timing, threshold values to define remission, and the interference of glucocorticoid replacement or previous treatment. In this context we emphasize serum cortisol levels obtained early (from hours to 12 days) in the postoperative period without any glucocorticoid replacement or treatment. Our experience demonstrates that: (i) early cortisol < 5 to 7 µg/dl, (ii) a period of glucocorticoid dependence > 6 mo, (iii) absence of response of cortisol/ACTH to CRH or DDAVP, (iv) return of dexamethasone suppression, and circadian rhythm of cortisol are appropriate indices of remission of CD. In patients with undetectable cortisol levels early after surgery, recurrence seems to be low. Finally, although certain biochemical patterns are more suggestive of remission or surgical failure, none has been proven to be completely accurate, with recurrence observed in approximately 10 to 15% of the patients in long-term follow-up. We recommended that patients with CD should have long-term monitoring of the CRH-ACTH-cortisol axis and associated co-morbidities, especially hypopituitarism, diabetes mellitus, hypertension, cardiovascular disturbances, and osteoporosis. RESUMOCritérios de Cura e Remissão na Doença de Cushing: Uma Atualização. Neste artigo, são revisados os principais critérios clínicos e hormonais utilizados para avaliação do tratamento cirúrgico da Doença de Cushing (DC). Inicialmente são comentados aspectos fisiopatológicos que orientam a avaliação hormonal e os principais fatores clínicos, laboratoriais, cirúrgicos e histológicos associados com melhores resultados, observados nas principais séries da literatura e em pacientes acompanhados prospectivamente pelos autores. Foram revisados, também, critérios adotados nas principais séries da literatura, nos últimos 25 anos, chamando-se atenção para as dosagens hormonais, o momento em que foram realizadas, a possibilidade de interferência de tratamentos prévios e da reposição glicocorticóide. À seguir, essas dosagens são discutidas salientando-se a importância do cortisol obtido seqüencialmente no pós-operatório e sem a interferência de reposição glicocorticóide. A experiência prospectiva dos autores, recentemente referendada na literatura, demonstra que valores de cortisol < 5 a 7 µg/dl associados com um período de dependência aos glicocorticóides > 6 meses, ausência de resposta do ACTH/cortisol ao DDAVP e/ou CRH, retorno da supressão à dexametasona e do ritmo circadiano, estão associados com remissão da DC. Em pacientes com cortisol indetectável após cirurgia transesfenoidal, a chance de recidiva parece ser menor d...

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“…Su embarazo llegó a término, con parto espontáneo vaginal y un recién nacido normal. Sus niveles de cortisol plasmá-tico postcirugía tanto en período precoz como tardío y la imagenología con RNM de control, indican que la enfermedad de Cushing fue curada y no ha habido recurrencia 14,15 . Así, de acuerdo a lo presentado, la cirugía transesfenoidal parece ser segura y efectiva como tratamiento de la enfermedad de Cushing durante el embarazo.…”

Section: Discussionunclassified

Cirugía transesfenoidal en enfermedad de Cushing durante gestación: Report of one case

Verdugo¹,

Alegría²,

Grant³

et al. 2004

Rev. méd. Chile

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(Rev Méd Chile 2004; 132: 75-80La causa más frecuente de síndrome de Cushing en pacientes embarazadas es un adenoma suprarrenal 2,3 . La causa hipofisiaria es infrecuente, al contrario de lo que ocurre en no gestantes. En la literatura se han publicado alrededor de 10 pacientes con enfermedad de Cushing durante el embarazo.La paciente que se presenta corresponde al quinto caso tratado durante la gestación mediante adenomectomía transesfenoidal. CASO CLÍNICOPaciente de 26 años de edad, quien presentó progresivamente, en un lapso de 9 meses antes de la consulta, cuadro caracterizado por aumento de peso de 20 kilos, aumento de volumen facial e

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Transsphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successfuI treatment

Cited by 262 publications

References 23 publications

Postoperative Plasma Cortisol Levels Predict Long-Term Outcome in Patients with Cushing's Disease and Determine Which Patients Should be Treated with Pituitary Irradiation after Surgery.

Postoperative Plasma Cortisol Levels Predict Long-Term Outcome in Patients with Cushing's Disease and Determine Which Patients Should be Treated with Pituitary Irradiation after Surgery.

Criteria of cure and remission in Cushing's disease: an update

Cirugía transesfenoidal en enfermedad de Cushing durante gestación: Report of one case

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