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- Title
Normalized Early Postoperative Cortisol and ACTH Values Predict Nonremission After Surgery for Cushing Disease.
- Authors
Asuzu, David; Chatain, Grégoire P; Hayes, Christina; Benzo, Sarah; McGlotten, Raven; Keil, Meg; Beri, Andrea; Sharma, Susmeeta T; Nieman, Lynnette; Lodish, Maya; Stratakis, Constantine; Lonser, Russell R; Oldfield, Edward H; Chittiboina, Prashant
- Abstract
<bold>Context: </bold>Perioperative increases in adrenocorticotropic hormone (ACTH) and cortisol mimic results of corticotropin-releasing hormone (CRH) stimulation testing. This phenomenon may help identify patients with residual adenoma after transsphenoidal surgery (TSS) for Cushing disease (CD).<bold>Objective: </bold>To predict nonremission after TSS for CD.<bold>Design: </bold>Retrospective case-control study of patients treated at a single center from December 2003 until July 2016. Early and medium-term remission were assessed at 10 days and 11 months.<bold>Patients and Setting: </bold>Two hundred and ninety-one consecutive TSS cases from 257 patients with biochemical evidence of CD seen at a clinical center.<bold>Interventions: </bold>Normalized early postoperative values (NEPVs) for cortisol and ACTH were calculated as immediate postoperative cortisol or ACTH levels minus preoperative post-CRH-stimulation test levels.<bold>Main Outcome Measures: </bold>Prediction of early nonremission was evaluated using logistic regression. Prediction of medium-term remission was assessed using Cox regression. Predictive ability was quantified by area under the receiver operating characteristic curve (AUROC).<bold>Results: </bold>NEPVs for cortisol and ACTH predicted early nonremission [adjusted odds ratio (OR): 1.1; 95% confidence interval (CI): 1.0, 1.1; P = 0.016 and adjusted OR: 1.0; 95% CI: 1.0, 1.0; P = 0.048, respectively]. AUROC for NEPV of cortisol was 0.78 (95% CI: 0.61, 0.95); for NEPV of ACTH, it was 0.80 (95% CI: 0.61, 0.98). NEPVs for cortisol and ACTH predicted medium-term nonremission [hazard ratio (HR): 1.1; 95% CI: 1.0, 1.1; P = 0.023 and HR: 1.0; 95% CI: 1.0, 1.0; P = 0.025, respectively].<bold>Conclusions: </bold>NEPVs for cortisol and ACTH predicted nonremission after TSS for CD.
- Subjects
ADRENOCORTICOTROPIC hormone; AGE distribution; HYDROCORTISONE; PITUITARY diseases; POSTOPERATIVE period; PROGNOSIS; REFERENCE values; RESEARCH funding; SEX distribution; PREDICTIVE tests; DISEASE remission; RETROSPECTIVE studies
- Publication
Journal of Clinical Endocrinology & Metabolism, 2017, pN.PAG
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/jc.2016-3908