title: Long-term predictive value of postsurgical cortisol concentrations for cure and risk of recurrence in Cushing's disease.
abstract: We assessed the value of postoperative plasma cortisol concentrations to predict cure and recurrence of Cushing's disease after transsphenoidal surgery (TS). Seventy-eight of 80 consecutive patients treated by TS for Cushing's disease were evaluated. TS cured 72% (n = 56) of the patients. Two weeks after surgery, patients with plasma cortisol levels below 138 nmol/liter (n = 50; three macroadenomas) and eight (27%) of 30 patients (nine macroadenomas) with cortisol greater than 138 nmol/liter were cured. Six (five with a macroadenoma) of these eight patients had cortisol values less than 50 nmol/liter 3 months after surgery. Therefore, the optimal cut-off value of cortisol predicting remission was 138 nmol/liter, measured 3 months after surgery (positive and negative predictive values 87 and 90%, respectively). Five patients (9%) had recurrent Cushing's disease during a median follow-up of 7 yr. Recurrence occurred in four of 24 (17%) patients with a follow-up of more than 10 yr. Therefore, cortisol levels above 138 nmol/liter, obtained 2 wk after TS, should be repeated, because they do not predict persistent Cushing's disease in 27% of those patients. Postoperative cortisol levels do not positively predict recurrence of disease during long-term follow-up of initially cured patients.
authors.affiliation: Departments of Endocrinology and Metabolism, Leiden University Medical Center, 2300 RC Leiden, The Netherlands. a.m.pereira@lumc.nl
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
authors.forename: Maarten O
authors.initials: MO
authors.lastname: van Aken
authors.forename: Hans
authors.initials: H
authors.lastname: van Dulken
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Schutte
authors.forename: Nienke R
authors.initials: NR
authors.lastname: Biermasz
authors.forename: Jan W A
authors.initials: JW
authors.lastname: Smit
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Roelfsema
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Romijn
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003480:Cushing Syndrome / Q000097:blood* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment; D013997:Time Factors
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone