title: Utility of the immediate postoperative cortisol concentrations in patients with Cushing's disease.
abstract: BACKGROUND
  Several investigators have recommended serial measurements of serum cortisol in the days following pituitary surgery to identify patients at risk of recurrence.
  
  
  OBJECTIVE
  We systematically reviewed the literature on this topic and analyzed the usefulness of this test in our own patient population.
  
  
  METHODS
  We identified studies publishing data regarding recurrence rates after transsphenoidal surgery for Cushing's disease, focusing on studies with data regarding patients with early postoperative cortisol levels. We determined a cumulative relative risk of having a subnormal vs normal cortisol level postoperatively using a fixed-effects meta-analysis model. Additionally, we analyzed our own patients with Cushing's disease undergoing transsphenoidal surgery and performed Kaplan-Meier analysis of recurrence-free survival for patients with undetectable, subnormal but detectable, and normal immediate 8 AM serum cortisol levels.
  
  
  RESULTS
  Fourteen studies met inclusion criteria. The length of follow-up varied between 32 and 115 months. The cumulative rate of recurrence in the group of patients with subnormal cortisol levels was 9% (95% confidence interval: 6%-12%). The cumulative rate of recurrence in the group with normal cortisol levels was 24% (95% confidence interval: 17%-31%). We analyzed 73 of our own patients and found similar recurrence rates in patients with subnormal vs normal early postoperative cortisol levels (4% vs 22%, chi2 test, P < .05).
  
  
  CONCLUSIONS
  Although a subnormal early postoperative cortisol level is predictive of improved outcome after transsphenoidal surgery for Cushing's disease, it is not analogous with cure, nor is a normal level completely predictive of future failure.
authors.affiliation: California Center for Pituitary Disorders, University of California, San Francisco, California 94143-0350, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Sughrue
authors.forename: Jugal K
authors.initials: JK
authors.lastname: Shah
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Devin
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kunwar
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Blevins
mesh_terms: D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000097:blood* / Q000378:metabolism; D008991:Monitoring, Physiologic / Q000379:methods*; D047748:Pituitary ACTH Hypersecretion / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D010902:Pituitary Gland / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011184:Postoperative Period
chemical_list: D006854:Hydrocortisone