title: The dynamics of post-operative plasma ACTH values following transsphenoidal surgery for Cushing's disease.
abstract: Rapid assessment of adrenal function is critical following transsphenoidal surgery (TSS) for Cushing's disease (CD) in order to determine surgical efficacy. We hypothesize that there may be a role for ACTH measurement as a rapid indicator of adrenal function. Following surgery for CD, glucocorticoids were withheld and paired plasma ACTH and serum cortisol levels were measured every 6 h. Post-operative hypocortisolemia was defined as serum cortisol <2 mcg/dl or a serum cortisol <5 mcg/dl with the onset of symptoms of adrenal insufficiency within 72 h. We studied 12 subjects, all female, mean age 44.6 years (range 25-55), including 13 surgeries: nine subjects attained hypocortisolemia. Plasma ACTH levels decreased more in subjects with hypocortisolemia (0.9 pg/ml/hr, P = 0.0028) versus those with persistent disease (0 0.2 pg/ml/hr, P = 0.26) within the first 48 h after surgery. In contrast to subjects with persistent disease, all subjects with hypocortisolemia achieved a plasma ACTH <20 pg/ml by 19 h (range 1-19 h). Four of the nine subjects with hypocortisolemia achieved plasma ACTH <20 pg/ml by 13 h and the remaining five subjects by 19 h. Hypocortisolemia occurred between 3-36 h following achievement of a plasma ACTH <20 pg/ml. In CD, a reduction in postoperative plasma ACTH levels differentiates subjects with surgical remission versus subjects with persistent disease. The utility of plasma ACTH measurements in the postoperative management of CD remains to be determined.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305-5821, USA.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Srinivasan
authors.forename: Edward R
authors.initials: ER
authors.lastname: Laws
authors.forename: Robert L
authors.initials: RL
authors.lastname: Dodd
authors.forename: Monique M
authors.initials: MM
authors.lastname: Monita
authors.forename: Christyn E
authors.initials: CE
authors.lastname: Tannenbaum
authors.forename: Kjersti M
authors.initials: KM
authors.lastname: Kirkeby
authors.forename: Olivia S
authors.initials: OS
authors.lastname: Chu
authors.forename: Griffith R
authors.initials: GR
authors.lastname: Harsh
authors.forename: Laurence
authors.initials: L
authors.lastname: Katznelson
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000097:blood / Q000150:complications / Q000601:surgery; D000236:Adenoma / Q000097:blood / Q000150:complications / Q000601:surgery; D000324:Adrenocorticotropic Hormone / Q000097:blood* / Q000378:metabolism; D000328:Adult; D013507:Endocrine Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007700:Kinetics; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000378:metabolism / Q000601:surgery*; D011184:Postoperative Period; D012074:Remission Induction; D013100:Sphenoid Bone / Q000601:surgery
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone