title: Sequential hormonal changes in 21 patients with recurrent Cushing's disease after successful pituitary surgery.
abstract: OBJECTIVE
  To describe the sequence of hormonal changes during recurrence of Cushing's disease (CD) after successful transsphenoidal surgery (TSS).
  
  
  METHODS
  Retrospective study in a single center.
  
  
  METHODS
  We studied 101 of the 127 patients treated by TSS for CD between 1996 and 2009, who had hypocortisolism or eucortisolism for at least 3 months post-TSS. We arbitrarily defined 'overt recurrence', as presence of two classical parameters of excess cortisol (increased midnight--either serum or salivary--and 24  h urinary cortisol (UC)), leading to further specific therapeutic action, and 'mild recurrence', as presence of a single classical parameter, leading to simple surveillance.
  
  
  RESULTS
  Of the 101 patients, 21 (20.8%) presented with recurrence, 'mild' or 'overt', during long-term follow-up (median 50.4 months, range 7-99). Recurrence occurred less frequently (16.8 vs 50%, P=0.02), and later (mean 44.7 months, median 43, range 7-94 vs mean 21.5 months, median 17, range 3-61, P=0.05), in patients with early post-TSS hypocortisolism compared with those with eucortisolism. Increase in midnight cortisol occurred in a mean time of 38.2 months, while UC elevation was observed at 50.6 months. Vasopressin analogs and CRH tests were eventually positive in 85 and 93% of all patients respectively; a positive response to one of the two dynamic tests preceded the increase in midnight cortisol or UC in 71 and 64% of the patients respectively.
  
  
  CONCLUSIONS
  A positive response to vasopressin analogs and/or CRH tests occurs early in recurrence, followed by an increase in midnight cortisol, while UC elevation is at a later stage.
authors: Centre de Référence des Maladies Rares de la Surrénale, Service des Maladies Endocriniennes et Métaboliques, Hôpital Cochin, 27, rue du Faubourg St-Jacques, 75014 Paris, France.
authors: Roula
authors: R
authors: Bou Khalil
authors: Camille
authors: C
authors: Baudry
authors: Laurence
authors: L
authors: Guignat
authors: Carmen
authors: C
authors: Carrasco
authors: Jean
authors: J
authors: Guibourdenche
authors: Stéphane
authors: S
authors: Gaillard
authors: Xavier
authors: X
authors: Bertagna
authors: Jérôme
authors: J
authors: Bertherat
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000096:biosynthesis / Q000097:blood / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000378:metabolism* / Q000601:surgery*; D010902:Pituitary Gland / Q000378:metabolism* / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012471:Salivary Proteins and Peptides / Q000096:biosynthesis / Q000097:blood / Q000378:metabolism; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D012471:Salivary Proteins and Peptides; D006854:Hydrocortisone