[Assessment of the hypothalamic-pituitary-adrenal axis in Cushing's disease diagnosis and remission].
Cushing's disease (CD) remains a medical challenge, with many questions still unanswered. Successful treatment of CD patients is closely related to correct approach to syndromic and etiological diagnosis, besides the experience and talent of the neurosurgeon. Pituitary transsphenoidal adenomectomy is the treatment of choice for DC. Assessment of remission after surgery and recurrence in the long term is an even greater challenge. In this regard, special attention should be paid to the role of postoperative serum cortisol as a marker of CD remission. Additionally, the postoperative use of exogenous glucocorticoids only in cases of adrenal insufficiency has been suggested by some authors as an essential practice to enable the use of serum cortisol in this scenario. In this article, we review the forms of evaluation of DC activity, and markers of remission and relapse of CD after transsphenoidal surgery.
Programa de Pós-Graduação em Ciências Médicas - Endocrinologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.
Fabíola
F
Costenaro
Ticiana C
TC
Rodrigues
Guilherme A F
GA
Rollin
Mauro A
MA
Czepielewski
D000309:Adrenal Insufficiency / Q000188:drug therapy; D000315:Adrenalectomy / Q000379:methods; D000324:Adrenocorticotropic Hormone / Q000097:blood; D015415:Biomarkers / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000601:surgery*; D010913:Pituitary-Adrenal System / Q000502:physiology; D011182:Postoperative Care; D011237:Predictive Value of Tests; D012008:Recurrence; D016896:Treatment Outcome
D015415:Biomarkers; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone