title: [Predictors of long-term remission after transsphenoidal surgery in Cushing's disease].
abstract: There is no consensus on the remission criteria for Cushing's disease or on the definition of disease recurrence after transsphenoidal surgery, and comparison of the different published series is therefore difficult. A long-term recurrence rate of Cushing's disease ranging from 2%-25% has been reported. Predictors of long-term remission reported include: 1) adenoma-related factors (aggressiveness, size, preoperative identification in MRI), 2) surgery-related factors, mainly neurosurgeon experience, 3) clinical factors, of which dependence on and duration of glucocorticoid treatment are most important, and 4) biochemical factors. Among the latter, low postoperative cortisol levels, less than 2 mcg/dL predict for disease remission. However, even when undetectable plasma cortisol levels are present, long-term recurrence may still occur and lifetime follow-up is required. We report the preliminary results of the first 20 patients with Cushing's disease operated on at our hospital using nadir cortisol levels less than 2 mcg/dl as remission criterion.
authors.affiliation: Unidad de Diabetes, Hospital General de Castellón, Castellón de la Plana, Castellón, España.
authors.forename: Pablo
authors.initials: P
authors.lastname: Abellán Galiana
authors.forename: Carmen
authors.initials: C
authors.lastname: Fajardo Montañana
authors.forename: Pedro Antonio
authors.initials: PA
authors.lastname: Riesgo Suárez
authors.forename: José
authors.initials: J
authors.lastname: Gómez Vela
authors.forename: Carlos Meseguer
authors.initials: CM
authors.lastname: Escrivá
authors.forename: Vicente Rovira
authors.initials: VR
authors.lastname: Lillo
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D000293:Adolescent; D000309:Adrenal Insufficiency / Q000188:drug therapy / Q000209:etiology; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D002940:Circadian Rhythm; D003131:Combined Modality Therapy; D003894:Deamino Arginine Vasopressin; D003907:Dexamethasone; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism; D007016:Hypophysectomy / Q000379:methods*; D008297:Male; D008797:Metyrapone; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000601:surgery* / Q000652:urine; D010911:Pituitary Neoplasms / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology; D012074:Remission Induction; D012189:Retrospective Studies; D012463:Saliva / Q000737:chemistry; D012636:Secretory Rate / Q000187:drug effects; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003894:Deamino Arginine Vasopressin; D006854:Hydrocortisone; D008797:Metyrapone