title: Evaluation of Cushing's disease remission after transsphenoidal surgery based on early serum cortisol dynamics.
abstract: OBJECTIVE
  To evaluate the ability of post-transsphenoidal pituitary surgery (TSS) serum cortisol levels (s-cortisol) to predict surgical remission and recurrence of Cushing's disease (CD).
  
  
  METHODS
  One hundred and three patients with CD from a tertiary referral centre were prospectively analysed over 6·0 ± 4·8 years of follow-up. Twenty patients received perioperative glucocorticoids as routine care and had s-cortisol measured 10-12 days after TSS (Protocol I). Eighty-six patients (91 surgeries) had s-cortisol measured at 6, 12, 18, 24, 48 h, and 10-12 days after TSS, and received glucocorticoids only in case of adrenal insufficiency (Protocol II).
  
  
  RESULTS
  Remission [clinical signs and symptoms of adrenal insufficiency (or hypocortisolism) plus cortisol <3 μg/dl on the 1-mg overnight test (OT) and/or normal free urinary cortisol] during follow-up. Recurrence was defined as loss of remission criteria at least 1 year after TSS.
  
  
  RESULTS
  The remission rate after first TSS was 80%; 8% had recurrence. An s-cortisol nadir ≤3·5 μg/dl within 48 h after TSS had sensitivity of 73%, specificity and positive predictive value (PPV) of 100% and negative predictive value (NPV) of 60% and an s-cortisol nadir ≤5·7 μg/dl within 10-12 days of TSS had specificity and PPV of 100% and sensitivity of 91% NPV of 78% for CD remission.
  
  
  CONCLUSIONS
  At hospital discharge, the s-cortisol nadir within 48 h after TSS was already able to predict surgical remission for some patients, and the s-cortisol nadir within 10-12 days of TSS was able to predict cohort-wide surgical remission.
authors.affiliation: Post Graduate Program in Medical Sciences - Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Fabíola
authors.initials: F
authors.lastname: Costenaro
authors.forename: Ticiana C
authors.initials: TC
authors.lastname: Rodrigues
authors.forename: Guilherme A F
authors.initials: GA
authors.lastname: Rollin
authors.forename: Nelson P
authors.initials: NP
authors.lastname: Ferreira
authors.forename: Mauro A
authors.initials: MA
authors.lastname: Czepielewski
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010351:Patient Discharge; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D011237:Predictive Value of Tests; D012008:Recurrence; D012074:Remission Induction; D013101:Sphenoid Sinus / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006854:Hydrocortisone