title: Time to recovery of adrenal function after curative surgery for Cushing's syndrome depends on etiology.
abstract: BACKGROUND
  Successful tumor resection in endogenous Cushing's syndrome (CS) results in tertiary adrenal insufficiency requiring hydrocortisone replacement therapy.
  
  
  OBJECTIVE
  The aim was to analyze the postsurgical duration of adrenal insufficiency of patients with Cushing's disease (CD), adrenal CS, and ectopic CS.
  
  
  METHODS
  We performed a retrospective analysis based on the case records of 230 patients with CS in our tertiary referral center treated from 1983-2014. The mean follow-up time was 8 years.
  
  
  METHODS
  We included 91 patients of the three subtypes of CS undergoing curative intended surgery and documented followup after excluding cases with persistent disease, pituitary radiation, concurrent adrenostatic or somatostatin analog treatment, and malignant adrenal disease.
  
  
  RESULTS
  The probability of recovering adrenal function within a 5 years followup differed significantly between subtypes (P = .001). It was 82% in ectopic CS, 58% in CD and 38% in adrenal CS. In the total cohort with restored adrenal function (n = 52) the median time to recovery differed between subtypes: 0.6 years (interquartile range [IQR], 0.03-1.1 y) in ectopic CS, 1.4 years (IQR, 0.9-3.4 y) in CD, and 2.5 years (IQR, 1.6-5.4 y) in adrenal CS (P = .002). In CD the Cox proportional-hazards model showed that the probability of recovery was associated with younger age (hazard ratio, 0.896; 95% confidence interval, 0.822-0.976; P = .012), independently of sex, body mass index, duration of symptoms, and basal ACTH and cortisol levels. There was no correlation with length and extend of hypercortisolism or postoperative glucocorticoid replacement doses.
  
  
  CONCLUSIONS
  Time to recovery of adrenal function is dependent on the underlying etiology of CS.
authors.affiliation: Medizinische Klinik und Poliklinik IV (C.M.B., G.D.D., A.O., K.R., M.B., N.R., J.S., F.B., M.R.), Institut für Klinische Radiologie (L.L.G., M.T.), Chirurgische Klinik und Poliklinik-Innenstadt (K.H.), 80336 München, Germany; Klinik für Neurochirurgie, Klinikum Grosshadern (W.R.), Ludwig-Maximilians-Universität München, 81377 München, Germany; and Institut für Medizinische Statistik und Epidemiologie (R.B.), Klinikum rechts der Isar der TU München, 81675 München, Germany.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Berr
authors.forename: Guido
authors.initials: G
authors.lastname: Di Dalmazi
authors.forename: Andrea
authors.initials: A
authors.lastname: Osswald
authors.forename: Katrin
authors.initials: K
authors.lastname: Ritzel
authors.forename: Martin
authors.initials: M
authors.lastname: Bidlingmaier
authors.forename: Lucas L
authors.initials: LL
authors.lastname: Geyer
authors.forename: Marcus
authors.initials: M
authors.lastname: Treitl
authors.forename: Klaus
authors.initials: K
authors.lastname: Hallfeldt
authors.forename: Walter
authors.initials: W
authors.lastname: Rachinger
authors.forename: Nicole
authors.initials: N
authors.lastname: Reisch
authors.forename: Rainer
authors.initials: R
authors.lastname: Blaser
authors.forename: Jochen
authors.initials: J
authors.lastname: Schopohl
authors.forename: Felix
authors.initials: F
authors.lastname: Beuschlein
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000534:rehabilitation / Q000601:surgery; D000236:Adenoma / Q000150:complications / Q000534:rehabilitation / Q000601:surgery; D000311:Adrenal Glands / Q000502:physiology*; D000309:Adrenal Insufficiency / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery; D000328:Adult; D003480:Cushing Syndrome / Q000209:etiology* / Q000534:rehabilitation* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors