title: Approach to the postoperative patient with Cushing's disease.
abstract: BACKGROUND
  Cushing's disease is a neuroendocrine disorder marked by hypercortisolemia secondary to overproduction of ACTH by a corticotropic pituitary adenoma. Due to the diverse and deleterious effects of hypercortisolemia including diabetes mellitus, hypertension, and cardiovascular disease, prompt and accurate diagnosis followed by surgical resection of the responsible corticotropic adenoma is critical.
  
  
  METHODS
  In the following review, we present a focused synopsis of recently published data and management strategies for the post-operative Cushing's disease patient with a particular focus on studies examining perioperative complications, establishment of biochemical remission, factors associated with disease remission, and predictors of recurrence.
  
  
  CONCLUSIONS
  Although no standard definition of remission exists, we suggest measurement of serum cortisol level on the morning of postoperative day 1 given the preponderance of evidence in the published literature suggesting its association with long-term remission and relatively low rates of recurrence. Nevertheless, all patients should be counseled that recurrence can occur in a delayed fashion and that annual endocrine testing should be utilized to track and confirm disease status.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M-779, San Francisco, CA, 94143, USA, Rutkowskim@neurosurg.ucsf.edu.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Rutkowski
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Breshears
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kunwar
authors.forename: Manish K
authors.initials: MK
authors.lastname: Aghi
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Blevins
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local; D047748:Pituitary ACTH Hypersecretion / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D011182:Postoperative Care; D012074:Remission Induction; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome