The role of early cortisol level in the assessment of the radicality of resection in central Cushing's disease.
BACKGROUND
To increase radicality and avoid surgical complications new treatment options are under investigation. One of the promising possibilities is to assess early morning cortisol levels on the first and second postoperative day.


METHODS
We enrolled 34 patients (9 males, 25 females) diagnosed with Cushing's disease. Blood samples to determine cortisol level were taken always at 06:00 and sent to the lab. The samples were taken on the first and second postoperative day. For all patients, standard four-handed, a bi-nostril endoscopic endonasal technique was used. Endocrinological follow-up (6-34 months) was performed using morning cortisol sampling.


RESULTS
In total, 36 patients (88%) were disease-free post-surgery. In the group with early postoperative levels of morning cortisol of less than 463 nmol/L, only 2 of 29 patients (7%) exceeded the final morning level of cortisol at follow-up. In patients with early postoperative cortisol levels between 17 nmol/l and 234 nmol/l all subjects showed normal postoperative cortisol levels.


CONCLUSIONS
In 30 of 34 patients (88%), the level of cortisol was within normal limits. The prediction importance of early measurement of cortisol is 93% for patients with early postoperative cortisol levels of less than 463 nmol/L. The prediction importance of early measurement of cortisol is 100% for patients with early postoperative cortisol levels from 17 to 234 nmol/L.


CONCLUSIONS
The monitoring of early morning cortisol levels seems to be an important tool in the management of central Cushing's disease.
Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Central Military Hospital, Czech Republic.
Vaclav
V
Masopust
Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Central Military Hospital, Czech Republic.
David
D
Netuka
Department of Neurosurgery, Faculty Hospital, Ústí nad Labem, Czech Republic.
Daniel
D
Horinek
3rd Department of Medicine, 1st Faculty of Medicine, Charles University, Czech Republic.
Mikulas
M
Kosak
3rd Department of Medicine, 1st Faculty of Medicine, Charles University, Czech Republic.
Vaclav
V
Hana
3rd Department of Medicine, 1st Faculty of Medicine, Charles University, Czech Republic.
Michal
M
Krsek
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D019635:Neurosurgical Procedures / Q000379:methods*; D047748:Pituitary ACTH Hypersecretion / Q000097:blood* / Q000601:surgery*; D010902:Pituitary Gland / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D016896:Treatment Outcome; D055815:Young Adult
D006854:Hydrocortisone