title: Adrenocorticotropic hormone levels before treatment predict recurrence of Cushing's disease.
abstract: OBJECTIVE
  Cushing's disease (CD) is the most common cause of endogenous Cushing's syndrome. Transsphenoidal surgery (TSS) is the first choice of treatment. Predicting prognosis after treatment can benefit further strategies of management, but currently there is no convenient predictor. This study aims to investigate characteristic changes after treatment and to identify potential prognostic predictors.
  
  
  METHODS
  We retrospectively studied the records of CD patients presenting to the National Taiwan University Hospital, Taipei, Taiwan between 1992 and 2011. They were categorized according to treatment response. Clinical features and examination findings were compared between groups.
  
  
  RESULTS
  Forty-one patients with CD were included. The follow-up time was 0.26-19.3 years. The time interval between the onset of symptoms and diagnosis was 2.1-120.0 months. The initial remission rate of CD after the first treatment was 82.9%. Mean body mass index (BMI) was 27.4 kg/m2before treatment and 26.0 kg/m23 months after treatment. The patients in remission had a greater decrease in BMI after treatment and lower dehydroepiandrosterone sulfate (DHEAS) levels before treatment, compared with the recurrent group (both p < 0.05). Adrenocorticotropic hormone (ACTH) levels before treatment showed a significant positive correlation with recurrent diseases (p < 0.05).
  
  
  CONCLUSIONS
  A larger decrease in BMI after treatment and lower DHEAS levels before treatment were noted for the patients who stayed in CD remission. Higher ACTH levels before treatment predicted a recurrence of CD. These are potentially simple and practical predictors of prognosis.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; New Taipei City Hospital, New Taipei City, Taiwan.
authors.forename: Chun-Heng
authors.initials: CH
authors.lastname: Kuo
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan; Center of Anti-aging and Health Consultation, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shyang-Rong
authors.initials: SR
authors.lastname: Shih
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Hung-Yuan
authors.initials: HY
authors.lastname: Li
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; New Taipei City Hospital, New Taipei City, Taiwan.
authors.forename: Szu-Chi
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
authors.forename: Po-Ju
authors.initials: PJ
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: fytseng@ntu.edu.tw.
authors.forename: Fen-Yu
authors.initials: FY
authors.lastname: Tseng
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan; Center of Anti-aging and Health Consultation, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: tienchunchang@ntu.edu.tw.
authors.forename: Tien-Chun
authors.initials: TC
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019314:Dehydroepiandrosterone Sulfate; D000324:Adrenocorticotropic Hormone
keywords: Cushing's disease; body mass index; dehydroepiandrosterone sulfate; recurrence