title: Follow-up intervals in patients with Cushing's disease: recommendations from a panel of experienced pituitary clinicians.
abstract: OBJECTIVE
  Follow-up guidelines are needed to assess quality of care and to ensure best long-term outcomes for patients with Cushing's disease (CD). The purpose of this study was to assess agreement by experts on recommended follow-up intervals for CD patients at different phases in their treatment course.
  
  
  METHODS
  The RAND/UCLA modified Delphi process was used to assess expert consensus. Eleven clinicians who regularly manage CD patients rated 79 hypothetical patient scenarios before and after ("second round") an in-person panel discussion to clarify definitions. Scenarios described CD patients at various time points after treatment. For each scenario, panelists recommended follow-up intervals in weeks. Panel consensus was assigned as follows: "agreement" if no more than two responses were outside a 2 week window around the median response; "disagreement" if more than two responses were outside a 2 week window around the median response. Recommendations were developed based on second round results.
  
  
  RESULTS
  Panel agreement was 65.9% before and 88.6% after the in-person discussion. The panel recommended follow-up within 8 weeks for patients in remission on glucocorticoid replacement and within 1 year of surgery; within 4 weeks for patients with uncontrolled persistent or recurrent disease; within 8-24 weeks in post-radiotherapy patients controlled on medical therapy; and within 24 weeks in asymptomatic patients with stable plasma ACTH concentrations after bilateral adrenalectomy.
  
  
  CONCLUSIONS
  With a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice.
authors.affiliation: Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA. geere@mskcc.org.
authors.forename: Eliza B
authors.initials: EB
authors.lastname: Geer
authors.affiliation: University of Miami and Jackson Memorial Hospital, 1500 NW 10th Avenue, Miami, FL, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Ayala
authors.affiliation: Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, USA.
authors.forename: Vivien
authors.initials: V
authors.lastname: Bonert
authors.affiliation: Keck School of Medicine of University of Southern California, 1520 San Pablo Street, Los Angeles, CA, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Carmichael
authors.affiliation: Allegheny Neuroendocrinology Center, Allegheny General Hospital, 420 East North Avenue, Pittsburgh, PA, USA.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Gordon
authors.affiliation: Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, USA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Katznelson
authors.affiliation: University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, USA.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Manuylova
authors.affiliation: University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, USA.
authors.forename: Ismat
authors.initials: I
authors.lastname: Shafiq
authors.affiliation: Harbor-UCLA Medical Center, 1124 W. Carson St., Torrance, CA, USA.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Surampudi
authors.affiliation: Harbor-UCLA Medical Center, 1124 W. Carson St., Torrance, CA, USA.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Swerdloff
authors.affiliation: Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Beverly Hills, CA, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Broder
authors.affiliation: Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Beverly Hills, CA, USA.
authors.forename: Dasha
authors.initials: D
authors.lastname: Cherepanov
authors.affiliation: Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Beverly Hills, CA, USA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Eagan
authors.affiliation: Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Beverly Hills, CA, USA.
authors.forename: Jackie
authors.initials: J
authors.lastname: Lee
authors.affiliation: Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, USA.
authors.forename: Qayyim
authors.initials: Q
authors.lastname: Said
authors.affiliation: Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, USA.
authors.forename: Maureen P
authors.initials: MP
authors.lastname: Neary
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
authors.forename: Beverly M K
authors.initials: BMK
authors.lastname: Biller
mesh_terms: D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000097:blood; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*; D010902:Pituitary Gland / Q000187:drug effects / Q000601:surgery
chemical_list: D005938:Glucocorticoids; D000324:Adrenocorticotropic Hormone
keywords: Biochemical status; Consensus statements; Cushing’s disease; Expert panel; Follow-up; Treatment