Normalized Early Postoperative Cortisol and ACTH Values Predict Nonremission After Surgery for Cushing Disease.
Perioperative increases in adrenocorticotropic hormone (ACTH) and cortisol mimic results of corticotropin-releasing hormone (CRH) stimulation testing. This phenomenon may help identify patients with residual adenoma after transsphenoidal surgery (TSS) for Cushing disease (CD).



To predict nonremission after TSS for CD.



Retrospective case-control study of patients treated at a single center from December 2003 until July 2016. Early and medium-term remission were assessed at 10 days and 11 months.



Two hundred and ninety-one consecutive TSS cases from 257 patients with biochemical evidence of CD seen at a clinical center.



Normalized early postoperative values (NEPVs) for cortisol and ACTH were calculated as immediate postoperative cortisol or ACTH levels minus preoperative post-CRH-stimulation test levels.



Prediction of early nonremission was evaluated using logistic regression. Prediction of medium-term remission was assessed using Cox regression. Predictive ability was quantified by area under the receiver operating characteristic curve (AUROC).



NEPVs for cortisol and ACTH predicted early nonremission [adjusted odds ratio (OR): 1.1; 95% confidence interval (CI): 1.0, 1.1; P = 0.016 and adjusted OR: 1.0; 95% CI: 1.0, 1.0; P = 0.048, respectively]. AUROC for NEPV of cortisol was 0.78 (95% CI: 0.61, 0.95); for NEPV of ACTH, it was 0.80 (95% CI: 0.61, 0.98). NEPVs for cortisol and ACTH predicted medium-term nonremission [hazard ratio (HR): 1.1; 95% CI: 1.0, 1.1; P = 0.023 and HR: 1.0; 95% CI: 1.0, 1.0; P = 0.025, respectively].



NEPVs for cortisol and ACTH predicted nonremission after TSS for CD.
Yale School of Medicine, New Haven, Connecticut 06510.|Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, Maryland 20824.
David
D
Asuzu
Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, Maryland 20824.|Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda, Maryland 20824.
Grégoire P
GP
Chatain
Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda, Maryland 20824.
Christina
C
Hayes
Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda, Maryland 20824.
Sarah
S
Benzo
Section on Clinical Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20847.
Raven
R
McGlotten
Section on Endocrinology and Genetics, Developmental Endocrinology Branch, and Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20847.
Meg
M
Keil
NIH Biomedical Translational Research Information System, National Institutes of Health Clinical Center, Bethesda, Maryland 20814.
Andrea
A
Beri
Pituitary Endocrinology Section, MedStar Washington Hospital Center, Washington, DC 20010.
Susmeeta T
ST
Sharma
Section on Clinical Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland 20847.
Lynnette
L
Nieman
Section on Endocrinology and Genetics, Developmental Endocrinology Branch, and Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20847.
Maya
M
Lodish
Section on Endocrinology and Genetics, Developmental Endocrinology Branch, and Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20847.
Constantine
C
Stratakis
Department of Neurologic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio 43202.
Russell R
RR
Lonser
Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, Virginia 22908.
Edward H
EH
Oldfield
Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, Maryland 20824.|Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda, Maryland 20824.
Prashant
P
Chittiboina
D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000601:surgery*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D012016:Reference Values; D012074:Remission Induction; D012189:Retrospective Studies; D012737:Sex Factors
D015415:Biomarkers; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone