In:
Experimental and Clinical Endocrinology & Diabetes, Georg Thieme Verlag KG, Vol. 130, No. 11 ( 2022-11), p. 704-713
Abstract:
Objective To identify early available predictors for the long-term outcome
of patients after transsphenoidal surgery (TSS) in the management of Cushing’s disease. Methods This single-center, retrospective study included 93 consecutive
patients with Cushing’s disease (follow-up 12–129 months, mean 48, median 38) who underwent TSS (21 had previous operations elsewhere). Six
cases had early re-operation, and the resulting data were evaluated instead of the respective first operation. During the postoperative course, serum cortisol
levels were assessed every four hours at least until the next morning. An association of parameters with long-term outcomes was tested using binary
logistic regression. Receiver operating characteristic curves were used to determine sensitivity, specificity, positive predictive value, and negative
predictive value of different cut-off values of serum cortisol in the postoperative course in the event of recurrence after remission. Results Eighty out of 93 patients (86%) showed postoperative
remission (after primary treatment, 60 out of 72 patients, 90.3%). Of these, 8 patients (10%) developed recurrence of hypercortisolism.
Compared to patients with persisting long-term remission, those with recurrence differed in cortisol levels starting from 4 pm on the day of surgery
plus an event of increasing cortisol during the early postoperative course (“peak”). Binary logistic regression showed the association
between a peak of serum cortisol in the early postoperative course with an increased probability of recurrence. Conclusions Patients with a peak of serum cortisol in the early
postoperative course show an increased recurrence rate. A cut-off value of serum cortisol for clear identification of patients with later recurrence could not be
determined.
Type of Medium:
Online Resource
ISSN:
0947-7349
,
1439-3646
Language:
English
Publisher:
Georg Thieme Verlag KG
Publication Date:
2022
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