ArticleEuropean journal of endocrinology2018
Earlier post-operative hypocortisolemia may predict durable remission from Cushing's disease.
Article in European journal of endocrinology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
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Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Prediction of remission in cushing's disease using artificial intelligence: A systematic review and meta-analysis.Neurosurgical review · 2026Pooled it
- The clinical outcomes of imaging modalities for surgical management Cushing's disease - A systematic review and meta-analysis.Frontiers in endocrinology · 2022Pooled it
- Article
- Early postoperative LDDST enhances remission prediction beyond morning cortisol in cushing's disease.Pituitary · 2026Article
- Outcomes of the Transsphenoidal Approach for ACTH-Secreting Pituitary Tumours and the Role of Postoperative ACTH in Predicting the Late Recurrence of Cushing's Disease: A Retrospective Analysis of 50 Cases.Healthcare (Basel, Switzerland) · 2025Article
- Specific focus on the basal dura for improving Cushing's disease surgery: a cohort study.Neurosurgical review · 2025Article
- Cushing syndrome.Nature reviews. Disease primers · 2025Review
- Cost outcomes of pituitary adenoma resection: The use of a hybrid microscopic/endoscopic surgery.Surgical neurology international · 2025Article
- Prospective Evaluation of Transsphenoidal Pituitary Surgery in Patients with Cushing's Disease: Delayed Remission and the Role of Postsurgical Cortisol as a Predictive Factor.Healthcare (Basel, Switzerland) · 2024Article
- Insights on epidemiology, morbidity and mortality of Cushing's disease in Northern Ireland.Endocrine-related cancer · 2024Article
- No requirement of perioperative glucocorticoid replacement in patients with endogenous Cushing's syndrome - a pilot study.Endocrine · 2024Article
- The State of Machine Learning in Outcomes Prediction of Transsphenoidal Surgery: A Systematic Review.Journal of neurological surgery. Part B, Skull base · 2023Article
- Diurnal Range and Intra-patient Variability of ACTH Is Restored With Remission in Cushing's Disease.The Journal of clinical endocrinology and metabolism · 2023Article
- Cushing disease in pediatrics: an update.Annals of pediatric endocrinology & metabolism · 2023Article
- Pitfalls in the Diagnosis and Management of Hypercortisolism (Cushing Syndrome) in Humans; A Review of the Laboratory Medicine Perspective.Diagnostics (Basel, Switzerland) · 2023Review
- Cortisol and ACTH Measurements at Extubation From Pituitary Surgery Predicts Hypothalamic-Pituitary-Adrenal Axis Function.Journal of the Endocrine Society · 2023Article
- The association of bone mineral density Z-score with the early postoperative remission and characteristics of bone mineral loss in patients with Cushing's disease: a retrospective study.Croatian medical journal · 2022Article
- Glucocorticoid Withdrawal Syndrome following treatment of endogenous Cushing Syndrome.Pituitary · 2022Review
- Characterization of a paradoxical post-operative increase in serum cortisol in Cushing disease.Pituitary · 2022Article
- Perioperative Management of a Patient With Cushing Disease.Journal of the Endocrine Society · 2022Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
contextAchievement of hypocortisolemia following transsphenoidal surgery (TSS) for Cushing's disease (CD) is associated with successful adenoma resection. However, up to one-third of these patients recur.
objectiveWe assessed whether delay in reaching post-operative cortisol nadir may delineate patients at risk of recurrence for CD following TSS.
methodsA retrospective review of 257 patients who received 291 TSS procedures for CD at NIH, between 2003 and 2016. Early biochemical remission (serum cortisol nadir <5 μg/dL) was confirmed with endocrinological and clinical follow-up. Recurrence was detected by laboratory testing, clinical stigmata or medication dependence during a median follow-up of 11 months.
resultsOf the 268 unique admissions, remission was recorded in 241 instances. Recurrence was observed in 9% of these cases with cortisol nadir ≤5 μg/dL and 6% of cases with cortisol nadir ≤2 μg/dL. The timing of hypocortisolemia was critical in detecting late recurrences. Morning POD-1 cortisol <3.3 μg/dL was 100% sensitive in predicting durable remission and morning POD-3 cortisol ≥18.5 μg/dL was 98.6% specific in predicting remote recurrence. AUROC analysis revealed that hypocortisolemia ≤5 µg/dL before 15 h (post-operative) had 95% sensitivity and an NPV of 0.98 for durable remission. Serum cortisol level ≤2 µg/dL, when achieved before 21 h, improved sensitivity to 100%.
conclusionsIn our cohort, early, profound hypocortisolemia could be used as a clinical prediction tool for durable remission. Achievement of hypocortisolemia ≤2 µg/dL before 21 post-operative hours appeared to accurately predict durable remission in the intermediate term.
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