Remission in Cushing's disease is predicted by cortisol burden and its withdrawal following pituitary surgery

Autor: Anil Bhansali, Rama Walia, Sanjay Kumar Bhadada, Aditya Dutta, Pinaki Dutta, Rosario Pivonello, Naresh Sachdeva, Abhishek Hajela, Chiara Simeoli, Chirag Kamal Ahuja, Nishkarsh Gupta, Uma Nahar Saikia, Sivashanmugam Dhandapani
Přispěvatelé: Dutta, A., Gupta, N., Walia, R., Bhansali, A., Dutta, P., Bhadada, S. K., Pivonello, R., Ahuja, C. K., Dhandapani, S., Hajela, A., Simeoli, C., Sachdeva, N., Saikia, U. N.
Rok vydání: 2020
Předmět:
Male
Hydrocortisone
Endocrinology
Diabetes and Metabolism
medicine.medical_treatment
Pituitary-Adrenal System
Disease
Logistic regression
Tertiary care
Gastroenterology
0302 clinical medicine
Endocrinology
Glucocorticoid
Retrospective Studie
Recurrence
Relapse
Cushing’s disease
Magnetic Resonance Imaging
Treatment Outcome
030220 oncology & carcinogenesis
Pituitary Gland
Female
medicine.drug
Human
Adult
medicine.medical_specialty
Hypothalamo-Hypophyseal System
Remission
Hormone Replacement Therapy
030209 endocrinology & metabolism
Follow-Up Studie
03 medical and health sciences
Young Adult
Diabetes mellitus
Internal medicine
Sphenoid Bone
medicine
Humans
Pituitary ACTH Hypersecretion
Glucocorticoids
Retrospective Studies
Transsphenoidal surgery
business.industry
Cushing's disease
Recovery of Function
medicine.disease
Pituitary surgery
business
Predictor
Follow-Up Studies
Zdroj: Journal of endocrinological investigation. 44(9)
ISSN: 1720-8386
Popis: Aim: To ascertain the predictors of remission and relapse in patients of Cushing’s disease (CD) undergoing pituitary transsphenoidal surgery (TSS). Methods: Patients with CD subjected to TSS over 35 years at a tertiary care center were included. Patients were grouped into remission and persistent disease at 1 year after surgery, and were further followed up for relapse. Demographic, clinical, biochemical, histological, radiological and post-operative follow-up parameters were analyzed. Results: Of the 152 patients of CD, 145 underwent TSS. Remission was achieved in 95 (65.5%) patients at 1 year. Patients in remission had shorter duration of symptoms prior to presentation (p = 0.009), more frequent presence of proximal myopathy (p = 0.038) and a tumor size of < 2.05 cm (p = 0.016) in comparison to those with persistent disease. Post-TSS, immediate post-operative 0800-h cortisol (< 159.85 nmol/L; p = 0.001), histological confirmation of tumor (p = 0.045), duration of glucocorticoid replacement (median 90 days; p = 0.001), non-visualization of tumor on MRI (p = 0.003), new-onset hypogonadism (p = 0.001), 3-month 0800-h cortisol (< 384.9 nmol/L; p = 0.001), resolution of diabetes (p = 0.001) and hypertension (p = 0.001), and recovery of hypothalamic–pituitary–adrenal axis (p = 0.018) favored remission. In logistic regression model, requirement of glucocorticoid replacement (p = 0.033), and resolution of hypertension post-TSS (p = 0.003) predicted remission. None of the parameters could predict relapse. Conclusion: The study could ascertain the predictors of remission in CD. Apart from the tumor characteristics, surgical aspects and low post-operative 0800-h cortisol, the results suggest that baseline clinical parameters, longer glucocorticoid replacement, and resolution of metabolic complications post-TSS predict remission in CD. Long-term follow-up is essential to look for relapse.
Databáze: OpenAIRE
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