Abstract:
:Postoperative serum cortisol is used as an indicator of Cushing's disease (CD) remission following transsphenoidal surgery (TSS) and guides (controversially) the need for immediate adjuvant treatment for CD. We investigated postoperative cortisol and adrenocorticotropic hormone (ACTH) levels as predictors of remission/recurrence in CD in a large retrospective cohort of patients with pathologically confirmed CD, over 6 years at a single institution. Midnight and morning cortisol, and ACTH at 24-48 h postoperatively (>24 h after last hydrocortisone dose) were measured. Remission was defined as normal 24-h urine free cortisol, normal midnight salivary cortisol, a normal dexamethasone-corticotropin releasing hormone (CRH) test or continued need for hydrocortisone, assessed periodically. Statistical analysis was performed using PASW 18. Follow up data was available for 52 patients (38 females and 14 males), median follow up was 16.5 month (range 2-143 months), median age was 45 years (range 21-72 years), 28 tumors were microadenomas and 16 were macroadenomas, and in eight cases no tumor was observed on magnetic resonance imaging. No patient with postoperative cortisol levels >10 mcg/dl were found to be in remission. Ten of the 52 patients with cortisol >10 mcg/dl by postoperative day 1-2 underwent a second TSS within 7 days. Forty-three patients (82.7%) achieved CD remission (36 after one TSS and 7 after a second early TSS) and six patients suffered disease recurrence (mean 39.2 ± 52.4 months). An immediate second TSS induced additional hormonal deficiencies (diabetes insipidus) in three patients with no surgical complications. Persistent disease was noted in nine patients despite three patients having an immediate second TSS. Positive predictive value for remission of cortisol <2 mcg/dl and ACTH <5 pg/ml was 100%. Cortisol and ACTH levels (at all postoperative time points and at 2 months) were correlated (r = 0.37, P < 0.001). Nadir serum cortisol of ≤2 mcg/dl and ACTH <5 pg/ml predicted remission (P < 0.005), but no level predicted lack of recurrence. Immediate postoperative ACTH/cortisol did not predict length of remission. No patients with postoperative cortisol >10 mcg/dl were observed to have delayed remission; all required additional treatment. There was no significant difference in age, body mass index, tumor size and length of follow-up between postoperative cortisol groups: cortisol ≤2 mcg/dl, cortisol >5 mcg/dl and cortisol >10 mcg/dl. Immediate postoperative cortisol levels should routinely be obtained in CD patients post TSS, until better tools to identify early remission are available. Immediate repeat TSS could be beneficial in patients with cortisol >10 mcg/dl and positive CD pathology: our combined (micro- and macroadenomas) remission rate with this approach was 82.7%. ACTH measurements correlate well with cortisol. However, because no single cortisol or ACTH cutoff value excludes all recurrences, patients require long-term clinical and biochemical follow-up. Further research is needed in this area.
journal_name
Pituitaryjournal_title
Pituitaryauthors
Hameed N,Yedinak CG,Brzana J,Gultekin SH,Coppa ND,Dogan A,Delashaw JB,Fleseriu Mdoi
10.1007/s11102-012-0455-zsubject
Has Abstractpub_date
2013-12-01 00:00:00pages
452-8issue
4eissn
1386-341Xissn
1573-7403journal_volume
16pub_type
杂志文章相关文献
Pituitary文献大全abstract::Resistance to dopamine agonists can be defined with respect to failure to normalize PRL levels and failure to decrease tumor size by > or = 50%. Using these definitions, failure to normalize PRL levels is seen in 24% of those treated with bromocriptine, 13% of those treated with pergolide and 11% of those treated with...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1023/a:1026225625897
更新日期:2003-01-01 00:00:00
abstract::Wegener's granulomatosis (WG) is an anti-neutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitis of small and medium-sized vessels. Pituitary involvement in WG is rare with only 22 previous case reports in the English medical literature between 1966 and 2006. Herein we report another patient with WG-rela...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-007-0021-2
更新日期:2008-01-01 00:00:00
abstract::The role of pituitary radiotherapy (RT) in the management of clinically non-functioning pituitary tumors (NFTs) remains controversial. Observational studies suggest that RT is effective in preventing the regrowth of NFT remnants following initial surgical debulking. However, not all tumor remnants will regrow in the a...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1023/b:pitu.0000004801.95086.e2
更新日期:2003-09-01 00:00:00
abstract:PURPOSE:To analyze the clinical characteristics of acromegalic patients with empty sella (ES, herniation of the subarachnoid space within the sella turcica) and the impact of ES on transsphenoidal surgery in such patients. METHODS:Seventy-eight patients, newly diagnosed with acromegaly who underwent transsphenoidal su...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-017-0798-6
更新日期:2017-08-01 00:00:00
abstract:PURPOSE:Approximately 25 % of cases of clinically active acromegaly cases treated in our academic center between 1996 and 2000, were diagnosed in patients who had elevated plasma IGF-1 levels, but apparently "normal" 24-h mean plasma GH levels. The current study served to update the data for patients with acromegaly re...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-016-0735-0
更新日期:2016-12-01 00:00:00
abstract::Nonfunctioning pituitary adenomas (NFPA) are typically benign neoplasms that can cause significant morbidity through local mass effects. MIB-1/Ki-67 and p53 immuno-reactivity are used to predict aggressive behavior but have known limitations. No marker to date is widely used to reliably predict tumor progression. Phos...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-011-0367-3
更新日期:2012-12-01 00:00:00
abstract::The management of invasive giant prolactinomas (IGP) has been an area of some controversy. The relative roles of transsphenoidal surgery, craniotomy, radiation therapy and dopamine agonist based medical therapy are gradually becoming clarified. We report the results of management of 30 patients with IGP. Surgery was t...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-005-5087-0
更新日期:2005-01-01 00:00:00
abstract::We describe two young men with cystic pituitary enlargement on magnetic resonance imaging (MRI) causing hypopituitarism. The first patient presented acutely unwell with headache and vomiting associated with anterior and posterior pituitary dysfunction. The second patient presented with hypopituitarism after a long his...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1023/b:pitu.0000011177.43408.56
更新日期:2003-01-01 00:00:00
abstract:PURPOSE:Hypofractionated stereotactic radiotherapy (HSRT) for refractory Cushing's disease may offer a condensed treatment schedule for patients with large tumors abutting the optic chiasm unsuitable for stereotactic radiosurgery (SRS). To-date only four patients have been treated by HSRT in the published literature. W...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-019-00992-6
更新日期:2019-12-01 00:00:00
abstract::Published data on the effects of androgen deficiency and testosterone administration on body composition in men and women are reviewed. In experimental paradigms, androgen deprivation decreases lean body mass and increases fat mass in men, and physiologic replacement reverses these abnormalities. The anabolic effects ...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-008-0121-7
更新日期:2009-01-01 00:00:00
abstract::Adipsic diabetes insipidus (ADI) is a rare condition in which thirst, an essential clinical feature for the prevention of hypernatraemic dehydration, is absent. We report the first case of adipsic diabetes insipidus to occur following surgery for a pituitary macroprolactinoma, with loss of both osmoregulated and baror...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-006-8280-x
更新日期:2006-01-01 00:00:00
abstract::Arterial bleeding during transsphenoidal surgery for pituitary adenoma is known complication. This usually happens due to rupture of intracavernous carotid or delayed hemorrhage due to the carotico-cavernous fistula and/or pseudoaneurysm. There is also evidence that cavernous carotid aneurysms may occur with pituitary...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-009-0198-7
更新日期:2010-06-01 00:00:00
abstract::Patients with adult GH deficiency (AGHD) have a high cardiovascular risk and probably an alteration of the oxidative balance, although evidence is lacking. To evaluate the presence of endothelial dysfunction and oxidative stress in patients with AGHD. Biochemical parameters of oxidative stress and endothelial dysfunct...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-011-0374-4
更新日期:2012-12-01 00:00:00
abstract::Inferior petrosal sinus sampling (IPSS) of ACTH with CRH stimulation helps distinguish pituitary ACTH-dependent Cushing's syndrome from the ectopic ACTH syndrome (EAS). The usefulness of the paradoxical response of other pituitary hormones including prolactin to CRH remains controversial. Data from 33 IPSS procedures ...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-009-0200-4
更新日期:2010-06-01 00:00:00
abstract::In western countries, the process of "ageing of the population" is increasingly forcing clinical medicine to find answers for pathologies affecting the elder segments of our community. In this respect, pituitary adenomas often raise difficult questions on surgical indications, since little is known about postoperative...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-012-0390-z
更新日期:2013-06-01 00:00:00
abstract::Acromegaly is associated with serious morbidity and mortality, if not well controlled. Approved somatostatin receptor ligands (SRLs) are a mainstay of medical therapy and exhibit preferential affinity for somatostatin receptor (SSTR) subtype 2. Our objective was to assess whether characteristic features of individual ...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-012-0445-1
更新日期:2013-12-01 00:00:00
abstract::In order to explore the presence of, and the potential role of, secretagogin in human pituitary adenomas, an analytical strategy that integrated comparative proteomics and comparative transcriptomics was used to detect the protein and the mRNA expression, respectively, of secretagogin in human non-functional pituitary...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1023/b:pitu.0000023426.99808.40
更新日期:2003-01-01 00:00:00
abstract::We report the case of a B-cell type pituitary lymphoma in a 65 year-old male immunocompetent patient who presented with hypogonadotropic hypogonadism and central hypothyroidism and subsequently developed pulmonary lymphoma. Only three cases of pituitary lymphoma have been previously reported, one in a patient with acq...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1023/a:1009969417380
更新日期:2000-05-01 00:00:00
abstract:INTRODUCTION:There has been growing interest on medical therapy for the management of Cushing's disease (CD), particularly in cases of persistent or recurrent hypercortisolism. Ketoconazole, an inhibitor of adrenal steroidogenesis, is the most widely used drug, whereas cabergoline and pasireotide are the most promising...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-015-0641-x
更新日期:2015-04-01 00:00:00
abstract::Anemia and other hematological abnormalities are common in patients with Sheehan's syndrome. The response of these abnormalities to replacement of thyroxine and glucocorticoids is not clear. The aim of the present study was to document the profile of hematological abnormalities and response to treatment in patients wi...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-010-0255-2
更新日期:2011-03-01 00:00:00
abstract:PURPOSE:Doses of growth hormone in adults with growth hormone deficiency are now lower than previously. However, it is not clear they are as effective as higher doses. The objective of this meta-analysis was to assess efficacy of low to moderate dose (LD) GH replacement on standard endpoints of GH compared to higher do...
journal_title:Pituitary
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s11102-014-0571-z
更新日期:2015-06-01 00:00:00
abstract::Ideal surgical treatment of craniopharyngiomas remains a major challenge for neurosurgeons. Craniopharyngiomas grow in the deep-seated hypothalamic area that is paramount for vegetative, emotional and endocrine function, and for maintaining worthwhile life. The benign histological nature of craniopharyngiomas belies t...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-008-0137-z
更新日期:2008-01-01 00:00:00
abstract:PURPOSE:Secondary empty sella syndrome (SESS) following pituitary surgery remains a diagnostic and therapeutic challenge. The aim of this study was to specify the diagnostic criteria, surgical indications and results of chiasmapexy in the SESS. METHODS:Three cases from two experienced neurosurgical centers were collec...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-020-01104-5
更新日期:2020-11-02 00:00:00
abstract::Cushing's Syndrome (CS) is associated with an increased mortality, where hypercoagulability seems to have a crucial role in both arterial and venous thrombosis. Parameters of in vitro thrombin generation (TG) such as lag time, peak thrombin and endogenous thrombin potential (ETP), that describe the time until thrombin...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-013-0467-3
更新日期:2014-02-01 00:00:00
abstract:CONTEXT:Octreotide causes significant tumour shrinkage in patients with acromegaly but the exact mechanism of action is unclear in vivo. OBJECTIVE:To determine the mechanism of action of octreotide in vivo using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). DESIGN:Five patients with acromegaly were ...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-007-0044-8
更新日期:2007-01-01 00:00:00
abstract:INTRODUCTION:Early disease onset, clinical manifestation, histomorphology, and increased tendency to relapse distinguish the adamantinomatous craniopharyngioma (adaCP) from the more favorable papillary variant (papCP). A molecular hallmark of adaCP is the activated Wnt signaling pathway indicated by nuclear β-catenin a...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-013-0543-8
更新日期:2014-12-01 00:00:00
abstract:PURPOSE:Thyrotropin-secreting pituitary adenoma is a rare disorder and was recently classified as an aggressive tumor in the World Health Organization guidelines. The number of available studies on cosecreting thyrotropin/growth hormone pituitary adenoma is especially limited. METHODS:A single-center retrospective ana...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-020-01064-w
更新日期:2020-10-01 00:00:00
abstract::A diabetic acromegalic man, not cured after surgery and radiosurgery, received lanreotide i.m. with great clinical and biochemical improvement. He required NPH insulin (76 to 84 units/day) to control his diabetes mellitus. Thirty-six hours after changing to LAR-octreotide (20 mg i.m/month) he presented symptomatic hyp...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1023/a:1020710800842
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:Survival rates among childhood cancer survivors (CCSs) have significantly risen in the last 40 years due to substantial improvements in treatment protocols. However, this improvement has brought with it serious late effects that frequently involve the endocrine system. Of the endocrine disorders, GH deficien...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-020-01052-0
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND/PURPOSE:During the early phase of sepsis, hypotension is accompanied by increase of plasma vasopressin hormone (AVP) levels, which decline during the late phase. This hypotension is due in part to increase of nitric oxide (NO) synthesis by nitric oxide synthase (NOS) enzyme. Neuronal isoform of this enzyme (...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-017-0786-x
更新日期:2017-06-01 00:00:00