Endocrine Abstracts

Abstract: Transsphenoidal surgery is the treatment of choice for Cushing’s disease. Despite the 70–90% remission rates relapses after successful transnasal adenectomy are frequently observed.

Aim: To evaluate the dynamics of intra- and early postoperative levels of adrenocorticotrophic hormone (ACTH) and cortizol and their role as predictors or Cushing’s disease remission.

Materials/methods: Fifty patients with Cushing’s disease underwent surgery in the Endocrinology Research Centre of Russian Federation. The hormone analyses were provided immunochemiluminiscent method. The blood was taken during the incision of dura mater, then after tumor debulking and then 20 min after it. Then ACTH levels measured 1 day after surgery. In case of early clinical signs of hypocorticism the blood was taken at first day followed by substitution therapy. The criteria of hypocorticism were the ACTH and cortizol levels lower than the nadir.

Results: In postoperative period 82% of patients had adrenal insufficiency (61% at day 0–1, 35% at day 2–4, 5% at day 7), in 10% hormone levels came to normal references, in 8% - stayed higher than reference. The level of hormone (ACTH and cortisol) increased after removal of the tumor (stress release). After 20–min he fell. There are not any dependency between remission and level of hormones during intraoperation research. Only hormone levels at the end of the first day after surgery in 60% showed Cushing’s disease remission. That confirmed by 6-months follow-up observation.