ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)
Post-operative serum cortisol levels as predictors of recurrence in Cushing's disease
Diana Martins 1 , Daniela Guelho 1 , Isabel Paiva 1 , Carla Baptista 1 , Nuno Vicente 1 , Luís Cardoso 1 , Diana Oliveira 1 , Margarida Balsa 2 & Francisco Carrilho 1
1Endocrinology, Diabetes and Metabolism Department of Coimbra Hospital and University Centre, Coimbra, Portugal; 2Endocrinology, Diabetes and Nutrition Department of Baixo Vouga Hospital Centre, Aveiro, Portugal.
Introduction: Cushing’s disease (CD) is characterized by increased secretion of ACTH often as a result of a pituitary adenoma. The surgical success rates after transsphenoidal pituitary surgery (TSS) range from 53 to 96% in different centres. Postoperative cortisol levels have been proposed as the standard criteria for prediction of surgical remission however, this variable is subject of a variety of interferences.
Objectives: Evaluate the potential of post-transsphenoidal pituitary surgery cortisol levels to predict surgical remission and recurrence of CD.
Methods: Retrospective cohort study of patients with clinical and biochemical diagnosis of CD, submitted to TSS and followed in our centre between 1977 and 2013 (n=84). Patients who lost follow-up or with insufficient data on their personal records were excluded (n=51). Statistical analysis: SPSS(21).
Results: Thirty three patients, 29 (87.9%) women, with a median age of 33 years were included. All patients underwent TSS as first treatment option and were followed postoperatively during a median period of 8 (1–28) years. Eighteen (57.8%) patients achieved disease remission after the first treatment, 11 (33.3%) presented recurrence and 3 (9.1%) patients had persistent disease. Post-operative morning cortisol levels were lower in cured patients than in patients with recurrent or persistent disease (5.3 vs 8.1 vs 16.1 μg/dl, respectively, P<0.05). It was also observed an inverse correlation between morning serum cortisol levels and time free of disease (r=−0.81, P<0.01). We verified that cortisol levels at midnight were significantly different in the immediate post-operative evaluation than in the evaluation at 1 month and a half (5.30±7.58 μg/dl vs 4.20±6.84 μg/dl, P<0.01). However both evaluations of midnight cortisol correlated significantly with the number of recurrences (P<0.01).
Conclusions: Serum cortisol levels can be a predictor of recurrence risk and also influence in time free of disease. However, midnight serum cortisol levels can fluctuate significantly in time.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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