Post-operative ACTH and cortisol values and its correlation with long-term clinical features in Cushing

Celia Rios Perez; Carmen Fajardo Montanana; Pablo Abellan Galiana; Pedro Riesgo Suarez; Jose Gomez Vela; Carlos Messeguer Escriva; Enrique Molla Olmos; Gisela Alaman Laguarda; Jose Luis Llacer Ortega; Jose Piquer Belloch

doi:10.1530/endoabs.37.EP831

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Endocrine Abstracts (2015) 37 EP831 | DOI: 10.1530/endoabs.37.EP831

ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)

Post-operative ACTH and cortisol values and its correlation with long-term clinical features in Cushing's disease

Celia Rios Perez ¹ , Carmen Fajardo Montañana ^1, , Pablo Abellan Galiana ^3, , Pedro Riesgo Suarez ¹ , Jose Gomez Vela ¹ , Carlos Messeguer Escriva ¹ , Enrique Molla Olmos ¹ , Gisela Alaman Laguarda ¹ , Jose Luis Llacer Ortega ¹ & Jose Piquer Belloch ^1,

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¹Facultad de Medicina, Universidad Católica San Vicente Martir (UCV), Valencia, Spain; ²Hospital Universitario de La Ribera, Alzira, Spain; ³Hospital General Universitario, Castellon, Spain; ⁴Facultad de Medicina, Universidad CEU Cardenal Herrera, Castellon, Spain.

Introduction: It has been described that early post-operative cortisol value <2 μg/dl might predict long-term remission while ACTH value has been less described.

Objective: To study early post-operative ACTH and cortisol levels in Cushing’s disease patients as predictor factor of long-term remission.

Patients: 61 consecutive patients (12 men/49 women), mean age 42.6 years (17–86 years) undergoing transphenoidal hypophysectomy for Cushing’s disease from 2005 to 2014 in our hospital. Mean followed-up period 32.1±23.6 months. Post-operative ACTH and cortisol were measured, without replacement treatment, every 4–6 h. We study early clinical features, hormone values, radiological images, histological and surgical findings and clinical outcome at the end of the follow-up period.

Results: 54 patients (88.5%) met clinical criteria for remission (97.3% micro, 77.7% macro, and 66.6% without MRI). Total surgical adenoma removal was performed in 86% patients (except six partial resections and two hemihypophysectomy based on cathetherism result). After initial surgery, post-operative serum cortisol was undetectable (<2 μg/dl) in 40 patients (27 micro, ten macro, and three without MRI). Recurrence was observed in 12/54 (22.2%) of the patients, 19.3±12.2 months after achieving disease-remission, with a higher ACTH nadir value after surgery (25.9±15.6 pg/ml vs 9.9±8.8 pg/ml; P=0.005) and a long time to achieve cortisol nadir <2 μg/dl (58.9±24.4 months vs 40±20.6 months; P=0.044), while there were not differences in cortisol nadir value, adenoma size, sex, and age between recurrence and remission patients.

Conclusions: Intraoperative identification and selective removal of the pituitary adenoma, even if they were not identified by preoperative MRI, correlated with initial clinical remission in our patients. Early post-operative cortisol and ACTH measurements (without hormonal therapy replacement) have a prognostic value. Cortisol level <2 μg/dl has a curative predictive value in patients with Cushing’s disease while a higher ACTH value after surgery and a long time to achieve cortisol nadir can predict recurrence.