Endocrine Abstracts

Objective

In patients with Cushing’s disease (CD), normal pituitary corticotrophs are suppressed by excessive and persistent cortisol secretion in responce to autonomous ACTH secretion by tumour. Therefore, patients exhibit signs and symptoms of ACTH deficiency shortly after resection of tumour and need steroid replacement therapy (SRT) until hypotalamo-pituitary-adrenal (HPA) axis recovery. We aimed to evaluate whether duration of SRT can serve as a predictive factor for disease recurrence in patients who underwent transsphenoidal surgery (TSS) and developed hypocortisolemia in early postoperative period.

Material-method

This retrospective study consists of thirty eight CD patients, aged 18–65 years who underwent TSS between 2003–2016 at University of Health Sciences Turkey, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Health Training and Research Hospital. Morning serum cortisol levels measured within first five postoperative days were < 5 µg/dl in 34 and < 10 µg/dl but with clinical features of adrenal failure in 4 patients. All patients were followed up with SRT and re-evaluated for HPA axis recovery every 3 months after withdrawal of SRT for at least 24 hours. HPA axis recovery was determined if morning serum cortisol was ≥ 18 µg/dl or if serum cortisol levels exceeded 18 µg/dl after ACTH stimulation. Patients with recovered HPA axis were assessed for disease recurrence in follow-up periodically. High 24 hour urinary free cortisol excretion, high midnight salivary cortisol and failure of cortisol suppression < 1.8 µg/dl after dexamethasone suppression tests were defined as markers for recurrence. Two groups according to disease status were designed as recurrence and remission groups and compared for early postoperative serum cortisol and duration of SRT.

Results

Remission and recurrence groups consisted 27 and 11 patients, respectively. The follow-up period was significantly high and age at presentation was significantly low in recurrence group. Duration of SRT didn’t significantly differ between both groups.

Conclusion

Although postoperative morning serum cortisol can be used for assessment of surgery success, how long the patient need SRT may not necessarily predict the recurrence risk. But if we lenghten the follow-up period in both groups, SRT may gain a significance in prediction of recurrence.