Journal
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
Volume 88, Issue 12, Pages 5858-5864Publisher
ENDOCRINE SOC
DOI: 10.1210/jc.2003-030751
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We assessed the value of postoperative plasma cortisol concentrations to predict cure and recurrence of Cushing's disease after transsphenoidal surgery (TS). Seventy-eight of 80 consecutive patients treated by TS for Cushing's disease were evaluated. TS cured 72% ( n = 56) of the patients. Two weeks after surgery, patients with plasma cortisol levels below 138 nmol/liter ( n = 50; three macroadenomas) and eight (27%) of 30 patients ( nine macroadenomas) with cortisol greater than 138 nmol/liter were cured. Six ( five with a macroadenoma) of these eight patients had cortisol values less than 50 nmol/liter 3 months after surgery. Therefore, the optimal cut-off value of cortisol predicting remission was 138 nmol/liter, measured 3 months after surgery ( positive and negative predictive values 87 and 90%, respectively). Five patients (9%) had recurrent Cushing's disease during a median follow-up of 7 yr. Recurrence occurred in four of 24 (17%) patients with a follow-up of more than 10 yr. Therefore, cortisol levels above 138 nmol/liter, obtained 2 wk after TS, should be repeated, because they do not predict persistent Cushing's disease in 27% of those patients. Postoperative cortisol levels do not positively predict recurrence of disease during long-term follow-up of initially cured patients.
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