Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2006) 11 P479

ECE2006 Poster Presentations Endocrine tumours and neoplasia (116 abstracts)

Post-operative serum cortisol for prediction of long-term remission from Cushing’s syndrome

JR Lindsay 1 , EH Oldfield 2 & LK Nieman 1


1Reproductive Biology and Medicine Branch, NICHD, National Institutes of Health, Bethesda, MD, United States; 2Surgical Neurology Branch, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.


Cushing’s disease (CD) may recur despite early remission following transsphenoidal surgery (TSS). We evaluated whether early post-operative serum cortisol (sF) levels on post-operative days 3, 4, 5 predict recurrence.

Methods: Patients with CD treated at NIH completed a questionnaire regarding remission status, treatment, and recent biochemistry. We analyzed patients with adenomectomy or hemihypophysectomy at initial TSS, with ACTH-staining tumor and at least one year follow-up. Pituitary irradiation was an exclusion criterion.

Results: Follow-up data was available on 322 patients (age at TSS 36.1±0.8 yrs, 80% female, 83% Caucasian). 87.9% of patients had apparent long-term remission (4.8±0.5 yrs). sF on post-operative days 3, 4 and 5 was <55 nmol/l in 77.4%, 76.2 and 72.0% and was <138 nmol/l in 93.0%, 91.9% and 89.6% respectively. 277 of 319 patients (86.8%) achieved at least one sF <55 nmol/l. Of 277 patients with at least one sF <55 nmol/l, 250 (90%) achieved long-term remission vs. 27 (10%) who recurred. Conversely, 73.8% (31/42) of patients with higher sF had long-term remission while 26.2% (11/42) recurred. The predictive value for long-term remission of a sF <55 nmol/l was 90% (250/277; 95% CI 86–94%) and the predictive value for recurrence of higher sF was 26% (11/42; 95% CI 14–42%). No sF value excluded all patients with recurrence.

Conclusion: An early post-operative sF < 55 nmol/l has high predictive value for long-term remission from CD. Immediate re-operation is not required for all patients with higher values, as most achieve long-term remission.

Volume 11

8th European Congress of Endocrinology incorporating the British Endocrine Societies

European Society of Endocrinology 
British Endocrine Societies 

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