Objective: The search for the predictors of the Cushings disease (CD) recurrence after surgical treatment among the following parameters - gender, age, adenoma size, preoperative levels of ACTH (morning) and cortisol (evening) in the blood, postoperative levels of ACTH (morning) and cortisol (morning) in the blood.
Material and methods: A retro- and prospective monocenter study of treatment outcomes in 181 patients with confirmed diagnosis of Cushings disease who underwent endoscopic transsphenoidal adenomectomy between 2007 and 2014 was performed. The inclusion criteria were: the absence of previous pathogenetic treatment (neurosurgical, medical and radiation therapy) for this disease and the development of remission of the disease in the early postoperative period in the form of adrenal insufficiency or normalization of the morning ACTH and cortisol secretion. The group consisted of 29 men and 152 women. The duration of follow-up period was three years and more. Within 3 years the remission was preserved in 135 patients (24 men, 111 women), the recurrence of Cushings disease developed in 46 patients (five men and 41 women). Recurrence probability, relative risks (RR) and 95% confidence intervals were calculated.
Results: No relationship between preoperative data (age, gender, adenoma size, preoperative levels of ACTH and plasma cortisol and serum, free cortisol level in daily urine) and the probability of recurrence of CD was found. However, the probability of CD recurrence was associated with levels of ACTH and cortisol in the early postoperative period. In patients with ACTH level less than 7 pg/ml, three year recurrence appeared to be 8%, 95% CI (3%, 17%), while at the level of ≥7 pg/ml recurrence was observed in 37% (28%, 46%) cases, RR 0.23 (0.09; 0.51). In patients with cortisol level below 123 nmol/l the recurrence developed in 17% (11%, 24%) of cases, while in patients with cortisol level ≥123 nmol/l, recurrence was equal to 50% (35%, 65%), RR 0.34 (0.21, 0.57).
Conclusion: The development of adrenal insufficiency with the decrease in ACTH level less than 7 pg/ml and cortisol level less than 123 nmol/l in early post-surgery period significantly reduces the probability of the recurrence of CD within three years after surgery.
Key words: Cushings disease, adrenocorticotropic hormone (ACTH), transsphenoidal adenomectomy, cortisol, recurrence.
19 - 22 May 2018
European Society of Endocrinology