Transsphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successful treatment.
OBJECTIVE: We tested the hypothesis that in Cushing's disease, ACTH secretion from the normal pituitary surrounding an ACTH-secreting adenoma is inhibited and hence removal of the entire adenoma should result in an undetectable serum cortisol in the immediate post-operative period. DESIGN: A re...
| Main Authors: | , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
1993
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| _version_ | 1826271882141237248 |
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| author | Trainer, P Lawrie, H Verhelst, J Howlett, T Lowe, D Grossman, A Savage, M Afshar, F Besser, G |
| author_facet | Trainer, P Lawrie, H Verhelst, J Howlett, T Lowe, D Grossman, A Savage, M Afshar, F Besser, G |
| author_sort | Trainer, P |
| collection | OXFORD |
| description | OBJECTIVE: We tested the hypothesis that in Cushing's disease, ACTH secretion from the normal pituitary surrounding an ACTH-secreting adenoma is inhibited and hence removal of the entire adenoma should result in an undetectable serum cortisol in the immediate post-operative period. DESIGN: A retrospective study of patients undergoing transsphenoidal selective adenomectomy, hemi-hypophysectomy or total hypophysectomy for Cushing's disease at St Bartholomew's Hospital between 1985 and 1990. PATIENTS: Forty-eight consecutive patients (33 women, mean age 43, range 7-69 years) undergoing transsphenoidal hypophysectomy for Cushing's disease. Ten patients who underwent a second operation were re-evaluated; the patients were followed for a median time of 40 months after operation (range 15-70). MEASUREMENTS: Post-operatively, serum cortisol was measured daily at 0900 h. Serum TSH, T4, prolactin, LH, FSH, testosterone or oestradiol plus plasma and urine osmolality were measured. RESULTS: After initial surgery, post-operative serum cortisol was undetectable (< 50 nmol/l) in 20 out of 48 patients (42%) and < 300 nmol/l in 32 out of 48 patients (67%). Re-exploration of the pituitary fossa in 10 patients found undetectable cortisol levels in 25 (52%) and levels < 300 nmol/l in 39 (81%) patients. Cushing's syndrome has not recurred, clinically or biochemically, in any patient in whom the post-operative cortisol was < 50 nmol/l. Post-operatively, hypothyroidism was present in 40% of patients and hypogonadism in 53% of men and 30% of premenopausal women. Diabetes insipidus, persisting for at least six months, occurred in 46% of patients. CONCLUSIONS: Cushing's disease has not recurred in any patient with an undetectable serum cortisol (< 50 nmol/l) post-operatively. Serum cortisol should be regarded as a tumour marker in Cushing's disease and the aim of transsphenoidal hypophysectomy for Cushing's disease should be to render the immediate post-operative serum cortisol undetectable. |
| first_indexed | 2024-03-06T22:03:45Z |
| format | Journal article |
| id | oxford-uuid:4f758046-0b65-48c4-9072-3dd895373a7e |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T22:03:45Z |
| publishDate | 1993 |
| record_format | dspace |
| spelling | oxford-uuid:4f758046-0b65-48c4-9072-3dd895373a7e2022-03-26T16:07:19ZTranssphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successful treatment.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:4f758046-0b65-48c4-9072-3dd895373a7eEnglishSymplectic Elements at Oxford1993Trainer, PLawrie, HVerhelst, JHowlett, TLowe, DGrossman, ASavage, MAfshar, FBesser, GOBJECTIVE: We tested the hypothesis that in Cushing's disease, ACTH secretion from the normal pituitary surrounding an ACTH-secreting adenoma is inhibited and hence removal of the entire adenoma should result in an undetectable serum cortisol in the immediate post-operative period. DESIGN: A retrospective study of patients undergoing transsphenoidal selective adenomectomy, hemi-hypophysectomy or total hypophysectomy for Cushing's disease at St Bartholomew's Hospital between 1985 and 1990. PATIENTS: Forty-eight consecutive patients (33 women, mean age 43, range 7-69 years) undergoing transsphenoidal hypophysectomy for Cushing's disease. Ten patients who underwent a second operation were re-evaluated; the patients were followed for a median time of 40 months after operation (range 15-70). MEASUREMENTS: Post-operatively, serum cortisol was measured daily at 0900 h. Serum TSH, T4, prolactin, LH, FSH, testosterone or oestradiol plus plasma and urine osmolality were measured. RESULTS: After initial surgery, post-operative serum cortisol was undetectable (< 50 nmol/l) in 20 out of 48 patients (42%) and < 300 nmol/l in 32 out of 48 patients (67%). Re-exploration of the pituitary fossa in 10 patients found undetectable cortisol levels in 25 (52%) and levels < 300 nmol/l in 39 (81%) patients. Cushing's syndrome has not recurred, clinically or biochemically, in any patient in whom the post-operative cortisol was < 50 nmol/l. Post-operatively, hypothyroidism was present in 40% of patients and hypogonadism in 53% of men and 30% of premenopausal women. Diabetes insipidus, persisting for at least six months, occurred in 46% of patients. CONCLUSIONS: Cushing's disease has not recurred in any patient with an undetectable serum cortisol (< 50 nmol/l) post-operatively. Serum cortisol should be regarded as a tumour marker in Cushing's disease and the aim of transsphenoidal hypophysectomy for Cushing's disease should be to render the immediate post-operative serum cortisol undetectable. |
| spellingShingle | Trainer, P Lawrie, H Verhelst, J Howlett, T Lowe, D Grossman, A Savage, M Afshar, F Besser, G Transsphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successful treatment. |
| title | Transsphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successful treatment. |
| title_full | Transsphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successful treatment. |
| title_fullStr | Transsphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successful treatment. |
| title_full_unstemmed | Transsphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successful treatment. |
| title_short | Transsphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successful treatment. |
| title_sort | transsphenoidal resection in cushing s disease undetectable serum cortisol as the definition of successful treatment |
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