Prognosis criteria for remission of hypercorticism after transsphenoidal endoscopic adenomectomy in patients with Cushing’s disease

The aim of the study. To assess the role of early postoperative examination in the prognosis of cd remission 1 year after TSS.

Patients and methods. 101 Patients (12 men, 89 women, mean age 41,2 years (15-72) with confirmed cd were included. Midnight and morning serum cortisol and plasma ACTH, late night salivary cortisol, 24-h urinary free cortisol (ufc) excretion were performed at the days 2-3 and 12-14 after the TSS. Hypercortisolism remission status was estimated one year after surgery. The optimal threshold values of ACTH and cortisol parameters at 2-3 and 12-14 days after surgery to prediction of cd remission after TSS were calculated by roc-analysis.

Results. One year after surgery cd remission was confirmed in 63 patients, whereas in 38 patients hypercortisolism persisted. Postoperative parameters of cortisol and ACTH secretion had comparable high specificity and sensitivity at 2-3 and 12-14 days after surgery for prediction cd remission.

Conclusion. According to our data, morning serum cortisol ≤388 nmol/l and plasma ACTH ≤20 pg/ml at 2-3 d after TSS may be used as a prognostic criterion for cd remission 1 year after surgery with sensitivity and specificity 94,9%, 75,9% and 83,3%, 95,8%, respectively.

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