| Criteria of cure and remission in Cushing's disease: an update. | |
| | |
MedLine Citation:
|
PMID: 18209875 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
We review the clinical and biochemical criteria used for evaluation of the transsphenoidal pituitary surgery results in the treatment of Cushing's disease (CD). Firstly, we discuss the pathophysiology of the hypothalamic-pituitary-adrenal axis in normal subjects and patients with CD. Considering the series published in the last 25 years, we observed a significant variation in the remission or cure criteria, including the choice of biochemical tests, timing, threshold values to define remission, and the interference of glucocorticoid replacement or previous treatment. In this context we emphasize serum cortisol levels obtained early (from hours to 12 days) in the postoperative period without any glucocorticoid replacement or treatment. Our experience demonstrates that: (i) early cortisol < 5 to 7 microg/dl, (ii) a period of glucocorticoid dependence > 6 mo, (iii) absence of response of cortisol/ACTH to CRH or DDAVP, (iv) return of dexamethasone suppression, and circadian rhythm of cortisol are appropriate indices of remission of CD. In patients with undetectable cortisol levels early after surgery, recurrence seems to be low. Finally, although certain biochemical patterns are more suggestive of remission or surgical failure, none has been proven to be completely accurate, with recurrence observed in approximately 10 to 15% of the patients in long-term follow-up. We recommended that patients with CD should have long-term monitoring of the CRH-ACTH-cortisol axis and associated co-morbidities, especially hypopituitarism, diabetes mellitus, hypertension, cardiovascular disturbances, and osteoporosis. |
| | |
Authors:
|
Mauro A Czepielewski; Guilherme A F S Rollin; Alessandra Casagrande; Nelson P Ferreira |
Related Documents
:
|
8266415 - Short course albendazole treatment for neurocysticercosis in columbia. 10417965 - Insulin-like growth factor-i treatment in two children with growth hormone gene deletions. 2866445 - Long-term treatment of acromegaly with the somatostatin analogue sms 201-995. 18478155 - Treatment of central precocious puberty by gnrh analogs: long-term outcome in men. 9100105 - Comparison of corneal sensation following photorefractive keratectomy and laser in situ... 22884345 - Associations of dairy cow behavior, barn hygiene, cow hygiene, and risk of elevated som... |
Publication Detail:
|
Type: Journal Article; Review |
Journal Detail:
|
Title: Arquivos brasileiros de endocrinologia e metabologia Volume: 51 ISSN: 0004-2730 ISO Abbreviation: Arq Bras Endocrinol Metabol Publication Date: 2007 Nov |
Date Detail:
|
Created Date: 2008-01-22 Completed Date: 2008-12-01 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0403437 Medline TA: Arq Bras Endocrinol Metabol Country: Brazil |
Other Details:
|
Languages: eng Pagination: 1362-72 Citation Subset: IM |
Affiliation:
|
Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, UFRGS, Porto Alegre, RS. maurocze@terra.com.br |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
ACTH-Secreting Pituitary Adenoma*
/
physiopathology,
surgery Adenoma* / physiopathology, surgery Adrenocorticotropic Hormone / blood Corticotropin-Releasing Hormone / blood Humans Hydrocortisone / blood, urine Hypophysectomy Hypothalamo-Hypophyseal System / physiopathology Pituitary ACTH Hypersecretion* / physiopathology, surgery Pituitary Neoplasms* / physiopathology, surgery Pituitary-Adrenal Function Tests Pituitary-Adrenal System / physiopathology Recurrence Treatment Outcome |
| Chemical | |
Reg. No./Substance:
|
50-23-7/Hydrocortisone; 9002-60-2/Adrenocorticotropic Hormone; 9015-71-8/Corticotropin-Releasing Hormone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Prospective evaluation of transsphenoidal pituitary surgery in 108 patients with Cushing's disease.
Next Document: Radiotherapy and radiosurgery for Cushing's disease.