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LONG-TERM REMISSION AND RECURRENCE RATES IN CUSHING'S DISEASE: PREDICTIVE FACTORS IN A SINGLE-CENTRE STUDY.
MedLine Citation:
PMID:  23371975     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the early and late outcomes of patients with Cushing's disease (CD) submitted to a neurosurgical procedure as first-line treatment. DESIGN: In this single-centre retrospective case-notes study, 131 patients with CD with a minimum follow-up period of 6 years [124 operated by transsphenoidal surgery (TSS), 7 by the transcranial approach] were studied. Apparent immediate cure: post-operative 09.00h serum cortisol level <50nmol/L; remission: cortisol insufficiency or restoration of 'normal' cortisol levels with resolution of clinical features; recurrence: dexamethasone-resistance and relapse of hypercortisolaemic features. RESULTS: In patients operated by TSS, remission of hypercortisolaemia was found in 72.8% of 103 microadenomas and 42.9% of 21 macroadenomas, with recurrence rates 22.7% and 33.3% respectively with a 15 year mean follow-up (range: 6-29y). Of 27 patients with microadenomas operated after 1991, with positive imaging and pathology, 93% obtained remission with 12% recurrence. In multivariate analysis, the time needed to achieve hypothalamo-pituitary-adrenal axis recovery was the only significant predictor of recurrence; all patients who recurred showed recovery within 3 years from surgery: 31.3% of patients had total hypophysectomy with no recurrence; 42% of patients with selective adenomectomy and 26% with hemi-hypophysectomy showed recurrence rates 31% and 13% respectively (chi-square=6.275, P=0.03). Strict remission criteria were not superior in terms of the probability of recurrence compared to post-operative normocortisolaemia.Conclusions:Life-long follow-up for patients with CD appears essential, particularly for patients who have shown rapid recovery of their axis. The strict criteria previously used for 'apparent cure' do not appear to necessarily predict a lower recurrence rate.
Authors:
Krystallenia I Alexandraki; Gregory Kaltsas; Andrea M Isidori; Helen L Storr; Fary Afshar; Hi Sabin; Scott A Akker; Shern Chew; Wm Drake; John P Monson; Michael G Besser; Ashley Grossman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-31
Journal Detail:
Title:  European journal of endocrinology / European Federation of Endocrine Societies     Volume:  -     ISSN:  1479-683X     ISO Abbreviation:  Eur. J. Endocrinol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-2-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
K Alexandraki, Department of Endocrinology, St Bartholomew's Hospital, Barts and the London NHS Trust, and Barts and the London School of Medicine, London, United Kingdom.
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