دورية أكاديمية
Dynamics of postoperative serum cortisol after transsphenoidal surgery for Cushing's disease: implications for immediate reoperation and remission.
| العنوان: | Dynamics of postoperative serum cortisol after transsphenoidal surgery for Cushing's disease: implications for immediate reoperation and remission. |
|---|---|
| المؤلفون: | Mayberg, Marc, Reintjes, Stephen, Patel, Anika, Moloney, Kelley, Moloney, Kelley J, Carlson, Alex, Scanlan, James M, Broyles, Frances |
| المصدر: | Articles, Abstracts, and Reports |
| بيانات النشر: | Providence St. Joseph Health Digital Commons |
| سنة النشر: | 2018 |
| المجموعة: | Providence St. Joseph Health Digital Commons |
| مصطلحات موضوعية: | ACTH = adrenocorticotropin hormone, AUC = area under the curve, BIPSS = bilateral inferior petrosal sinus sampling, BMI = body mass index, CD = Cushing’s disease, CST = cosyntropin stimulation test, Cushing’s disease, NPV = negative predictive value, PACS = picture archiving and communication system, POD = postoperative day, PPV = positive predictive value, ROC = receiver operating characteristic, TSA = transsphenoidal adenomectomy, UFC = urinary free cortisol, late recurrence, pituitary surgery, postoperative cortisol, remission, reoperation, transsphenoidal surgery, Endocrinology, Diabetes, and Metabolism, Neurology, Surgery |
| الوصف: | OBJECTIVESuccessful transsphenoidal surgery for adrenocorticotropin hormone (ACTH)-producing pituitary tumors is associated with subnormal postoperative serum cortisol levels, which may guide decisions regarding immediate reoperation. However, little is known about the detailed temporal course of changes in serum cortisol in the immediate postoperative period, and the relationship of postoperative cortisol dynamics to remission and late recurrence.METHODSA single-center retrospective cohort analysis was performed for all patients undergoing pituitary surgery from 2007 through 2015. Standardized diagnostic and treatment algorithms were applied to all patients with potential Cushing's disease (CD), including microsurgical transsphenoidal adenomectomy (TSA) by a single surgeon. All patients had serum cortisol levels drawn at 6-hour intervals for 72 hours after surgery, and were offered reoperation within 3 days for normal or supranormal postoperative cortisol levels. Primary outcomes were 6-month remission and late recurrence; secondary outcomes were persistent postoperative hypocortisolism and surgical morbidity. Discriminatory levels of postoperative serum cortisol for predicting remission were calculated at various intervals after surgery using receiver operating characteristic (ROC) curves.RESULTSAmong 89 patients diagnosed with CD, 81 underwent initial TSA for a potentially curable lesion; 23 patients (25.8%) underwent an immediate second TSA. For the entire cohort, 6-month remission was achieved in 77.8% and late recurrences occurred in 9.5%, at a mean of 43.5 months. Compared with patients with a single surgery, those with an immediate second TSA had similar rates of remission (78.3% vs 77.6%) and late recurrence (5.6% vs 11.1%). The rate of hypocortisolism for patients with 2 surgeries (12/23, 52.2%) was significantly greater than that for patients with single surgeries (13/58, 22.4%; p < 0.001). There was no difference in the incidence of CSF leaks between the first and second operations. Remission was ... |
| نوع الوثيقة: | text |
| اللغة: | unknown |
| العلاقة: | https://digitalcommons.psjhealth.org/publications/1395Test; https://www.ncbi.nlm.nih.gov/pubmed/29271716Test |
| الإتاحة: | https://digitalcommons.psjhealth.org/publications/1395Test https://www.ncbi.nlm.nih.gov/pubmed/29271716Test |
| رقم الانضمام: | edsbas.B928F789 |
| قاعدة البيانات: | BASE |
| الوصف غير متاح. |