Follow-up intervals in patients with Cushing’s disease: recommendations from a panel of experienced pituitary clinicians

Geer, Eliza B.; Ayala, Alejandro; Bonert, Vivien; Carmichael, John D.; Gordon, Murray B.; Katznelson, Laurence; Manuylova, Ekaterina; Shafiq, Ismat; Surampudi, Vijaya; Swerdloff, Ronald S.; Broder, Michael S.; Cherepanov, Dasha; Eagan, Marianne; Lee, Jackie; Said, Qayyim; Neary, Maureen P.

doi:10.1007/s11102-017-0801-2

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…Several studies have now shown that loss of the nadir of cortisol secretion late at night is the earliest detectable biochemical abnormality in patients with recurrent CD often preceding elevations of urine cortisol or an abnormal low-dose DST [ 78 , 80 , 82 , 83 ]. Experts have now recommended an annual assessment of LNSC in order to establish an early diagnosis of recurrent CD [ 82 , 84-86 ].…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of Late-Night Salivary Cortisol and Cortisone by EIA and LC-MS/MS in Suspected Cushing Syndrome

Kannankeril

Carroll

Findling

et al. 2020

Journal of the Endocrine Society

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Context Late-night salivary cortisol (LNSC) measured by enzyme immunoassay (EIA-F) is a first-line screening test for Cushing’s syndrome (CS) with a reported sensitivity and specificity of >90%. However, liquid chromatography-tandem mass spectrometry, validated to measure salivary cortisol (LCMS-F) and cortisone (LCMS-E), has been proposed to be superior diagnostically. Objective, Setting, and Main Outcome Measures Prospectively evaluate the diagnostic performance of EIA-F, LCMS-F, and LCMS-E in 1453 consecutive late-night saliva samples from 705 patients with suspected CS. Design Patients grouped by the presence or absence of at least one elevated salivary steroid result and then subdivided by diagnosis. Results We identified 283 patients with at least one elevated salivary result; 45 had an established diagnosis of neoplastic hypercortisolism (CS) for which EIA-F had a very high sensitivity (97.5%). LCMS-F and LCMS-E had lower sensitivity but higher specificity than EIA-F. EIA-F had poor sensitivity (31.3%) for ACTH-independent CS (5 patients with at least one and 11 without any elevated salivary result). In patients with Cushing’s disease (CD), most non-elevated LCMS-F results were in patients with persistent/recurrent CD; their EIA-F levels were lower than in patients with newly diagnosed CD. Conclusions Since the majority of patients with ≥1 elevated late-night salivary cortisol or cortisone result did not have CS, a single elevated level has poor specificity and positive predictive value. LNSC measured by EIA is a sensitive test for ACTH-dependent Cushing’s syndrome but not for ACTH-independent CS. We suggest that neither LCMS-F nor LCMS-E improves the sensitivity of late-night EIA-F for CS.

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Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of Late-Night Salivary Cortisol and Cortisone by EIA and LC-MS/MS in Suspected Cushing Syndrome

Kannankeril

Carroll

Findling

et al. 2020

Journal of the Endocrine Society

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“…Fleseriu et al recommend to evaluate patients clinically on an annual basis [34] and to conduct a biochemical screening when the patient has new evidence of a tumor in the MRI or worsening/onset of symptoms and comorbidities that might be related to CS [34]. In an expert statement, Geer et al suggested a complex and detailed scheme, taking into account the time passed since pituitary surgery, the requirement for steroid replacement therapy, and previous clinical and biochemical evidence of remission [35]. Suggested test intervals vary between 2 and 6 months.…”

Section: Diagnosis Of Recurrencementioning

confidence: 99%

Recurrence after pituitary surgery in adult Cushing’s disease: a systematic review on diagnosis and treatment

et al. 2020

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Purpose Recurrence after pituitary surgery in Cushing’s disease (CD) is a common problem ranging from 5% (minimum) to 50% (maximum) after initially successful surgery, respectively. In this review, we give an overview of the current literature regarding prevalence, diagnosis, and therapeutic options of recurrent CD. Methods We systematically screened the literature regarding recurrent and persistent Cushing’s disease using the MESH term Cushing’s disease and recurrence. Of 717 results in PubMed, all manuscripts in English and German published between 1980 and April 2020 were screened. Case reports, comments, publications focusing on pediatric CD or CD in veterinary disciplines or studies with very small sample size (patient number < 10) were excluded. Also, papers on CD in pregnancy were not included in this review. Results and conclusions Because of the high incidence of recurrence in CD, annual clinical and biochemical follow-up is paramount. 50% of recurrences occur during the first 50 months after first surgery. In case of recurrence, treatment options include second surgery, pituitary radiation, targeted medical therapy to control hypercortisolism, and bilateral adrenalectomy. Success rates of all these treatment options vary between 25 (some of the medical therapy) and 100% (bilateral adrenalectomy). All treatment options have specific advantages, limitations, and side effects. Therefore, treatment decisions have to be individualized according to the specific needs of the patient.

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“…[167][168][169][170] Evaluation for recurrence should begin after HPA axis recovery, and then annually or sooner if clinical suspicion. 171,172 In practice, however, clinical manifestations and biomarkers may be discordant. Moreover, diagnosis of early recurrence presents the additional challenge about when and how to intervene with treatment.…”

Section: Introductionmentioning

confidence: 99%

Consensus on diagnosis and management of Cushing's disease: a guideline update

Fleseriu

Auchus

Bancos

et al. 2021

The Lancet Diabetes & Endocrinology

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578

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Follow-up intervals in patients with Cushing’s disease: recommendations from a panel of experienced pituitary clinicians

Abstract: With a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice.

Cited by 8 publications

References 27 publications

Prospective Evaluation of Late-Night Salivary Cortisol and Cortisone by EIA and LC-MS/MS in Suspected Cushing Syndrome

Prospective Evaluation of Late-Night Salivary Cortisol and Cortisone by EIA and LC-MS/MS in Suspected Cushing Syndrome

Recurrence after pituitary surgery in adult Cushing’s disease: a systematic review on diagnosis and treatment

Consensus on diagnosis and management of Cushing's disease: a guideline update

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