A Combined Dexamethasone Desmopressin Test as an Early Marker of Postsurgical Recurrence in Cushing’s Disease

Castinetti, Frédéric; Martinie, M.; Morange, Isabelle; Dufour, Henry; Stürm, Nathalie; Passagia, J.-G.; Conte-Devolx, B.; Chabre, Olivier; Brue, Thierry

doi:10.1210/jc.2008-2234

Cited by 44 publications

(35 citation statements)

References 28 publications

(36 reference statements)

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“…In contrast to previous studies, age, the presence of a macroadenoma and pre-operative tumour visualisation were not predictive of recurrence (20,25,28,50,53,54). The importance of continuing long-term assessment is emphasised by our finding of a 14% recurrence at 5 years, similar to other studies (10,16).…”

Section: Recurrence Rates and Interval-free Estimationsupporting

confidence: 61%

“…Thus, data regarding recurrence may underestimate a problem, which may increase over time. Early studies reported relatively low recurrence rates, with the more recent studies suggesting much higher recurrence rates in the long-term, often between 20 and 30% (18,28). However, even these longer term studies have few patients followed for the longer periods.…”

Section: Introductionmentioning

confidence: 99%

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Long-term remission and recurrence rates in Cushing's disease: predictive factors in a single-centre study

Alexandraki

Kaltsas

Isidori

et al. 2013

European Journal of Endocrinology

169

123

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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) and seven by the transcranial approach) were studied. Apparent immediate cure: post-operative 0900 h serum cortisol level !50 nmol/l; remission: cortisol insufficiency or restoration of 'normal' cortisol levels with resolution of clinical features; and 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, 6-29 years). 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 recovery of hypothalamo-pituitary-adrenal axis 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 26.5% with hemi-hypophysectomy showed recurrence rates of 31 and 13% respectively (c 2 Z6.275, PZ0.03). Strict remission criteria were not superior in terms of the probability of recurrence compared with post-operative normocortisolaemia. Conclusions: Lifelong 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.

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Section: Recurrence Rates and Interval-free Estimationsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Long-term remission and recurrence rates in Cushing's disease: predictive factors in a single-centre study

Alexandraki

Kaltsas

Isidori

et al. 2013

European Journal of Endocrinology

169

123

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“…Undetectable early morning serum cortisol (!18 ng/ml, 50 nmol/l) is as a good index of long-term remission (10,16,17,20,(29)(30)(31)(32)42). Yet, it is not a full protector (10-12, 16, 20, 21, 29, 33, 42, 45).…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, an unsuppressed early morning post-TSS serum cortisol level can be associated with long-term remission. Dynamic tests, such as CRH and vasopressin analogs (lysine vasopressin (LVP) and desmopressin) stimulation tests, and the recently coupled dexamethasone desmopressin test, have been used to predict recurrence (15,28,29,(34)(35)(36). In patients showing ACTH and cortisol response to desmopressin in the preoperative period, the persistence or the reappearance of the positive response during long-term follow-up could be an early predictor of late recurrence, preceding by several months the classical markers of recurrence and the overt clinical signs of hypercortisolism (37,38).…”

Section: Introductionmentioning

confidence: 99%

Sequential hormonal changes in 21 patients with recurrent Cushing's disease after successful pituitary surgery

Khalil

Baudry

Guignat

et al. 2011

European Journal of Endocrinology

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Objective: To describe the sequence of hormonal changes during recurrence of Cushing's disease (CD) after successful transsphenoidal surgery (TSS). Design: Retrospective study in a single center. Patients and methods: We studied 101 of the 127 patients treated by TSS for CD between 1996 and 2009, who had hypocortisolism or eucortisolism for at least 3 months post-TSS. We arbitrarily defined 'overt recurrence', as presence of two classical parameters of excess cortisol (increased midnight -either serum or salivary -and 24 h urinary cortisol (UC)), leading to further specific therapeutic action, and 'mild recurrence', as presence of a single classical parameter, leading to simple surveillance. Results: Of the 101 patients, 21 (20.8%) presented with recurrence, 'mild' or 'overt', during long-term follow-up (median 50.4 months, range 7-99). Recurrence occurred less frequently (16.8 vs 50%, PZ0.02), and later (mean 44.7 months, median 43, range 7-94 vs mean 21.5 months, median 17, range 3-61, PZ0.05), in patients with early post-TSS hypocortisolism compared with those with eucortisolism. Increase in midnight cortisol occurred in a mean time of 38.2 months, while UC elevation was observed at 50.6 months. Vasopressin analogs and CRH tests were eventually positive in 85 and 93% of all patients respectively; a positive response to one of the two dynamic tests preceded the increase in midnight cortisol or UC in 71 and 64% of the patients respectively. Conclusion: A positive response to vasopressin analogs and/or CRH tests occurs early in recurrence, followed by an increase in midnight cortisol, while UC elevation is at a later stage.

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“…АКТГ-зависимый синдром Кушинга (СК) -тя-желое эндокринное заболевание, характеризующе-еся хроническим избытком кортизола из-за АКТГ-секретирующей аденомы гипофиза [1,2].…”

Section: Introductionunclassified

Оцінка Ефективності Хірургічного Лікування Актг-Залежного Синдрому Кушинга В Ранньому І Пізньому Післяопераційному Періоді

Narimova¹

2021

Mìžnarodnij endokrinologìčnij žurnal

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Актуальність. АКТГ-залежний синдром Кушинга (СК) — тяжке ендокринне захворювання, що характеризується хронічним надлишком кортизолу внаслідок АКТГ-секретуючої аденоми гіпофіза. Метою роботи є оцінка ефективності проведеного хірурічного лікування АКТГ-залежного СК в ранньому і пізньому післяопераційному періоді. Матеріали та методи. Під спостереженням перебувало 234 пацієнти, середній вік чоловіків становив 26,38 ± 3,40 року, жінок — 27,58 ± 3,40 року. Усім хворим виконувався комплекс досліджень, що містив загальноклінічні, біохімічні, гормональні аналізи, а також магнітно-резонансна томографія головного мозку, рентгенографія органів грудної клітки, денситометрія. Результати. Трансназальна аденомектомія гіпофіза (ТАГ) була виконана первинно у 200 пацієнтів, з них повторно — у 34. При цьому ремісія у пацієнтів, які зазнали ТАГ з приводу АКТГ-залежного СК, настала у 42 %, рецидив розвинувся у 5 %, ремісія не досягнута у 46 %. Визначена вірогідність відмінностей між такими параметрами, як число пацієнтів в період ремісії і число рецидивів після ТАГ, рівень вільного кортизолу плазми і глікемії натще у хворих в період ремісії і рецидиву. Вивчений кореляційний зв’язок між рівнем вільного кортизолу плазми в ранньому постопераційному періоді після ТАГ і частотою рецидивів. Висновки. Найбільш вірогідним, інформативним прогностичним маркером рецидиву пухлини є рівень кортизолу плазми в ранньому післяопераційному періоді: чим нижче рівень кортизолу, тим стійкішою спостерігається ремісія. Безпосередні результати хірургічного лікування СК залежать від розмірів пухлини, ступеня тяжкості загального стану пацієнта, наявності нейроендокринних і кістково-метаболічних ускладнень.

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A Combined Dexamethasone Desmopressin Test as an Early Marker of Postsurgical Recurrence in Cushing’s Disease

Abstract: CDDT is an early predictor of recurrence of CD and could be of particular interest in the first 3 yr after surgery, by selecting patients at high risk of recurrence despite falsely reassuring classical hormonal markers.

Cited by 44 publications

References 28 publications

Long-term remission and recurrence rates in Cushing's disease: predictive factors in a single-centre study

Long-term remission and recurrence rates in Cushing's disease: predictive factors in a single-centre study

Sequential hormonal changes in 21 patients with recurrent Cushing's disease after successful pituitary surgery

Оцінка Ефективності Хірургічного Лікування Актг-Залежного Синдрому Кушинга В Ранньому І Пізньому Післяопераційному Періоді

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