Recurrences of ACTH-Secreting Adenomas After Pituitary Adenomectomy Can Be Accurately Predicted by Perioperative Measurements of Plasma ACTH Levels

Abdelmannan, Dima; Chaiban, Joumana; Selman, Warren R.; Arafah, Baha M.

doi:10.1210/jc.2012-3910

Cited by 32 publications

(30 citation statements)

References 23 publications

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“…Some previous studies [11, 14, 45, 46] demonstrated that patients with higher postoperative ACTH levels faced a higher risk of recurrence, which were consistent with our results. Given the short half-life of ACTH in the circulation, a low postoperative ACTH level might indicate that the ACTH-secreting adenoma was completely excised, therefore the recurrence rate was low.…”

Section: Discussionsupporting

confidence: 93%

“…Incorporating feature selection and univariate analysis, some results corroborated the previous studies, suggesting that younger age [43, 44], higher postoperative morning serum cortisol [6, 9-13], and higher postoperative morning ACTH [11, 14, 45, 46] had a detrimental effect on recurrence.…”

Section: Discussionsupporting

confidence: 75%

“…Some studies suggested that patients with subnormal postoperative cortisol levels [6, 9-13], low postoperative UFC levels [11], or low postoperative ACTH levels [14] tended to have a lower risk of recurrence after initial TSS for CD, while others indicated that there were no reliable risk factors [41, 42]. A meta-analysis [15] also concluded that no reliable predictors of recurrence after TSS were found.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown that patients with subnormal postoperative cortisol levels [6, 9-13], low postoperative urinary free cortisol (UFC) levels [11], or low postoperative ACTH levels [14] tended to face a lower risk of recurrence after initial TSS for CD. However, no clear predictive models for recurrence were developed.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of Recurrence after Transsphenoidal Surgery for Cushing’s Disease: The Use of Machine Learning Algorithms

Liu

Hong

et al. 2019

Neuroendocrinology

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Background: There are no reliable predictive models for recurrence after transsphenoidal surgery (TSS) for Cushing’s disease (CD). Objectives: This study aimed to develop machine learning (ML)-based predictive models for CD recurrence after initial TSS and to evaluate their performance. Method: A total of 354 CD patients were included in this retrospective, supervised learning, data mining study. Predictive models for recurrence were developed according to 17 variables using 7 algorithms. Models were evaluated based on the area under the receiver operating characteristic curve (AUC). Results: All patients were followed up for over 12 months (mean ± SD 43.80 ± 35.61). The recurrence rate was 13.0%. Age (p < 0.001), postoperative morning serum cortisol nadir (p = 0.002), and postoperative (p < 0.001) and preoperative (p = 0.04) morning adrenocorticotropin (ACTH) level were significantly related to recurrence. AUCs of the 7 models ranged from 0.608 to 0.781. The best performance (AUC = 0.781, 95% CI 0.706, 0.856) appeared when 8 variables were introduced to the random forest (RF) algorithm, which was much better than that of logistic regression (AUC = 0.684, p = 0.008) and that of using only postoperative morning serum cortisol (AUC = 0.635, p < 0.001). According to the feature selection algorithms, the top 3 predictors were age, postoperative serum cortisol, and postoperative ACTH. Conclusions: Using ML-based models for prediction of the recurrence after initial TSS for CD is feasible, and RF performs best. The performance of most of ML-based models was significantly better than that of some conventional models.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prediction of Recurrence after Transsphenoidal Surgery for Cushing’s Disease: The Use of Machine Learning Algorithms

Liu

Hong

et al. 2019

Neuroendocrinology

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“…23,27,32,37,52 Interestingly, subnormal serum ACTH is significantly less sensitive for sustained disease remission but also more specific for long-term disease remission than subnormal serum cortisol. 1,3,20,23,37 However, an ACTH value that may predict long-term recurrence has not been determined.…”

Section: Postoperative Acthmentioning

confidence: 99%

Cushing's disease: predicting long-term remission after surgical treatment

Pendharkar¹,

Sussman²,

Ho³

et al. 2015

FOC

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Cushing's disease (CD) is a state of excess glucocorticoid production resulting from an adrenocorticotropic hormone (ACTH)–secreting pituitary adenoma. The gold-standard treatment for CD is transsphenoidal adenomectomy. In the hands of an experienced neurosurgeon, gross-total resection is possible in the majority of ACTH-secreting pituitary adenomas, with early postoperative remission rates ranging from 67% to 95%. In contrast to the strong data in support of resection, the clinical course of postsurgical persistent or recurrent disease remains unclear. There is significant variability in recurrence rates, with reports as high as 36% with a mean time to recurrence of 15–50 months. It is therefore important to develop biochemical criteria that define postsurgical remission and that may provide prognosis for long-term recurrence. Despite the use of a number of biochemical assessments, there is debate regarding the accuracy of these tests in predicting recurrence. Here, the authors review the various biochemical criteria and assess their utility in predicting CD recurrence after resection.

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Machine Learning in Pituitary Surgery

Stumpo

Staartjes

Regli

et al. 2021

Acta Neurochirurgica Supplement

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Recurrences of ACTH-Secreting Adenomas After Pituitary Adenomectomy Can Be Accurately Predicted by Perioperative Measurements of Plasma ACTH Levels

Abstract: Despite profound hypocortisolemia after adenomectomy, a simultaneously measured plasma ACTH level of >20 ng/L in the perioperative period is highly predictive of future recurrence of ACTH-secreting adenomas.

Cited by 32 publications

References 23 publications

Prediction of Recurrence after Transsphenoidal Surgery for Cushing’s Disease: The Use of Machine Learning Algorithms

Prediction of Recurrence after Transsphenoidal Surgery for Cushing’s Disease: The Use of Machine Learning Algorithms

Cushing's disease: predicting long-term remission after surgical treatment

Machine Learning in Pituitary Surgery

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