Post Graduate Program in Medical Sciences - Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Clin Endocrinol (Oxf). 2014 Mar;80(3):411-8. doi: 10.1111/cen.12300. Epub 2013 Sep 4.
To evaluate the ability of post-transsphenoidal pituitary surgery (TSS) serum cortisol levels (s-cortisol) to predict surgical remission and recurrence of Cushing's disease (CD).
One hundred and three patients with CD from a tertiary referral centre were prospectively analysed over 6·0 ± 4·8 years of follow-up. Twenty patients received perioperative glucocorticoids as routine care and had s-cortisol measured 10-12 days after TSS (Protocol I). Eighty-six patients (91 surgeries) had s-cortisol measured at 6, 12, 18, 24, 48 h, and 10-12 days after TSS, and received glucocorticoids only in case of adrenal insufficiency (Protocol II).
Remission [clinical signs and symptoms of adrenal insufficiency (or hypocortisolism) plus cortisol <3 μg/dl on the 1-mg overnight test (OT) and/or normal free urinary cortisol] during follow-up. Recurrence was defined as loss of remission criteria at least 1 year after TSS.
The remission rate after first TSS was 80%; 8% had recurrence. An s-cortisol nadir ≤3·5 μg/dl within 48 h after TSS had sensitivity of 73%, specificity and positive predictive value (PPV) of 100% and negative predictive value (NPV) of 60% and an s-cortisol nadir ≤5·7 μg/dl within 10-12 days of TSS had specificity and PPV of 100% and sensitivity of 91% NPV of 78% for CD remission.
At hospital discharge, the s-cortisol nadir within 48 h after TSS was already able to predict surgical remission for some patients, and the s-cortisol nadir within 10-12 days of TSS was able to predict cohort-wide surgical remission.
评估经蝶窦垂体手术后（TSS）血清皮质醇水平（s-cortisol）预测库欣病（CD）手术缓解和复发的能力。
对来自三级转诊中心的 103 例 CD 患者进行前瞻性分析，随访时间为 6.0±4.8 年。20 例患者接受围手术期糖皮质激素治疗，并在 TSS 后 10-12 天测量 s-cortisol（方案 I）。86 例患者（91 例手术）在 TSS 后 6、12、18、24、48 小时和 10-12 天测量 s-cortisol，并仅在出现肾上腺功能不全时给予糖皮质激素（方案 II）。
随访期间缓解[肾上腺功能不全（或低皮质醇血症）的临床体征和症状，加上 1 毫克过夜试验（OT）时皮质醇<3μg/dl 和/或正常游离尿皮质醇]。复发定义为 TSS 后至少 1 年失去缓解标准。
首次 TSS 后的缓解率为 80%；8%复发。TSS 后 48 小时内 s-cortisol 最低点≤3.5μg/dl 的敏感性为 73%，特异性和阳性预测值（PPV）为 100%，阴性预测值（NPV）为 60%，TSS 后 10-12 天内 s-cortisol 最低点≤5.7μg/dl 的特异性和 PPV 为 100%，敏感性为 91%，NPV 为 78%，用于 CD 缓解。
在出院时，TSS 后 48 小时内的 s-cortisol 最低点已经能够预测某些患者的手术缓解，而 TSS 后 10-12 天内的 s-cortisol 最低点能够预测全队列的手术缓解。
