Article ; Online: Cushing disease: use of perioperative serum cortisol measurements in early determination of success following pituitary surgery.
2007 Volume 23, Issue 3, Page(s) E6
Abstract: ... the histopathological findings, and the changes in serum cortisol levels as well as the patient's wishes and concerns ... biochemical marker of ACTH deficiency and is associated with clinical remission of Cushing disease. Higher serum ... immediately after adenomectomy until there is clinical or biochemical evidence of ACTH deficiency. A serum ...
| Abstract | Despite many recent advances, management of cases of Cushing disease continues to be challenging. After complete resection of ACTH-secreting adenomas, patients develop transient ACTH deficiency requiring glucocorticoid replacement for several months. The current recommendation by many centers, including ours, for patients with ACTH-secreting adenomas is to withhold glucocorticoid therapy during and immediately after adenomectomy until there is clinical or biochemical evidence of ACTH deficiency. A serum cortisol level of less than 2 microg/dl within the first 48 hours after adenomectomy is a reliable biochemical marker of ACTH deficiency and is associated with clinical remission of Cushing disease. Higher serum cortisol levels in the immediate postoperative period should be interpreted with caution. The decision to immediately reexplore the sella turcica should be individualized, taking into account the findings at surgery, the histopathological findings, and the changes in serum cortisol levels as well as the patient's wishes and concerns. Optimal diagnosis and therapy for patients with Cushing disease require thorough and close coordination and involvement of all members of the management team. |
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| MeSH term(s) | ACTH-Secreting Pituitary Adenoma/surgery ; Adenoma/surgery ; Glucocorticoids/administration & dosage ; Humans ; Hydrocortisone/blood ; Pituitary ACTH Hypersecretion/blood ; Pituitary ACTH Hypersecretion/drug therapy ; Pituitary ACTH Hypersecretion/surgery ; Predictive Value of Tests ; Treatment Outcome |
| Chemical Substances | Glucocorticoids ; Hydrocortisone (WI4X0X7BPJ) |
| Language | English |
| Publishing date | 2007 |
| Publishing country | United States |
| Document type | Journal Article ; Review |
| ZDB-ID | 2026589-X |
| ISSN | 1092-0684 ; 1092-0684 |
| ISSN (online) | 1092-0684 |
| ISSN | 1092-0684 |
| DOI | 10.3171/foc.2007.23.3.8 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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