Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 16;12(5):798.
doi: 10.3390/jpm12050798.

A Comprehensive Approach to Predicting the Outcomes of Transsphenoidal Endoscopic Adenomectomy in Patients with Cushing's Disease

Natalia V Kuritsyna  1 , Uliana A Tsoy  1 , Vladislav Y Cherebillo  1 , Artem A Paltsev  1 , Anton V Ryzhkov  1 , Pavel A Ryazanov  1 , Vladimir K Ryzhkov  1 , Elena N Grineva  1
Affiliations

A Comprehensive Approach to Predicting the Outcomes of Transsphenoidal Endoscopic Adenomectomy in Patients with Cushing's Disease

Natalia V Kuritsyna et al. J Pers Med. .

Abstract

Persistent and recurrent hypercortisolism after transsphenoidal endoscopic surgery (TSS) is considered to be an urgent issue prompting the search for Cushing's disease (CD) remission predictors. The goal was to find a combination of predictors that can forecast the remission of CD after TSS. A total of 101 patients with CD who had undergone TSS were included. One year after surgery, CD remission status was evaluated. Preoperative pituitary magnetic resonance imaging (MRI) data, preoperative results of a high-dose dexamethasone suppression test (HDDST) and morning serum cortisol level collected 24 h after TSS (24 h MSeC) were compared in patients with and without remission of hypercortisolism. Remission one year after TSS was confirmed in 63 patients. CD remission predictors one year after TSS were: adenoma size ≥ 3 mm in the absence of invasive growth and the suppression of serum cortisol ≥ 74% in the HDDST, 24 h MSeC ≤ 388 nmol/L. A total of 38 patients had three favorable values of detected predictors; all of them had CD remission one year after TSS. With long-term follow-up, 36 of them remained in remission. Patients who had no one favorable predictor had no remission of hypercortisolism one year after TSS. Our data confirmed the prospects of using a combination of selected predictors to forecast CD remission after TSS.

Keywords: Cushing’s disease; hypercortisolism; predictors; remission; transsphenoidal surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Receiver-operating-characteristic (ROC) curve of the size of a non-invasive pituitary adenoma for predicting CD remission one year after TSS. The optimal cutoff of corticotropinoma size for predicting CD remission after TSS was ≥3 mm, with the sensitivity 82.8% and the specificity 82.4% (p < 0.001, AUC = 0.832, 95% CI = 71.5–94.8%).
Figure 2
Figure 2
Receiver-operating-characteristic (ROC) curve of serum cortisol suppression in the HDDST for the prognosis of CD remission one year after TSS. The optimal threshold of serum cortisol suppression in the HDDST for predicting the CD remission was 74%; the sensitivity and specificity of the method were 86.3% and 81.5%, respectively (p < 0.001, AUC = 0.850, 95% CI = 74.4–95.6%).
Figure 3
Figure 3
Receiver-operating-characteristic (ROC) curve of morning serum cortisol collected 24 h after TSS for prognosis of CD remission one year after TSS. The optimal threshold of 24 h MseC for predicting CD remission was ≤388 nmol/L; the sensitivity and specificity of the method were 97.4% and 79.3%, respectively (p < 0.001, AUC = 0.935, 95% CI = 87.7–99.2%).
Figure 4
Figure 4
Remission rate one year after TSS depending on the number of favorable values of predictors of CD remission after surgery.
Figure 5
Figure 5
Remission rate after TSS depending on the number of favorable values of predictors of CD remission after surgery (long-term follow-up).
See this image and copyright information in PMC

References

    1. Newell-Price J., Trainer P.J., Besser G.M., Grossman A.B. The diagnosis and differential diagnosis of Cushing’s and pseudo-Cushing’s states. Endocr. Rev. 1999;19:647–672. doi: 10.1210/edrv.19.5.0346. - DOI - PubMed
    1. Bertagna X., Guignat L., Groussin L., Bertherat J. Cushing’s disease. Best Pract. Res. Clin. Endocrinol. Metab. 2009;23:607–623. doi: 10.1016/j.beem.2009.06.001. - DOI - PubMed
    1. Arnaldi G., Angeli A., Atkinson A.B., Bertagna X., Cavagnini F., Chrousos G.P., Fava G.A., Findling J.W., Gaillard R.C., Grossman A.B., et al. Diagnosis and complications of Cushing’s syndrome: A consensus statement. J. Clin. Endocrinol. Metab. 2003;88:5593–5602. doi: 10.1210/jc.2003-030871. - DOI - PubMed
    1. Sharma S.T., Nieman L.K., Feelders R.A. Cushing’s syndrome: Epidemiology and developments in disease management. Clin. Epidemiol. 2015;7:281–293. doi: 10.2147/CLEP.S44336. - DOI - PMC - PubMed
    1. Invitti C., Giraldi F.P., De Martin M., Cavagnini F. The Study Group of the Italian Society of Endocrinology on the Pathophysiology of the Hypotalamic-Pituitary-Adrenal Axis Diagnosis and Management of Cushing’s syndrome: Results of an Italian Multicentre Study. J. Clin. Endocrinol. Metab. 1999;84:440–448. doi: 10.1210/jcem.84.2.5465. - DOI - PubMed

LinkOut - more resources