Abstract
Background The suppressed hypothalamic-pituitary-adrenal (HPA) axis after successful surgery for Cushing's disease (CD) will recover in almost all patients. We aimed to identify the predictive factors for HPA axis recovery in CD patients with postoperative remission. Design and Methods. This observational retrospective cross-sectional study enrolled 69 CD patients with postoperative remission in Huashan Hospital from 2015 to 2019. All subjects had a detailed clinical evaluation. The low-dose ACTH stimulation test (LDT) was conducted as the gold standard for assessing the HPA axis function. Results Peak cortisol in LDT was found only to be positively correlative with morning serum cortisol (MSC) (ρ=0.451, p < 0.001). The MSC was higher (p < 0.001), and the median postoperative course was significantly longer (p=0.025) in the patients with the recovered HPA axis function compared with unrecovered patients. The AUC value of MSC for predicting the recovery of the HPA axis was 0.701, and the optimal cutoff was 6.25 μg/dl (sensitivity 85.19% and specificity 47.62%). Other useful cutoff values were 10.74 μg/dl (specificity 100%) and 4.18 μg/dl (sensitivity 100%). Besides, combined with the postoperative course, the AUC values were higher than MSC alone (0.935 vs. 0.701, p < 0.001). Conclusions MSC is a viable first-step diagnostic predictor for HPA axis recovery in CD patients with postoperative remission. For the patients with cortisol levels between 4.18 and 10.74 μg/dl, a confirmatory test should be conducted. When the MSC level was 10.74 μg/dl or greater, the replacement therapy could be discontinued.
Highlights
Cushing’s disease (CD) is caused by pituitary adrenocorticotropic hormone- (ACTH-) secreting adenoma
By low-dose ACTH stimulation test (LDT), we divided the patients into the central adrenal sufficient (CAS) group (n 27) and central adrenal insufficient (CAI) group (n 42)
Our results support the role of morning serum cortisol (MSC) as a viable first-step diagnostic test to evaluate the recovery of HPA axis function in postoperative CD patients
Summary
Cushing’s disease (CD) is caused by pituitary adrenocorticotropic hormone- (ACTH-) secreting adenoma. It is the most common etiology of Cushing’s syndrome (CS), and the optimal treatment is transsphenoidal surgery (TSS) performed by an experienced pituitary surgeon [1,2,3]. Besides the insulin tolerance test (ITT), which was previously considered the gold standard, the low-dose ACTH stimulation test (LDT) axis is highly correlated with the ITT. It could be used as a reliable test to assess the HPA axis function. These methods are all time and resource consuming [7,8,9]. e failure to detect the HPA axis recovery and an unnecessary replacement leads to complications from excess glucocorticoid administration
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.