What can predict postoperative "endocrinological cure" in Cushing's disease?

Abstract

The goal of surgical treatment for Cushing's disease is "endocrinological cure." The purpose of this study was to determine predictors for postoperative endocrinological cure in Cushing's disease. Postoperative endocrinological studies were evaluated in 18 patients with Cushing's disease who underwent transsphenoidal surgery for selective adenomectomy. Serum adrenocorticotropic hormone (ACTH) levels were measured by radioimmunoassay during the first week after surgery. One week after surgery, a test using corticotropin-releasing hormone (CRH) was performed on each patient to check the reserve function of normal ACTH-secreting cells. In eight patients, postoperative ACTH levels were below the measurable level for 1 week, and ACTH showed no response to the CRH test. In these patients, serum ACTH and cortisol levels were kept in the normal range with a normal diurnal variation during long-term follow-up. These patients can be defined as endocrinologically cured. In seven patients, the ACTH level returned to within normal range on the day after surgery, but ACTH was provoked by the CRH test. Five of these seven patients showed subsequent re-elevation of ACTH above the normal range. ACTH levels were never normalized in the remaining three patients, and medical treatments were unavoidable. The most reliable indicators for predicting endocrinological cure in Cushing's disease are no response of ACTH to the CRH test in the early postoperative stage and an unmeasurably low ACTH level in the week after surgery. Obtaining a normal range of ACTH level postoperatively is insufficient to define endocrinological cure.