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Does the speed of reduction in peripheral cortisol levels correlates with long term post hypophysectomy Cushing disease control?
EANS Academy. Hassan S. Sep 27, 2019; 276155; EP04069
Mr. Samih Hassan
Mr. Samih Hassan

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Abstract
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Objectives: To examine the relationship between the speed of peripheral cortisol level drop following pituitary surgery for Cushing disease (CD) and long-term CD recurrence.
Design: A retrospective study of patients presenting to our centre between 2007 and 2018.
Subject: All patients who underwent pituitary surgery for CD at our centre.
Methods: We reviewed our centre's database to identify all patients with confirmed pituitary-driven CD. The target cortisol level for remission of CD was defined as less than 50 nmol/l.
Results: We identified 148 patients (43 males and 105 females, age range: 17 - 84 years). 20 patients were excluded due to being lost to follow-up. Median follow-up from diagnosis was 59 months (range: 4 - 126 months). Patients who achieved the target cortisol of < 50 nmol/l within 48H had a recurrence rate of 2.1% during the follow-up period. Patients who achieved that level within 48 to 96H had a recurrence rate of 10%, and those who achieved this level after 96H had recurrence rate of 33.3%. Interestingly, we identified 13 patients who attained long term CD remission during follow-up with a persistent cortisol level of > 50 nmol/l post operatively (range: 59 - 270 nmol/l).
Conclusions: The speed of reduction in peripheral cortisol levels correlates with long term CD control. This can be used as a predicting factor to guide the treating physicians in counselling patients with CD. In addition, some individuals with cortisol levels above 50 nmol/l are in long term remission. This suggesting a need to further analysis and perhaps reconsidering this threshold value.
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