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An early post-operative ACTH suppression test can safely predict short- and long-term remission after surgery of Cushing’s disease

Uvelius, Erik LU ; Höglund, Peter LU ; Valdemarsson, Stig LU and Siesjö, Peter LU (2018) In Pituitary 21(5). p.490-498
Abstract

Purpose: The present study evaluates the usefulness of an ACTH suppression test shortly after surgery, and to determine optimal cut-off values of included laboratory analyses, in predicting short- and long-term remission after surgery of Cushing’s disease. Methods: A 48 h suppression test with betamethasone 2 mg/day applied after 45 transphenoidal adenomectomies in 28 patients was evaluated. Receiver operating characteristic (ROC)-curves were created for the included assays: plasma cortisol, plasma adrenocorticotropic hormone (ACTH) and urinary free cortisol (UFC). Plasma levels of cortisol and ACTH were measured both at 24 and 48 h. Youden’s index was used to determine cut-off with the highest sensitivity and specificity in predicting... (More)

Purpose: The present study evaluates the usefulness of an ACTH suppression test shortly after surgery, and to determine optimal cut-off values of included laboratory analyses, in predicting short- and long-term remission after surgery of Cushing’s disease. Methods: A 48 h suppression test with betamethasone 2 mg/day applied after 45 transphenoidal adenomectomies in 28 patients was evaluated. Receiver operating characteristic (ROC)-curves were created for the included assays: plasma cortisol, plasma adrenocorticotropic hormone (ACTH) and urinary free cortisol (UFC). Plasma levels of cortisol and ACTH were measured both at 24 and 48 h. Youden’s index was used to determine cut-off with the highest sensitivity and specificity in predicting short- (3 months) and long-term (5 years or longer) remission. The area under curve (AUC) illustrated the clinical accuracy of the different assays. Results: Plasma cortisol after 24 h with betamethasone was most accurate in predicting both short- and long-term remission. 3 months remission with cut-off 107 nmol/L: sensitivity 0.85, specificity 0.94, positive predictive value (PPV) 0.96 and AUC 0.92 (95% CI 0.85–1). 5 years remission with cut-off 49 nmol/L: sensitivity: 0.94, specificity 0.93, PPV 0.88, AUC 0.98 (95% CI 0.95–1). Analyses of ACTH or UFC did not improve diagnostic accuracy. Conclusions: A 48 h, 2 mg/day betamethasone suppression test after transphenoidal surgery of Cushing’s disease could predict short- and long-term remission with a high accuracy. Suppression of plasma cortisol after 24 h with betamethasone to values excluding Cushings disease in the diagnostic setting yielded the highest accuracy in predicting long-term remission.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ACTH-secreting pituitary adenoma, Cushing disease, Pituitary adenoma, Pituitary neoplasms/surgery, Recurrence, Transphenoidal surgery, Treatment outcome
in
Pituitary
volume
21
issue
5
pages
9 pages
publisher
Springer
external identifiers
  • scopus:85050513559
ISSN
1386-341X
DOI
10.1007/s11102-018-0902-6
language
English
LU publication?
yes
id
b4e586f5-ba5e-4927-b045-b617eb688e85
date added to LUP
2018-09-24 14:27:26
date last changed
2019-04-05 13:03:05
@article{b4e586f5-ba5e-4927-b045-b617eb688e85,
  abstract     = {<p>Purpose: The present study evaluates the usefulness of an ACTH suppression test shortly after surgery, and to determine optimal cut-off values of included laboratory analyses, in predicting short- and long-term remission after surgery of Cushing’s disease. Methods: A 48 h suppression test with betamethasone 2 mg/day applied after 45 transphenoidal adenomectomies in 28 patients was evaluated. Receiver operating characteristic (ROC)-curves were created for the included assays: plasma cortisol, plasma adrenocorticotropic hormone (ACTH) and urinary free cortisol (UFC). Plasma levels of cortisol and ACTH were measured both at 24 and 48 h. Youden’s index was used to determine cut-off with the highest sensitivity and specificity in predicting short- (3 months) and long-term (5 years or longer) remission. The area under curve (AUC) illustrated the clinical accuracy of the different assays. Results: Plasma cortisol after 24 h with betamethasone was most accurate in predicting both short- and long-term remission. 3 months remission with cut-off 107 nmol/L: sensitivity 0.85, specificity 0.94, positive predictive value (PPV) 0.96 and AUC 0.92 (95% CI 0.85–1). 5 years remission with cut-off 49 nmol/L: sensitivity: 0.94, specificity 0.93, PPV 0.88, AUC 0.98 (95% CI 0.95–1). Analyses of ACTH or UFC did not improve diagnostic accuracy. Conclusions: A 48 h, 2 mg/day betamethasone suppression test after transphenoidal surgery of Cushing’s disease could predict short- and long-term remission with a high accuracy. Suppression of plasma cortisol after 24 h with betamethasone to values excluding Cushings disease in the diagnostic setting yielded the highest accuracy in predicting long-term remission.</p>},
  author       = {Uvelius, Erik and Höglund, Peter and Valdemarsson, Stig and Siesjö, Peter},
  issn         = {1386-341X},
  keyword      = {ACTH-secreting pituitary adenoma,Cushing disease,Pituitary adenoma,Pituitary neoplasms/surgery,Recurrence,Transphenoidal surgery,Treatment outcome},
  language     = {eng},
  month        = {10},
  number       = {5},
  pages        = {490--498},
  publisher    = {Springer},
  series       = {Pituitary},
  title        = {An early post-operative ACTH suppression test can safely predict short- and long-term remission after surgery of Cushing’s disease},
  url          = {http://dx.doi.org/10.1007/s11102-018-0902-6},
  volume       = {21},
  year         = {2018},
}