Endocrinology ·
Early Cortisol Levels Predict Recurrence After Surgery for Cushing’s Disease
A multicenter retrospective cohort study of 162 patients assessed early postoperative cortisol levels after endoscopic endonasal resection of pituitary tumors causing Cushing’s disease. Cortisol below 5 µg/dL during the first three postoperative days was associated with lower odds of recurrence; follow-up averaged 29.8 months in the analysis of patients with cortisol below 2 µg/dL on postoperative day 1.
- Retrospective study included 162 surgical patients.
- Early cortisol below 5 µg/dL was associated with lower recurrence odds.
- Day-1 cortisol below 2 µg/dL corresponded to 91.8% recurrence-free survival.
- Comparing thresholds showed no statistically significant difference.
This multicenter retrospective cohort included 162 patients with biochemically confirmed Cushing’s disease who underwent endoscopic endonasal pituitary tumor resection at three institutions in the United States and Europe between 2007 and 2021. The investigators examined whether morning cortisol levels in the first three postoperative days were associated with later recurrence.
Cortisol below 2 µg/dL during the first three days was associated with lower odds of recurrence (OR 0.08, 95% CI 0.004–0.38), as was cortisol below 5 µg/dL (OR 0.25, 95% CI 0.09–0.61). Comparing the two thresholds, higher cortisol showed a nonsignificant trend toward increased recurrence risk (OR 2.1, 95% CI 0.59–7.81; p = 0.25). For patients with cortisol below 2 µg/dL on postoperative day 1, recurrence-free survival was 91.8%, with mean follow-up of 29.8 ± 28.7 months.
The findings support early postoperative cortisol as a prognostic marker, but do not establish that either threshold should determine management. The study was retrospective, and follow-up duration varied; the source does not report further details on treatment decisions or outcomes beyond recurrence associations.
In practice
For patients undergoing endoscopic endonasal resection for Cushing’s disease, early postoperative hypocortisolemia may help estimate recurrence risk: this retrospective multicenter cohort found lower odds of recurrence with morning cortisol below 5 µg/dL during the first three postoperative days. A level below 2 µg/dL on postoperative day 1 was associated with 91.8% recurrence-free survival over mean follow-up of about 30 months. These associations do not establish a management threshold or prove that changing care based on cortisol values improves outcomes; follow-up varied and the evidence is observational.
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Journal of Neurosurgery: Endoscopic endonasal approach for adrenocorticotropic hormone–producing pituitary neuroendocrine tumor causing Cushing’s disease: multicenter retrospective study on 162 patients with early postoperative cortisol assessment ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.