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Erschienen in: Pituitary 2/2022

21.01.2022

Characterization of a paradoxical post-operative increase in serum cortisol in Cushing disease

verfasst von: Michael P. Catalino, Aaron Gelinne, Natasha Ironside, Justin Coley, Rachel Jonas, Kathryn Kearns, Alexander Munoz, Alaa Montaser, Mary Lee Vance, John A. Jane Jr, Edward R. Laws Jr

Erschienen in: Pituitary | Ausgabe 2/2022

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Abstract

Purpose

In Cushing disease, early post-operative serum cortisol fluctuations have not been adequately characterized, and their association with initial remission and recurrence is unclear.

Methods

A retrospective cohort study of patients with Cushing disease was conducted at two institutions. A “riser” was defined a priori as a paradoxical increase in serum cortisol with an immediate incremental increase in serum cortisol over three consecutive cortisol draws separated by roughly 6-h (definition 1). Post hoc analyses used a definition of two consecutive increases (definition 2). Risers were compared to non-risers for initial remission and time-to-recurrence.

Results

A total of 505 patients with Cushing disease were screened, and 469 had adequate data for group assignment. Analysis of post-operative cortisol showed a subgroup of “risers” with a frequency of 3.6% for definition 1 and 42.6% for definition 2. In these patients, cortisol levels were significantly higher until approximately 36 h post-operatively, and cortisol had a significantly longer mean serum half-life. In the post hoc analysis, definition 2 risers had a lower remission rate compared to non-risers (162/196, 82.7%, versus 243/264, 92.0%) with an odds ratio of 0.41 (0.23–0.73; p = 0.003). For both definitions, recurrence was similar between groups.

Conclusions

We found that almost half of Cushing disease patients experienced a temporary increase in serum cortisol level during the early post-operative period. Serum cortisol half-life was longer, and the remission rates were lower, however, recurrence rates were similar to non-risers.
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Metadaten
Titel
Characterization of a paradoxical post-operative increase in serum cortisol in Cushing disease
verfasst von
Michael P. Catalino
Aaron Gelinne
Natasha Ironside
Justin Coley
Rachel Jonas
Kathryn Kearns
Alexander Munoz
Alaa Montaser
Mary Lee Vance
John A. Jane Jr
Edward R. Laws Jr
Publikationsdatum
21.01.2022
Verlag
Springer US
Erschienen in
Pituitary / Ausgabe 2/2022
Print ISSN: 1386-341X
Elektronische ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-021-01203-x

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