Prognostic usefulness of ACTH in the postoperative period of Cushing’s disease

Abstract

Objectives: To analyze the usefulness of plasma ACTH in predicting CD remission after surgery and to evaluate the prognostic usefulness of ACTH measurement after the cortisol and ACTH nadir (48 h prior to discharge). Design: A prospective study was made of 65 patients with CD operated upon between 2005 and 2016. Methods: Postsurgery plasma ACTH and cortisol were measured every 6 h, in the absence of corticosteroid coverage. Hydrocortisone was started in the presence of adrenal insufficiency or cortisol 3.2 pmol/L of recurrence (AUC 0.810; P 39 h was indicative of recurrence (AUC 0.773; P = 0.001). Conclusions: We propose an ACTH value <3.3 pmol/L as a good long-term progno stic marker in the postoperative period of CD. Reaching the ACTH nad ir in less time is associated to a lesser recurrence rate.

Keywords

• Cushing’s disease
• ACTH
• cortisol
• transsphenoidal surgery
• remission
• recurrence