The Value of Peri-operative Levels of ACTH, DHEA and DHEA-S and Tumor Size in Predicting Recurrence of Cushing's Disease.

The Value of Peri-operative Levels of ACTH, DHEA and DHEA-S and Tumor Size in Predicting Recurrence of Cushing's Disease.

J Clin Endocrinol Metab. 2017 Dec 13;:

Authors: El Asmar N, Rajpal A, Selman WR, Arafah BM

Abstract
Background and Objectives: Despite the development of hypocortisolemia after corticotroph surgical adenomectomy, 15-20% patients have recurrence of Cushing's disease (CD). In this study, we investigated the impact of tumor size and the value of peri-operative assessment of ACTH and adrenal steroid levels in predicting recurrence.
Methods: Peri-operatively, no glucocorticoids were administered until the serum cortisol was ≤ 3 ug/dL. Blood samples were obtained before and repeatedly after adenomectomy in 79 patients with CD. Of these, 66 had a nadir serum cortisol of ≤ 3.0 ug/dl and had clinical and biochemical remissions. During a median follow-up of 131 months, 11/66 had disease recurrence (REC) while 55/66 did not (No-REC).
Results: Pre-operative hormone levels in the REC and NO-REC groups were similar. After adenomectomy a brief and similar increase in ACTH, cortisol and DHEA levels was observed in both groups followed by gradual decline in those levels. Although REC and NO-REC patients had similar cortisol levels (3.4±1.7 VS 2.9±2.2 ug/dL) at the 36th postoperative hour their respective ACTH (33±7.1 VS 12.1±5.4 ng/L; P<0.0001), DHEA (3.8±1.7 VS 1.2±1.1 ng/ml; P=0.005) and DHEA-S (143.9±45.2 VS 48.9±38.2 ug/dL; P<0.0001) were higher. At nadir hypocortisolemia, perioperative ACTH levels were > 20 in all REC patients and <20 ng/L in the No-REC group. Patients with REC had larger tumors than those with NO-REC.
Conclusion: Recurrent CD is characterized by persistent perioperative ACTH secretion after adenomectomy. Higher peri-operative levels of ACTH, DHEA and DHEAS are highly predictive of future disease recurrence particularly in those with profound hypocortisolemia.

PMID: 29244084 [PubMed - as supplied by publisher]

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