{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T23:52:13Z","timestamp":1781653933321,"version":"3.54.5"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurooncol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Cushing\u2019s disease (CD), caused by ACTH-secreting pituitary adenomas, results in hypercortisolism. Transsphenoidal surgery (TSS) is the first-line treatment. Early postoperative cortisol trends are frequently monitored, though standard interpretation is lacking. We sought to determine whether early postoperative cortisol trajectories are associated with biochemical remission at 1 year using unsupervised machine learning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 94 adult patients with CD who underwent TSS between 2011 and 2021 at two academic centers. Serum cortisol was measured every 6\u00a0h, and the resulting time series was clustered with the goal of predicting the primary outcome of biochemical remission at 1-year follow up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 94 patients, 77 (82%) achieved biochemical remission. There were no significant differences in demographic or tumor characteristics between remission and non-remission groups. The nadir cortisol value for the remission group was lower than the non-remission group (4.8 [5.5] versus 19.3 [13.7]) though this difference was also not statistically significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.1022). Clustering analysis identified three optimal clusters for remission subgroup. Statistically significant differences in cortisol trends were observed from 6\u00a0h to 30\u00a0h (p\u2009&lt;\u2009=\u20090.0002). At 6\u00a0h, average cortisol values by cluster ranged from 25.51 to 61.17 mcg\/dL. Two of the three clusters demonstrated an initial decrease in cortisol values, while one cluster did not immediately decrease. No significant differences in clinical, tumor, or treatment variables were observed between clusters.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Postoperative cortisol trajectories show distinct early patterns but are not independently predictive of 1-year biochemical remission following TSS for CD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-026-05532-4","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T02:20:16Z","timestamp":1777515616000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unsupervised clustering analysis reveals distinct postoperative cortisol trajectories following pituitary adenoma resection in Cushing\u2019s disease"],"prefix":"10.1007","volume":"177","author":[{"given":"Rushmin","family":"Khazanchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachin","family":"Govind","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishi","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Vignolles-Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas","family":"Munjal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Chaliparambil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Damante","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P.","family":"Chandler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luma","family":"Ghalib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyu","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen T.","family":"Magill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Prevedello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"5532_CR1","doi-asserted-by":"crossref","unstructured":"Tritos NA, Biller BMK (2014) Cushing\u2019s disease. 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No identifying information is present in this manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate and publish"}},{"value":"N\/A.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Grant support"}},{"value":"This study was approved by the Northwestern University Institutional Review Board and the Ohio State University Institutional Review Board.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"IRB approval"}},{"value":"A preliminary version of this paper was presented in a poster session at the Congress of Neurological Surgeons 2024 Annual Meeting and the North American Skull Base Society 2025 Annual Meeting.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Presentation"}},{"value":"The authors declare no competing interests.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"132"}}