{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:25:59Z","timestamp":1791246359418,"version":"4.1.0"},"reference-count":48,"publisher":"Georg Thieme Verlag KG","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Exp Clin Endocrinol Diabetes"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective To identify early available predictors for the long-term outcome\n                    of patients after transsphenoidal surgery (TSS) in the management of\n                    Cushing\u2019s disease.<\/jats:p><jats:p>\n          Methods This single-center, retrospective study included 93 consecutive\n                    patients with Cushing\u2019s disease (follow-up 12\u2013129 months, mean\n                    48, median 38) who underwent TSS (21 had previous operations elsewhere). Six\n                    cases had early re-operation, and the resulting data were evaluated instead of\n                    the respective first operation. During the postoperative course, serum cortisol\n                    levels were assessed every four hours at least until the next morning. An\n                    association of parameters with long-term outcomes was tested using binary\n                    logistic regression. Receiver operating characteristic curves were used to\n                    determine sensitivity, specificity, positive predictive value, and negative\n                    predictive value of different cut-off values of serum cortisol in the\n                    postoperative course in the event of recurrence after remission.<\/jats:p><jats:p>\n          Results Eighty out of 93 patients (86%) showed postoperative\n                    remission (after primary treatment, 60 out of 72 patients, 90.3%). Of\n                    these, 8 patients (10%) developed recurrence of hypercortisolism.\n                    Compared to patients with persisting long-term remission, those with recurrence\n                    differed in cortisol levels starting from 4\u2009pm on the day of surgery\n                    plus an event of increasing cortisol during the early postoperative course\n                    (\u201cpeak\u201d). Binary logistic regression showed the association\n                    between a peak of serum cortisol in the early postoperative course with an\n                    increased probability of recurrence.<\/jats:p><jats:p>\n          Conclusions Patients with a peak of serum cortisol in the early\n                    postoperative course show an increased recurrence rate. A cut-off value of serum\n                    cortisol for clear identification of patients with later recurrence could not be\n                    determined.<\/jats:p>","DOI":"10.1055\/a-1909-1639","type":"journal-article","created":{"date-parts":[[2022,9,10]],"date-time":"2022-09-10T00:18:46Z","timestamp":1662769126000},"page":"704-713","source":"Crossref","is-referenced-by-count":3,"title":["Predictive Value of Early Postoperative Course of Serum Cortisol\n                    After Transsphenoidal Surgery for Cushing\u2019s Disease"],"prefix":"10.1055","volume":"130","author":[{"given":"Matthias","family":"Meier","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johannes Wesling Klinikum, University\n                    Hospital of the Ruhr-University Bochum, Minden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Alomari","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johannes Wesling Klinikum, University\n                    Hospital of the Ruhr-University Bochum, Minden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Feldkamp","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Endocrinology and Diabetes,\n                    Infectious Diseases, Klinikum Bielefeld, Universit\u00e4tsklinikum OWL,\n                    Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W Alexander","family":"Mann","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Endokrinologikum Frankfurt,\n                    Frankfurt\/Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinhard","family":"Santen","sequence":"additional","affiliation":[{"name":"Deutsches Endokrinologisches Versorgungszentrum,\n                    Frankfurt\/Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Ewald","sequence":"additional","affiliation":[{"name":"Institute of Endocrinology, Diabetology and Metabolism, Johannes\n                    Wesling Klinikum, Minden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich J","family":"Knappe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johannes Wesling Klinikum, University\n                    Hospital of the Ruhr-University Bochum, Minden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,9,9]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/S2213-8587(16)00086-3","article-title":"Complications of Cushing\u2019s syndrome: State of the art","volume":"4","author":"R Pivonello","year":"2016","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"404","DOI":"10.3171\/2016.1.JNS152119","article-title":"Cushing\u2019s disease: Pathobiology, diagnosis, and management","volume":"126","author":"R R Lonser","year":"2017","journal-title":"J Neurosurg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1210\/jc.2010-1942","article-title":"Mortality and morbidity in Cushing\u2019s disease over 50 years in\n                    Stoke-on-Trent, UK: Audit and meta-analysis of literature","volume":"96","author":"R N Clayton","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1111\/cen.12094","article-title":"Hypercoagulability in Cushing\u2019s syndrome: Prevalence, pathogenesis and\n                    treatment","volume":"78","author":"R van der Pas","year":"2013","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"2807","DOI":"10.1210\/jc.2015-1818","article-title":"Treatment of Cushing\u2019s syndrome: An Endocrine Society Clinical Practice\n                    Guideline","volume":"100","author":"L K Nieman","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.wneu.2019.10.077","article-title":"Cerebral venous sinus thrombosis after transsphenoidal resection: A rare\n                    complication of Cushing disease-associated hypercoagulability","volume":"134","author":"P Soni","year":"2020","journal-title":"World Neurosurg"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1210\/jc.2009-1672","article-title":"Delayed remission after transsphenoidal surgery in patients with\n                    Cushing\u2019s disease","volume":"95","author":"E Valassi","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1227\/01.NEU.0000374722.50042.FF","article-title":"Utility of the immediate postoperative cortisol concentrations in patients with\n                    Cushing\u2019s disease","volume":"67","author":"M E Sughrue","year":"2010","journal-title":"Neurosurgery"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.3390\/jcm8111951","article-title":"Cushing\u2019s disease","volume":"8","author":"H Nishioka","year":"2019","journal-title":"J Clin Med"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1023\/A:1012909500847","article-title":"Cushing`s disease: A surgical view","volume":"54","author":"D K L\u00fcdecke","year":"2001","journal-title":"J Neurooncol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1055\/s-0029-1241207","article-title":"Ultrasound-assisted microsurgery for Cushing`s disease","volume":"119","author":"U J Knappe","year":"2011","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s00701-007-1133-1","article-title":"Early post-operative ACTH and cortisol as predictors of remission in\n                    Cushing\u2019s disease","volume":"149","author":"J J Acebes","year":"2007","journal-title":"Acta Neurochir (Wien)"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1111\/j.1365-2265.2011.04268.x","article-title":"Contemporary microsurgical concept for the treatment of Cushing`s\n                    disease: Endocrine outcome in 83 consecutive patients","volume":"76","author":"J Honegger","year":"2012","journal-title":"Clin Endocrinol"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1530\/EC-17-0175","article-title":"Duration of post-operative hypocortisolism predicts sustained remission after\n                    pituitary surgery for Cushing\u2019s disease","volume":"6","author":"P Bansal","year":"2017","journal-title":"Endocr Connect"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1007\/s11102-017-0802-1","article-title":"Surgical outcomes in patients with Cushing\u2019s disease: The Cleveland\n                    clinic experience","volume":"20","author":"P C Johnston","year":"2017","journal-title":"Pituitary"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.1210\/jc.2011-0456","article-title":"The postoperative basal cortisol and CRH tests for prediction of long-term\n                    remission from Cushing\u2019s disease after transsphenoidal surgery","volume":"96","author":"J R Lindsay","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s12902-015-0055-9","article-title":"Low immediate postoperative serum-cortisol nadir predicts the short-term, but\n                    not long-term, remission after pituitary surgery for Cushing\u2019s\n                    disease","volume":"15","author":"J Ramm-Pettersen","year":"2015","journal-title":"BMC Endocr Disord"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1210\/jc.2016-3908","article-title":"Normalized early postoperative cortisol and ACTH values predict nonremission\n                    after surgery for Cushing disease","volume":"102","author":"D Asuzu","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"key":"ref19","first-page":"31","article-title":"Persistent and recurrent hypercortisolism after transsphenoidal surgery for\n                    Cushing`s disease","volume":"Suppl. 65","author":"U J Knappe","year":"1996","journal-title":"Acta Neurochir (Wien)"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1227\/01.NEU.0000313117.35824.9F","article-title":"Outcomes after repeat transsphenoidal surgery for recurrent Cushing\u2019s\n                    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experience","volume":"16","author":"N Hameed","year":"2013","journal-title":"Pituitary"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3171\/2014.3.JNS131532","article-title":"Morbidity of repeat transsphenoidal surgery assessed in more than 1000\n                    operations","volume":"121","author":"A Jahangiri","year":"2014","journal-title":"J Neurosurg"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1227\/NEU.0000000000001319","article-title":"Ectopic adrenocorticotropic hormone-secreting pituitary adenomas: An\n                    underestimated entity","volume":"80","author":"U J Knappe","year":"2017","journal-title":"Neurosurgery"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"E13","DOI":"10.3171\/2014.10.FOCUS14682","article-title":"Cushing\u2019s disease: Predicting long-term remission after surgical\n                    treatment","volume":"38","author":"A V Pendharkar","year":"2015","journal-title":"Neurosurg Focus"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1046\/j.0300-0664.2001.01444.x","article-title":"Undetectable postoperative cortisol does not always predict long-term remission\n                    in Cushing\u2019s disease: A single centre audit","volume":"56","author":"L B Yap","year":"2002","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/S0140-6736(14)61375-1","article-title":"Cushing\u2019s syndrome","volume":"386","author":"A Lacroix","year":"2015","journal-title":"Lancet"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1210\/jc.2012-3910","article-title":"Recurrences of ACTH-secreting adenomas after pituitary adenomectomy can be\n                    accurately predicted by perioperative measurements of plasma ACTH levels","volume":"98","author":"D Abdelmannan","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"531","DOI":"10.3171\/2008.8.JNS08339","article-title":"Outcome of using the histological pseudocapsule as a surgical capsule in Cushing\n                    disease","volume":"111","author":"J Jagannathan","year":"2009","journal-title":"J Neurosurg"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1530\/EC-17-0292","article-title":"Usefulness of desmopressin testing to predict relapse during long-term follow-up\n                    in patients in remission from Cushing\u2019s disease","volume":"6","author":"A G Ambrogio","year":"2017","journal-title":"Endocr Connect"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1210\/jc.2003-031170","article-title":"Dynamics of serum cortisol levels after transsphenoidal surgery in a cohort of\n                    patients with Cushing\u2019s disease","volume":"89","author":"GAF S Rollin","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3171\/JNS\/2008\/108\/01\/0009","article-title":"Long-term results after microsurgery for Cushing disease: Experience with 426\n                    primary operations over 35 years","volume":"108","author":"B M Hofmann","year":"2008","journal-title":"Journal of Neurosurgery"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s00701-018-3736-0","article-title":"Long-term outcome of trans-sphenoidal surgery for Cushing\u2019s disease in\n                    Indian patients","volume":"161","author":"S Saini","year":"2019","journal-title":"Acta Neurochirurgica"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1007\/s11102-018-0902-6","article-title":"An early post-operative ACTH suppression test can safely predict short- and\n                    long-term remission after surgery of Cushing\u2019s disease","volume":"21","author":"E Uvelius","year":"2018","journal-title":"Pituitary"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"R227","DOI":"10.1530\/EJE-14-0883","article-title":"Therapy of endocrine disease: Outcomes in patients with Cushing\u2019s\n                    disease undergoing transsphenoidal surgery: Systematic review assessing criteria\n                    used to define remission and recurrence","volume":"172","author":"S Petersenn","year":"2015","journal-title":"Eur J Endocrinol"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1210\/er.2013-1048","article-title":"The treatment of Cushing\u2019s disease","volume":"36","author":"R Pivonello","year":"2015","journal-title":"Endocr Rev"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"466","DOI":"10.4158\/EP15922.RA","article-title":"Predictors of biochemical remission and recurrence after surgical and radiation\n                    treatments of Cushing disease: A systematic review and meta-analysis","volume":"22","author":"AM A Abu Dabrh","year":"2016","journal-title":"Endocr Pract"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2014.11.FOCUS14704","article-title":"Pitfalls in the diagnosis and management of Cushing\u2019s syndrome","volume":"38","author":"V Bansal","year":"2015","journal-title":"Neurosurg Focus"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1507\/endocrj.15-0463","article-title":"Therapeutic outcomes in patients undergoing surgery after diagnosis of\n                    Cushing\u2019s disease: A single-center study","volume":"62","author":"S Yamada","year":"2015","journal-title":"Endocr J"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.3171\/2017.6.JNS17635","article-title":"Dynamics of postoperative serum cortisol after transsphenoidal surgery for\n                    Cushing\u2019s disease: Implications for immediate reoperation and\n                    remission","volume":"129","author":"M Mayberg","year":"2018","journal-title":"J Neurosurg"},{"key":"ref42","doi-asserted-by":"crossref","first-page":"101270","DOI":"10.1016\/j.beem.2019.04.004","article-title":"Therapeutic options after surgical failure in Cushing\u2019s disease: A\n                    critical review","volume":"33","author":"G Rubinstein","year":"2019","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"ref43","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1007\/s11102-020-01066-8","article-title":"Outcomes of pituitary surgery for Cushing\u2019s disease: A systematic review\n                    and meta-analysis","volume":"23","author":"A Stroud","year":"2020","journal-title":"Pituitary"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.ecl.2018.02.002","article-title":"Prognostic factors of long-term remission after surgical treatment of\n                    Cushing\u2019s disease","volume":"47","author":"A G Ioachimescu","year":"2018","journal-title":"Endocrinol Metab Clin North Am"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1530\/EJE-17-0873","article-title":"Earlier post-operative hypocortisolemia may predict durable remission from\n                    Cushing\u2019s disease","volume":"178","author":"N Ironside","year":"2018","journal-title":"Eur J Endocrinol"},{"key":"ref46","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1530\/EJE-12-0921","article-title":"Long-term remission and recurrence rates in Cushing\u2019s disease:\n                    Predictive factors in a single-centre study","volume":"168","author":"K I Alexandraki","year":"2013","journal-title":"Eur J Endocrinol"},{"key":"ref47","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1055\/s-2003-37145","article-title":"The use of postoperative ACTH levels as a marker for successful transsphenoidal\n                    microsurgery in Cushing\u2019s disease","volume":"64","author":"J Flitsch","year":"2003","journal-title":"Zentralbl Neurochir"},{"key":"ref48","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1210\/jc.2017-01797","article-title":"The value of perioperative levels of ACTH, DHEA, and DHEA-S and tumor size in\n                    predicting recurrence of Cushing disease","volume":"103","author":"N El Asmar","year":"2018","journal-title":"J Clin Endocrinol Metab"}],"container-title":["Experimental and Clinical Endocrinology &amp; Diabetes"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1909-1639.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,22]],"date-time":"2022-11-22T00:36:24Z","timestamp":1669077384000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1909-1639"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,9]]},"references-count":48,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,21]]},"published-print":{"date-parts":[[2022,11]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1909-1639","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0947-7349","1439-3646"],"issn-type":[{"value":"0947-7349","type":"print"},{"value":"1439-3646","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,9]]}}}