{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:35:48Z","timestamp":1791387348767,"version":"4.3.3"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Cushing\u2019s disease (CD) is characterized by endogenous hypercortisolism\n                    that is associated with increased mortality and morbidity. Due to high\n                    recurrence rates in CD, the determination of high-risk patients is of paramount\n                    importance. In this study, we aimed to determine recurrence rates and clinical,\n                    laboratory, and histological predictors of recurrence in a high volume\n                    single-center. This retrospective study included 273 CD patients operated in a\n                    single pituitary center between 1997 and 2020. The patients with early\n                    postoperative remission were further grouped according to recurrence status\n                    (recurrent and sustained remission groups). Demographic, radiologic, laboratory,\n                    pathologic, and follow-up clinical data of the patients were analyzed and\n                    compared between groups. The recurrence rate was 9.6% in the first 5\n                    years; however, the overall recurrence rate was 14.2% in this study.\n                    Higher preoperative basal ACTH levels were significantly correlated with CD\n                    recurrence even with ACTH levels adjusted for tumor size, Ki-67 levels, and\n                    tumoral invasion. Recurrence rates were significantly higher in patients with\n                    ACTH levels higher than 55\u2009pg\/ml, tumor\n                    diameter&gt;9.5\u2009mm, and if adrenal axis recovery was before 6\n                    months. The severity of hypercortisolism, morbidities, and demographic factors\n                    except age were not predictive factors of recurrence. Based on our study data,\n                    younger age at diagnosis, a diagnosis of osteoporosis, higher preoperative ACTH\n                    levels, larger tumor size, invasive behavior, higher Ki 67 index, and early\n                    recovery of the adrenal axis during the postoperative period attracted attention\n                    as potential predictors of recurrent disease.<\/jats:p>","DOI":"10.1055\/a-2047-6017","type":"journal-article","created":{"date-parts":[[2023,4,4]],"date-time":"2023-04-04T22:59:56Z","timestamp":1680649196000},"page":"520-527","source":"Crossref","is-referenced-by-count":6,"title":["Recurrent Cushing\u2019s Disease in Adults: Predictors and\n                    Long-Term Follow-Up"],"prefix":"10.1055","volume":"55","author":[{"given":"Mustafa","family":"\u00dcnal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kocaeli University, Kocaeli,\n                    Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alev","family":"Selek","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Pituitary Center, Kocaeli\n                    University, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8428-1115","authenticated-orcid":false,"given":"Mehmet","family":"S\u00f6zen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Pituitary Center, Kocaeli\n                    University, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emre","family":"Gezer","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Pituitary Center, Kocaeli\n                    University, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damla","family":"K\u00f6ksalan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Pituitary Center, Kocaeli\n                    University, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep","family":"Canturk","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Pituitary Center, Kocaeli\n                    University, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berrin","family":"Cetinarslan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Pituitary Center, Kocaeli\n                    University, Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak","family":"\u00c7abuk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Pituitary Center, Kocaeli University,\n                    Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ihsan","family":"An\u0131k","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Pituitary Center, Kocaeli University,\n                    Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sava\u015f","family":"Ceylan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Pituitary Center, Kocaeli University,\n                    Kocaeli, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,4,4]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1016\/S0140-6736(06)68699-6","article-title":"Cushing's syndrome","volume":"367","author":"J 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Encyclopedia of endocrine diseases. In: Martini L, Lacroix A,\n                    Mantero F (eds). Ilpo Huhtaniemi, Vol 3, 2nd ed","author":"A Ferriere","year":"2019"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"R227","DOI":"10.1530\/EJE-14-0883","article-title":"Therapy of endocrine disease: outcomes in patients with Cushing's\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":"ref8","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1159\/000496846","article-title":"Recovery of adrenal function after pituitary surgery in patients with Cushing\n                    disease: persistent remission or recurrence?","volume":"108","author":"A L Serban","year":"2019","journal-title":"Neuroendocrinology"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1007\/s11102-014-0567-8","article-title":"Long-term remission and recurrence rate in a cohort of Cushing's\n                    disease: the need for long-term follow-up","volume":"18","author":"G Aranda","year":"2015","journal-title":"Pituitary"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1530\/EJE-12-0921","article-title":"Long-term remission and recurrence rates in Cushing's disease:\n                    predictive factors in a single-centre study","volume":"168","author":"K I Alexandraki","year":"2013","journal-title":"Eur J Endocrinol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1007\/s11102-022-01226-y","article-title":"Cushing's disease: risk of recurrence following trans-sphenoidal\n                    surgery, timing and methods for evaluation","volume":"25","author":"M Balomenaki","year":"2022","journal-title":"Pituitary"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1007\/s12020-020-02432-z","article-title":"Recurrence after pituitary surgery in adult Cushing's disease: a\n                    systematic review on diagnosis and treatment","volume":"70","author":"L T Braun","year":"2020","journal-title":"Endocrine"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"E1030","DOI":"10.1093\/neuros\/nyz193","article-title":"Outcomes after repeat transsphenoidal surgery for recurrent Cushing disease:\n                    updated","volume":"85","author":"W T Burke","year":"2019","journal-title":"Neurosurgery"},{"key":"ref14","first-page":"313","article-title":"Predictive factors for the recurrence of Cushing's disease after\n                    surgical treatment in childhood","volume":"71","author":"K Pasternak-Pietrzak","year":"2020","journal-title":"Endokrynol Pol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1227\/NEU.0b013e31822dda2c","article-title":"Transsphenoidal surgery for Cushing disease: experience with 136 patients","volume":"70","author":"I Ciric","year":"2012","journal-title":"Neurosurgery"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"635795","DOI":"10.3389\/fendo.2021.635795","article-title":"Machine learning in preoperative prediction of postoperative immediate remission\n                    of histology-positive Cushing's disease","volume":"12","author":"W Zhang","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"106","DOI":"10.4103\/jnrp.jnrp_308_17","article-title":"The utility of preoperative ACTH\/cortisol ratio for the diagnosis and\n                    prognosis of Cushing's disease","volume":"9","author":"A Selek","year":"2018","journal-title":"J Neurosci Rural Pract"},{"key":"ref18","first-page":"7","article-title":"Predicting factors of recurrence in patients with Cushing's Disease","volume":"6","author":"A Selek","year":"2017","journal-title":"Kocaeli Med J"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"101382","DOI":"10.1016\/j.beem.2020.101382","article-title":"Cushing's syndrome \u2013 Disease monitoring: recurrence,\n                    surveillance with biomarkers or imaging studies","volume":"34","author":"O Ragnarsson","year":"2020","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1007\/s40618-020-01225-5","article-title":"Results and predictors of outcome of endoscopic endonasal surgery in\n                    Cushing's disease: 20-year experience of an Italian referral Pituitary\n                    Center","volume":"43","author":"F Guaraldi","year":"2020","journal-title":"J Endocrinol Invest"},{"key":"ref21","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's disease","volume":"6","author":"A G Ambrogio","year":"2017","journal-title":"Endocr Connect"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1111\/cen.12133","article-title":"Predicting late recurrence in surgically treated patients with Cushing's\n                    disease","volume":"79","author":"M Barbot","year":"2013","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ghir.2019.01.001","article-title":"The effect of somatostatin analogues on Ki-67 levels in GH-secreting\n                    adenomas","volume":"45","author":"A Selek","year":"2019","journal-title":"Growth Horm IGF Res"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"e213","DOI":"10.1016\/j.wneu.2018.01.214","article-title":"Expression of matrix metalloproteinase-9, pituitary tumor transforming gene,\n                    high mobility group A 2, and Ki-67 in adrenocorticotropic hormone-secreting\n                    pituitary tumors and their association with tumor recurrence","volume":"113","author":"X Liu","year":"2018","journal-title":"World Neurosurg"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1111\/cen.13802","article-title":"The USP8 mutational status may predict long-term remission in patients with\n                    Cushing's disease","volume":"89","author":"A Albani","year":"2018","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref26","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's disease","volume":"6","author":"P Bansal","year":"2017","journal-title":"Endocr Connect"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2047-6017.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T23:02:22Z","timestamp":1690844542000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2047-6017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,4]]},"references-count":26,"journal-issue":{"issue":"08","published-online":{"date-parts":[[2023,7,31]]},"published-print":{"date-parts":[[2023,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2047-6017","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,4]]}}}