{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:11:07Z","timestamp":1761894667656},"reference-count":84,"publisher":"FapUNIFESP (SciELO)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Bras Endocrinol Metab"],"published-print":{"date-parts":[[2007,11]]},"abstract":"<jats:p>We review the clinical and biochemical criteria used for evaluation of the transsphenoidal pituitary surgery results in the treatment of Cushing's disease (CD). Firstly, we discuss the pathophysiology of the hypothalamic-pituitary-adrenal axis in normal subjects and patients with CD. Considering the series published in the last 25 years, we observed a significant variation in the remission or cure criteria, including the choice of biochemical tests, timing, threshold values to define remission, and the interference of glucocorticoid replacement or previous treatment. In this context we emphasize serum cortisol levels obtained early (from hours to 12 days) in the postoperative period without any glucocorticoid replacement or treatment. Our experience demonstrates that: (i) early cortisol &lt; 5 to 7 \u00b5g\/dl, (ii) a period of glucocorticoid dependence &gt; 6 mo, (iii) absence of response of cortisol\/ACTH to CRH or DDAVP, (iv) return of dexamethasone suppression, and circadian rhythm of cortisol are appropriate indices of remission of CD. In patients with undetectable cortisol levels early after surgery, recurrence seems to be low. Finally, although certain biochemical patterns are more suggestive of remission or surgical failure, none has been proven to be completely accurate, with recurrence observed in approximately 10 to 15% of the patients in long-term follow-up. We recommended that patients with CD should have long-term monitoring of the CRH-ACTH-cortisol axis and associated co-morbidities, especially hypopituitarism, diabetes mellitus, hypertension, cardiovascular disturbances, and osteoporosis.<\/jats:p>","DOI":"10.1590\/s0004-27302007000800023","type":"journal-article","created":{"date-parts":[[2008,1,18]],"date-time":"2008-01-18T08:17:09Z","timestamp":1200644229000},"page":"1362-1372","source":"Crossref","is-referenced-by-count":27,"title":["Criteria of cure and remission in Cushing's disease: an update"],"prefix":"10.1590","volume":"51","author":[{"given":"Mauro A.","family":"Czepielewski","sequence":"first","affiliation":[{"name":"UFRGS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guilherme A.F.S.","family":"Rollin","sequence":"additional","affiliation":[{"name":"UFRGS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Casagrande","sequence":"additional","affiliation":[{"name":"UFRGS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nelson P.","family":"Ferreira","sequence":"additional","affiliation":[{"name":"UFRGS"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","reference":[{"key":"ref1","series-title":"Endocrinologia Cl\u00ednica","first-page":"418","volume-title":"Tratamento da S\u00edndrome de Cushing","author":"Czepielewski MA","year":"2006"},{"key":"ref2","series-title":"Rotinas Diagn\u00f3sticas em Endocrinologia","first-page":"153","volume-title":"S\u00edndrome de Cushing","author":"Rollin GAFS","year":"2004"},{"key":"ref3","series-title":"Endocrinologia Cl\u00ednica","first-page":"397","volume-title":"Diagn\u00f3stico e diagn\u00f3stico diferencial da S\u00edndrome de Cushing","author":"Vilar L","year":"2006"},{"issue":"4","key":"ref4","first-page":"566","article-title":"Endogenous Cushing's syndrome: Clinical and laboratorial features in 73 cases","volume":"51","author":"Vilar L","year":"2007","journal-title":"Arq Bras Endocrinol Metab"},{"issue":"12","key":"ref5","doi-asserted-by":"crossref","first-page":"5593","DOI":"10.1210\/jc.2003-030871","article-title":"Diagnosis and complications of Cushing's syndrome: A consensus statement","volume":"88","author":"Arnaldi G","year":"2003","journal-title":"J Clin Endocrinol Metab","ISSN":"http:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref6","series-title":"The Pituitary","first-page":"592","volume-title":"Cushing's disease","author":"Bertagna X","year":"2002","edition":"2"},{"key":"ref7","first-page":"647","article-title":"The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states","volume":"19","author":"Newell-Price J","year":"1998","journal-title":"Endocr Rev","ISSN":"http:\/\/id.crossref.org\/issn\/0163-769X","issn-type":"print"},{"issue":"12","key":"ref8","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1016\/j.amjmed.2005.01.059","article-title":"Evaluation and treatment of Cushing's syndrome","volume":"118","author":"Nieman LK","year":"2005","journal-title":"Am J Med","ISSN":"http:\/\/id.crossref.org\/issn\/0002-9343","issn-type":"print"},{"issue":"10","key":"ref9","doi-asserted-by":"crossref","first-page":"3746","DOI":"10.1210\/jc.2006-0997","article-title":"Cushing's syndrome: Important issues in diagnosis and management","volume":"91","author":"Findling JW","year":"2006","journal-title":"J Clin Endocrinol Metab","ISSN":"http:\/\/id.crossref.org\/issn\/0021-972X","issn-type":"print"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.ecl.2005.01.007","article-title":"Pituitary surgery and postoperative management in Cushing's disease","volume":"34","author":"Utz AL","year":"2005","journal-title":"Endocrinol Metab Clin North Am","ISSN":"http:\/\/id.crossref.org\/issn\/0889-8529","issn-type":"print"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1210\/jcem-54-2-413","article-title":"Cushing's disease: Transient secondary adrenal insufficiency after selective removal of pituitary microadenomas; 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