{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:24:58Z","timestamp":1788783898584,"version":"build-2803163510"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,4]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Subnormal postoperative serum cortisol levels indicate successful surgery and predict long-term remission of Cushing disease. Given the short serum half-lives of adrenocorticotropic hormone (ACTH) and cortisol, it is unclear why the decline in cortisol postoperatively is delayed for 18\u201336 hours. Furthermore, the relevance of the rate of cortisol drop immediately after surgery has not been investigated.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Patient data were analyzed from a prospectively accrued database. After surgery, cortisol replacement was withheld and serum cortisol measurements were obtained every 6 hours until values of 1.0\u20132.0 \u03bcg\/dl or less were reached. The authors selected patients in whom serum cortisol dropped to 2 \u03bcg\/dl or less after surgery (101 patients). Tumor resection was categorized as follows: 1) complete resection using the histological pseudocapsule as a surgical capsule, 2) complete piecemeal resection), 3) known incomplete resection, and 4) total hypophysectomy.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The median time to reach a cortisol level of less than or equal to 2.0 \u03bcg\/dl was 9.9, 19.4, 25.3, and 29.5 hours with hypophysectomy, pseudocapsule, incomplete resection, and piecemeal techniques, respectively. Pseudocapsule resection produced a faster decline in cortisol than piecemeal techniques (p = 0.0001), but not as rapid a decline as hypophysectomy (p = 0.033).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Complete resection by other techniques is associated with delayed cortisol decline compared with pseudocapsule surgery, which may represent the product of residual tumor cells and therefore may explain the higher rate of recurrent disease associated with piecemeal techniques. The prompt drop in cortisol after hypophysectomy compared with patients with pseudocapsule surgery suggests that the corticotrophs of the normal gland can secrete ACTH for 10\u201336 hours after surgery despite prolonged and severe hypercortisolism.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.12.jns11886","type":"journal-article","created":{"date-parts":[[2012,1,27]],"date-time":"2012-01-27T20:49:11Z","timestamp":1327697351000},"page":"721-727","source":"Crossref","is-referenced-by-count":48,"title":["Use of the histological pseudocapsule in surgery for Cushing disease: rapid postoperative cortisol decline predicting complete tumor resection"],"prefix":"10.3171","volume":"116","author":[{"given":"Stephen J.","family":"Monteith","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Starke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Jane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward H.","family":"Oldfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns11886","series-title":"Acta Neurochir (Wien)","first-page":"471","article-title":"Early post-operative ACTH and cortisol as predictors of remission in Cushing's disease","volume":"149","author":"Acebes","year":"2007"},{"key":"b2-jns11886","series-title":"Clin Endocrinol (Oxf)","first-page":"549","article-title":"Long-term remission rates after pituitary surgery for Cushing's disease: the need for long-term surveillance","volume":"63","author":"Atkinson","year":"2005"},{"key":"b3-jns11886","series-title":"J Clin Endocrinol Metab","first-page":"2757","article-title":"Postoperative testing to predict recurrent Cushing disease in children","volume":"94","author":"Batista","year":"2009"},{"key":"b4-jns11886","series-title":"J Clin Endocrinol Metab","first-page":"2454","article-title":"Treatment of adrenocorticotropin-dependent Cushing's syndrome: a consensus statement","volume":"93","author":"Biller","year":"2008"},{"key":"b5-jns11886","series-title":"N Engl J Med","first-page":"622","article-title":"The corticotropin-releasing factor stimulation test. An aid in the evaluation of patients with Cushing's syndrome","volume":"310","author":"Chrousos","year":"1984"},{"key":"b6-jns11886","series-title":"Acta Neurochir (Wien)","first-page":"971","article-title":"Intra- and postoperative plasma ACTH concentrations in patients with Cushing's disease cured by transsphenoidal pituitary surgery","volume":"144","author":"Czirj\u00e1k","year":"2002"},{"key":"b7-jns11886","series-title":"J Neurosurg","first-page":"1343","article-title":"Basis of persistent and recurrent Cushing disease: an analysis of findings at repeated pituitary surgery","volume":"97","author":"Dickerman","year":"2002"},{"key":"b8-jns11886","series-title":"J Clin Endocrinol Metab","first-page":"7","article-title":"Clinical review: Early morning cortisol levels as a predictor of remission after transsphenoidal surgery for Cushing's disease","volume":"91","author":"Esposito","year":"2006"},{"key":"b9-jns11886","series-title":"J Clin Endocrinol Metab","first-page":"419","article-title":"Pituitary-adrenal dynamics during surgical stress","volume":"23","author":"Estep","year":"1963"},{"key":"b10-jns11886","series-title":"J Clin Endocrinol Metab","first-page":"770","article-title":"In vitro corticotropin-releasing hormone (CRH) stimulation of adrenocorticotropin release from corticotroph adenoma cells: effect of prolonged exposure to CRH and its interaction with cortisol","volume":"66","author":"Grino","year":"1988"},{"key":"b11-jns11886","series-title":"Endocrinology","first-page":"1527","article-title":"Differential regulation of brain and pituitary corticotropin-releasing factor receptors by corticosterone","volume":"120","author":"Hauger","year":"1987"},{"key":"b12-jns11886","series-title":"J Clin Endocrinol Metab","first-page":"1276","article-title":"Intensive venous sampling paradigms disclose high frequency adrenocorticotropin release episodes in normal men","volume":"71","author":"Iranmanesh","year":"1990"},{"key":"b13-jns11886","series-title":"J Neurosurg","first-page":"531","article-title":"Outcome of using the histological pseudocapsule as a surgical capsule in Cushing disease. Clinical article","volume":"111","author":"Jagannathan","year":"2009"},{"key":"b14-jns11886","series-title":"Neurosurgery","first-page":"201","article-title":"Intraoperative measurement of adrenocorticotropic hormone in peripituitary blood in Cushing's disease","volume":"24","author":"L\u00fcdecke","year":"1989"},{"key":"b15-jns11886","series-title":"J Neurosurg","first-page":"7","article-title":"Development of a histological pseudocapsule and its use as a surgical capsule in the excision of pituitary tumors","volume":"104","author":"Oldfield","year":"2006"},{"key":"b16-jns11886","series-title":"J Clin Endocrinol Metab","first-page":"358","article-title":"Late recurrences of Cushing's disease after initial successful transsphenoidal surgery","volume":"93","author":"Patil","year":"2008"},{"key":"b17-jns11886","series-title":"J Endocrinol Invest","first-page":"83","article-title":"Adrenocorticotropin levels do not change during early recovery of transsphenoidal surgery for ACTH-secreting pituitary tumors","volume":"24","author":"Pimentel-Filho","year":"2001"},{"key":"b18-jns11886","series-title":"J Endocrinol Invest","first-page":"502","article-title":"Pituitary-adrenal dynamics after ACTH-secreting pituitary tumor resection in patients receiving no steroids post-operatively","volume":"28","author":"Pimentel-Filho","year":"2005"},{"key":"b19-jns11886","series-title":"J Clin Endocrinol Metab","first-page":"1131","article-title":"Dynamics of serum cortisol levels after transsphenoidal surgery in a cohort of patients with Cushing's disease","volume":"89","author":"Rollin","year":"2004"},{"key":"b20-jns11886","series-title":"J Neurosurg","first-page":"1","article-title":"Serum cortisol response to transsphenoidal surgery for Cushing disease","volume":"95","author":"Simmons","year":"2001"},{"key":"b21-jns11886","series-title":"Neuroendocrinology","first-page":"611","article-title":"Desensitization of the hypothalamicpituitary-adrenal axis following prolonged administration of corticotropin-releasing hormone or vasopressin","volume":"56","author":"Tizabi","year":"1992"},{"key":"b22-jns11886","series-title":"J Clin Endocrinol Metab","first-page":"1616","article-title":"Twenty-four-hour rhythms in plasma concentrations of adenohypophyseal hormones are generated by distinct amplitude and\/or frequency modulation of underlying pituitary secretory bursts","volume":"71","author":"Veldhuis","year":"1990"},{"key":"b23-jns11886","series-title":"Clin Endocrinol (Oxf)","first-page":"25","article-title":"Undetectable postoperative cortisol does not always predict long-term remission in Cushing's disease: a single centre audit","volume":"56","author":"Yap","year":"2002"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/4\/article-p721.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/4\/article-p721.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/4\/article-p721.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T01:18:07Z","timestamp":1679879887000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/4\/article-p721.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2012,4]]},"references-count":23,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2011.12.jns11886","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,4]]}}}