{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:41Z","timestamp":1787025761874,"version":"build-2736575974"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,11]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Successful transsphenoidal surgery for adrenocorticotropin hormone (ACTH)\u2013producing pituitary tumors is associated with subnormal postoperative serum cortisol levels, which may guide decisions regarding immediate reoperation. However, little is known about the detailed temporal course of changes in serum cortisol in the immediate postoperative period, and the relationship of postoperative cortisol dynamics to remission and late recurrence.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A single-center retrospective cohort analysis was performed for all patients undergoing pituitary surgery from 2007 through 2015. Standardized diagnostic and treatment algorithms were applied to all patients with potential Cushing\u2019s disease (CD), including microsurgical transsphenoidal adenomectomy (TSA) by a single surgeon. All patients had serum cortisol levels drawn at 6-hour intervals for 72 hours after surgery, and were offered reoperation within 3 days for normal or supranormal postoperative cortisol levels. Primary outcomes were 6-month remission and late recurrence; secondary outcomes were persistent postoperative hypocortisolism and surgical morbidity. Discriminatory levels of postoperative serum cortisol for predicting remission were calculated at various intervals after surgery using receiver operating characteristic (ROC) curves.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Among 89 patients diagnosed with CD, 81 underwent initial TSA for a potentially curable lesion; 23 patients (25.8%) underwent an immediate second TSA. For the entire cohort, 6-month remission was achieved in 77.8% and late recurrences occurred in 9.5%, at a mean of 43.5 months. Compared with patients with a single surgery, those with an immediate second TSA had similar rates of remission (78.3% vs 77.6%) and late recurrence (5.6% vs 11.1%). The rate of hypocortisolism for patients with 2 surgeries (12\/23, 52.2%) was significantly greater than that for patients with single surgeries (13\/58, 22.4%; p < 0.001). There was no difference in the incidence of CSF leaks between the first and second operations. Remission was achieved in 58 (92.1%) of 64 patients who completed the 2-surgery protocol. The temporal course of postoperative serum cortisol levels among patients varied considerably, with subnormal nadir levels < 2 \u03bcg\/dl occurring between 12 hours and 66 hours. Patients achieving remission had significantly lower mean serum cortisol levels at every time point after surgery (p < 0.01). By ROC curve analysis, nadir cortisol levels < 2.1 \u03bcg\/dl were predictive of 6-month remission for the entire cohort over 3 days (positive predictive value [PPV] = 94%); discriminating cortisol levels for predicting remission on postoperative day (POD) 2 were < 5.4 \u03bcg\/dl (PPV = 97%), although patients with remission after postoperative cortisol levels of 2\u20135 \u03bcg\/dl had a significantly higher rate of late recurrence.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n There is substantial variation in the temporal course of serum cortisol levels over the first 72 hours after TSA for CD, with nadir levels predictive for remission occurring as late as POD 3. Although a cortisol level of 2.1 \u03bcg\/dl at any point was an accurate predictor of 6-month remission, levels less than 5.4 \u03bcg\/dl on POD 2 were reasonably accurate. These data may enable decisions regarding the efficacy of an immediate second surgical procedure performed during the same hospitalization; immediate reoperation is associated with excellent remission rates and low recurrence rates in patients otherwise unlikely to achieve remission, but carries a higher risk of permanent hypocortisolism.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2017.6.jns17635","type":"journal-article","created":{"date-parts":[[2017,12,22]],"date-time":"2017-12-22T10:01:37Z","timestamp":1513936897000},"page":"1268-1277","source":"Crossref","is-referenced-by-count":37,"title":["Dynamics of postoperative serum cortisol after transsphenoidal surgery for Cushing\u2019s disease: implications for immediate reoperation and remission"],"prefix":"10.3171","volume":"129","author":[{"given":"Marc","family":"Mayberg","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Reintjes","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of South Florida, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anika","family":"Patel","sequence":"additional","affiliation":[{"name":"Swedish Pituitary Center, Swedish Neuroscience Institute;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelley","family":"Moloney","sequence":"additional","affiliation":[{"name":"Swedish Pituitary Center, Swedish Neuroscience Institute;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Mercado","sequence":"additional","affiliation":[{"name":"Swedish Pituitary Center, Swedish Neuroscience Institute;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Carlson","sequence":"additional","affiliation":[{"name":"Swedish Center for Research and Innovation; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Scanlan","sequence":"additional","affiliation":[{"name":"Swedish Center for Research and Innovation; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances","family":"Broyles","sequence":"additional","affiliation":[{"name":"Swedish Pituitary Center, Swedish Neuroscience Institute;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Endocrinol Nutr","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.endonu.2012.09.009","article-title":"[Predictors of long-term remission after transsphenoidal surgery in Cushing\u2019s disease.]","volume":"60","author":"Abell\u00e1n Galiana P","year":"2013","unstructured":"Abell\u00e1n Galiana P, Fajardo Monta\u00f1ana C, Riesgo Su\u00e1rez PA, G\u00f3mez Vela J, Escriv\u00e1 CM, Lillo VR: [Predictors of long-term remission after transsphenoidal surgery in Cushing\u2019s disease.] Endocrinol Nutr 60:475\u2013482, 2013 (Span)10.1016\/j.endonu.2012.09.009"},{"key":"b2","series-title":"Eur J Endocrinol","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1530\/EJE-12-0921","article-title":"Long-term remission and recurrence rates in Cushing\u2019s disease: predictive factors in a single-centre study","volume":"168","author":"Alexandraki KI","year":"2013","unstructured":"Alexandraki KI, Kaltsas GA, Isidori AM, Storr HL, Afshar F, Sabin I, : Long-term remission and recurrence rates in Cushing\u2019s disease: predictive factors in a single-centre study. 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