Endocrine · 2025
The prevalence and predictors of Cushing disease recurrence: a 10-year experience of a pituitary tumor center of excellence.
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Lamback Elisa, Kasuki Leandro, Miranda Renan Lyra, de Figueiredo Camila Saggioro, Wildemberg Luiz Eduardo, Gadelha Mônica R
Аннотация
PURPOSE: Identifying predictors of recurrence in Cushing disease (CD) guides monitoring strategies. We aimed at analyzing the frequency and predictive factors of recurrence in CD.
METHODS: Patients with CD operated between August/2013-December/2023 were included. Retrospective data on biochemical, radiological, histopathological and genetic data were collected. Remission was defined as post-operative cortisol concentrations below 2 mcg/dL within the first week of surgery or normalized cortisol values post-operatively. Recurrence was defined as new onset of hypercortisolism confirmed biochemically.
RESULTS: Surgical remission was achieved in 81% of patients, but recurrence occurred in 27.4% of cases after a median follow up period of 38 months (range 16-101). Lower cortisol concentrations on the first and second post-operative days, and longer duration of glucocorticoid replacement (2.5 months vs 8-10 months, p = 0.045) were identified as protective factors for recurrence. Nadir cortisol concentrations ≤3 mcg/dL during the first post-operative week predicted long-term remission with 74% sensitivity, 85% specificity, 94% positive predictive value, and 50% negative predictive value (area under the curve 0.808, p = 0.001). Recurrence rates were lower in patients with microadenomas/no visible lesion compared to those with macroadenomas (19% vs 45%; p = 0.03). Age, gender, tumor diameter, USP8 and USP48 mutational status, cortisol on the 7th post-operative day and, ACTH immuno-positivity in histology were not associated with recurrence.
CONCLUSION: Recurrence in CD was seen in 27.4% of cases. Immediate post-operative cortisol concentrations and the duration of glucocorticoid use were predictors of recurrence. Recurrence was more frequent in patients with macroadenomas compared to those with microadenomas/no visible adenomas.
METHODS: Patients with CD operated between August/2013-December/2023 were included. Retrospective data on biochemical, radiological, histopathological and genetic data were collected. Remission was defined as post-operative cortisol concentrations below 2 mcg/dL within the first week of surgery or normalized cortisol values post-operatively. Recurrence was defined as new onset of hypercortisolism confirmed biochemically.
RESULTS: Surgical remission was achieved in 81% of patients, but recurrence occurred in 27.4% of cases after a median follow up period of 38 months (range 16-101). Lower cortisol concentrations on the first and second post-operative days, and longer duration of glucocorticoid replacement (2.5 months vs 8-10 months, p = 0.045) were identified as protective factors for recurrence. Nadir cortisol concentrations ≤3 mcg/dL during the first post-operative week predicted long-term remission with 74% sensitivity, 85% specificity, 94% positive predictive value, and 50% negative predictive value (area under the curve 0.808, p = 0.001). Recurrence rates were lower in patients with microadenomas/no visible lesion compared to those with macroadenomas (19% vs 45%; p = 0.03). Age, gender, tumor diameter, USP8 and USP48 mutational status, cortisol on the 7th post-operative day and, ACTH immuno-positivity in histology were not associated with recurrence.
CONCLUSION: Recurrence in CD was seen in 27.4% of cases. Immediate post-operative cortisol concentrations and the duration of glucocorticoid use were predictors of recurrence. Recurrence was more frequent in patients with macroadenomas compared to those with microadenomas/no visible adenomas.