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Approach to the postoperative patient with Cushing’s disease

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Abstract

Introduction

Cushing’s disease is a neuroendocrine disorder marked by hypercortisolemia secondary to overproduction of ACTH by a corticotropic pituitary adenoma. Due to the diverse and deleterious effects of hypercortisolemia including diabetes mellitus, hypertension, and cardiovascular disease, prompt and accurate diagnosis followed by surgical resection of the responsible corticotropic adenoma is critical.

Methods

In the following review, we present a focused synopsis of recently published data and management strategies for the post-operative Cushing’s disease patient with a particular focus on studies examining perioperative complications, establishment of biochemical remission, factors associated with disease remission, and predictors of recurrence.

Conclusions

Although no standard definition of remission exists, we suggest measurement of serum cortisol level on the morning of postoperative day 1 given the preponderance of evidence in the published literature suggesting its association with long-term remission and relatively low rates of recurrence. Nevertheless, all patients should be counseled that recurrence can occur in a delayed fashion and that annual endocrine testing should be utilized to track and confirm disease status.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M-779, San Francisco, CA, 94143, USA

    Martin J. Rutkowski & Jonathan D. Breshears

  2. California Center for Pituitary Disorders, Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M-779, San Francisco, CA, 94143, USA

    Sandeep Kunwar, Manish K. Aghi & Lewis S. Blevins

  3. Center of Minimally Invasive Skull Base Surgery, University of California, San Francisco, 505 Parnassus Avenue, M-779, San Francisco, CA, 94143, USA

    Manish K. Aghi

Authors
  1. Martin J. Rutkowski
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  2. Jonathan D. Breshears
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Correspondence to Martin J. Rutkowski.

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Rutkowski, M.J., Breshears, J.D., Kunwar, S. et al. Approach to the postoperative patient with Cushing’s disease. Pituitary 18, 232–237 (2015). https://doi.org/10.1007/s11102-015-0644-7

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  • DOI: https://doi.org/10.1007/s11102-015-0644-7

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