Approach to the postoperative patient with Cushing’s disease

Martin J. Rutkowski, Jonathan D. Breshears, Sandeep Kunwar, Manish K. Aghi, Lewis S. Blevins

Research output: Contribution to journalReview article

6 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)232-237
Number of pages6
JournalPituitary
Volume18
Issue number2
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

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Keywords

  • Adenoma
  • Cortisol
  • Cushing
  • Recurrence
  • Remission

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Rutkowski, M. J., Breshears, J. D., Kunwar, S., Aghi, M. K., & Blevins, L. S. (2015). Approach to the postoperative patient with Cushing’s disease. Pituitary, 18(2), 232-237. https://doi.org/10.1007/s11102-015-0644-7