Intraoperative adrenocorticotropin levels during transsphenoidal surgery for Cushing's disease do not predict cure

The Journal of Clinical Endocrinology and Metabolism
K E GrahamD M Cook

Abstract

Recently, intraoperative rapid immunochemiluminometric assay (ICMA) ACTH measurements have been used to evaluate the completeness of resection of ectopic ACTH-secreting tumors. This study evaluates whether this method can be applied to patients undergoing transsphenoidal surgery (TSS) for Cushing's disease to predict complete pituitary tumor resection. Eighteen patients with Cushing's disease undergoing TSS had plasma ACTH concentrations measured by a standard ICMA every 10 min for 1 h immediately after pituitary tumor removal. Patients were evaluated postoperatively for cure by standard criteria. ACTH levels were evaluated for percentage decrease from baseline at each time point. Patients who were cured (n = 11) had statistically greater decreases in ACTH levels (mean decrease 54%) than patients who were not (n = 7; 26% mean decrease, P < 0.04). By Receiver-Operator Characteristic (ROC) analysis, a reduction of at least 40% best predicted which patients were cured and which were not cured. This level of reduction was observed in 82% of cured patients, and a reduction of less than 40% was observed in 71% of those not cured. The analysis misclassified 4 of the 18 patients, resulting in a diagnostic accuracy of 78%. Although the ...Continue Reading

References

Jan 1, 1985·Medical Decision Making : an International Journal of the Society for Medical Decision Making·R M Centor
Apr 25, 2008·Current Protocols in Immunology·J P Reeves, P A Reeves

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Citations

Mar 27, 2001·Journal of Endocrinological Investigation·F R Pimentel-FilhoB Liberman
Jan 16, 2008·World Journal of Surgery·John R PorterfieldClive S Grant
Jun 18, 2010·Reviews in Endocrine & Metabolic Disorders·Dima AbdelMannanBaha M Arafah
Mar 23, 2017·The Journal of Clinical Endocrinology and Metabolism·David AsuzuPrashant Chittiboina
Aug 26, 1998·The Journal of Clinical Endocrinology and Metabolism·H RaffJ W Findling

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