Cushing’s disease is characterized by chronic hypercortisolism due to a hyperactive adrenocorticotropic hormone-secreting pituitary adenoma. Patients with the disease often develop debilitating sequelae of cardiovascular disease, glucose intolerance and cognitive impairment, underscoring the urgent need for early diagnosis and treatment. Transsphenoidal surgical resection (TSS) is the first line of treatment, but surgical success rates vary widely, and the disease may recur years after remission.
“Recognizing Cushing’s disease recurrence after surgery can be challenging,” Ayala said. “Although there is general acceptance among endocrinologists that surgically treated patients need lifelong follow-up, there are currently no standardized guidelines for long-term monitoring following TSS.”
The authors suggest that high post-operative cortisol levels often signify persistent disease and the need for a second line of treatment, such as immediate repeat pituitary surgery, radiotherapy or medical therapy. They recommend that patients’ serum cortisol levels be measured two to three days after surgery, monitored semiannually for three years and annually thereafter.
“This algorithm may prove helpful to general endocrinologists and primary care practitioners who do not often deal with this rare disease,” Ayala said. “The next step is to seek wider validation by applying it prospectively to our patients while incorporating new diagnostic tools such as salivary cortisol measurements.”
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