PMC:4143611 / 13489-15137
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/4143611","sourcedb":"PMC","sourceid":"4143611","source_url":"https://www.ncbi.nlm.nih.gov/pmc/4143611","text":"As demonstrated, there is a lack of standardized post-surgical monitoring of patients with CD. To address this gap in clinical practice, we propose an evidence- and empirically-based algorithm to facilitate early detection and treatment of recurrence (Fig. 1). As determined by post-surgical early morning (8–10 a.m.) serum cortisol levels measured 2–3 days post-surgery, patients may be categorized as being in immediate remission (cortisol \u003c2 µg/dL) [40, 41], potentially persistent (cortisol 2–5 µg/dL), or persistent (i.e., surgical failures; cortisol \u003e5 µg/dL). Different courses of action are suggested for each of the three outcomes. As there is a scarcity of timing guidelines in the literature, proposed timing of evaluations is based on our own experiences.\nFig. 1 Proposed algorithm for the post-operative monitoring of patients with CD. Evaluation strategies are determined by a patient’s immediate post-surgical status as determined by early morning serum cortisol levels. Asterisk repeat surgery practice varies by center. Longer follow-up could be considered in patients with subnormal levels of post-operative cortisol as they may either experience delayed remission and/or may not necessarily experience recurrence. Re-intervention can be considered if cortisol levels begin to rise or if symptoms of the disease return. Dagger UFC upper limit of normal (ULN) as determined by specific assay used. Double dagger medical therapy: pasireotide (somatostatin analog), cabergoline (dopamine receptor agonists), mifepristone (glucocorticoid receptor antagonist), steroidogenesis inhibitors (ketoconazole, mitotane, etomidate, metyrapone)","divisions":[{"label":"label","span":{"begin":768,"end":774}}],"tracks":[{"project":"2_test","denotations":[{"id":"24980037-20651632-63233438","span":{"begin":453,"end":455},"obj":"20651632"},{"id":"24980037-23401686-63233439","span":{"begin":457,"end":459},"obj":"23401686"}],"attributes":[{"subj":"24980037-20651632-63233438","pred":"source","obj":"2_test"},{"subj":"24980037-23401686-63233439","pred":"source","obj":"2_test"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"2_test","color":"#e693ec","default":true}]}]}}