Immediate remission cases
Immediate remission is, by definition, a condition of acute post-operative hypocortisolism. Accordingly, patients whose post-operative serum levels are <2 µg/dL will require glucocorticoid therapy. These patients should be monitored regularly to evaluate recovery of adrenal function and exogenous glucocorticoid dose should be tapered appropriately.
We propose that early morning serum cortisol levels of patients in immediate remission be monitored at semiannual intervals for 3 years. This recommendation is based on the finding that the highest rates of recurrence are observed within approximately 5 years following TSS [27]. If no elevation is observed within 3 years, monitoring frequency can be tapered to an annual basis. However, patients should be strongly encouraged to return for testing sooner if symptoms of CD begin to reappear at any point.