PMC:4143611 / 18478-19923 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/4143611","sourcedb":"PMC","sourceid":"4143611","source_url":"https://www.ncbi.nlm.nih.gov/pmc/4143611","text":"Potentially persistent cases\nPatients with post-operative serum cortisol levels between 2 and 5 µg/dL require much closer monitoring. These individuals are at increased risk for subclinical CD that is challenging to diagnose. We recommend that the first test be performed at 3 weeks following surgery to evaluate changes in cortisol levels (i.e., identify cases of delayed remission). If serum cortisol level declines to \u003c2 µg/dL, the patient can be considered in remission. If serum cortisol remains elevated or if there is a mild increase in UFC values, the patient could potentially be afflicted with subclinical CD.\nCareful consideration of any accompanying clinical symptoms will determine the course of action. If symptoms worsen over time, the first surgery was probably not curative and a second surgery, pituitary irradiation (radiotherapy or radiosurgery, depending on availability and the center’s practice), or medical therapy may be considered, as appropriate. If a mild elevation in serum cortisol or UFC is accompanied by either no changes or by slight improvements in clinical symptoms, the patient should be further monitored every 2–3 months. If serum cortisol levels then decrease to \u003c2 µg/dL, the patient can be considered to be in remission. If not, treatment options, such as a second surgery, pituitary irradiation, or medical therapy may be considered if appropriate, especially if other symptoms of CD begin to reappear.","divisions":[{"label":"title","span":{"begin":0,"end":28}},{"label":"p","span":{"begin":29,"end":619}}],"tracks":[]}