PMC:4143611 / 1898-3943 JSONTXT

{"project":"2_test","denotations":[{"id":"24980037-22728347-63233394","span":{"begin":412,"end":413},"obj":"22728347"},{"id":"24980037-14557445-63233395","span":{"begin":600,"end":601},"obj":"14557445"},{"id":"24980037-18413427-63233396","span":{"begin":603,"end":604},"obj":"18413427"},{"id":"24980037-23450054-63233397","span":{"begin":764,"end":765},"obj":"23450054"},{"id":"24980037-20556520-63233398","span":{"begin":767,"end":768},"obj":"20556520"},{"id":"24980037-2303869-63233399","span":{"begin":888,"end":889},"obj":"2303869"},{"id":"24980037-22785183-63233400","span":{"begin":891,"end":892},"obj":"22785183"},{"id":"24980037-18413427-63233401","span":{"begin":952,"end":953},"obj":"18413427"}],"text":"Introduction\nCushing’s disease (CD), a rare illness characterized by chronic hypercortisolemia secondary to the overproduction of adrenocorticotropic hormone (ACTH) by a pituitary adenoma, is associated with high risk of developing serious complications such as diabetes mellitus, cardiovascular disease, and depression, and a mortality rate between 1.7- and 4.8-fold higher than that of the general population [1].\nThe primary treatment of choice for CD is adenomectomy by transsphenoidal surgery (TSS). Surgical success rates are variable, ranging from 65 to 90 %, and depend on surgeon expertise [2, 3]. Furthermore, criteria and testing parameters for assessing immediate remission vary from center to center, making the interpretation of results challenging [4, 5]. Additionally, post-surgical recurrence of CD is not uncommon, with reported recurrence rates ranging from 3 to 47 % [6, 7], and an observed mean time to recurrence of 16–49 months [3]. For patients in whom pituitary surgery fails or is contraindicated, radiotherapy or medical treatment are alternative options.\nGiven the complications associated with untreated CD, it is crucial that patients receive appropriate post-surgical follow-up so that recurrence is identified and treated as early as possible. However, despite this urgency there is little published information on systematic post-surgical patient monitoring and no standardized guidelines for follow-up evaluation have been established. Moreover, patients may ultimately seek care in a wide variety of primary care and specialist settings, particularly as remission time increases, thereby necessitating a wider understanding of CD sequelae and the importance of lifelong monitoring to detect any early signs of recurrence across multiple disciplines. The aims of this review are to provide a critical overview of reported short- and long-term outcomes following surgical treatment of CD, and to propose a practical algorithm for monitoring post-surgical patients in order to detect and treat recurrence swiftly."}