PMC:4143611 / 4438-6106 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":"Biochemical indication of remission\nEarly morning serum cortisol measured between 8 and 10 a.m. is the most commonly utilized measure of immediate remission following surgery. Cortisol secretion normally follows a diurnal pattern with highest levels between 7–9 a.m. that decline to lowest levels around 10–11 p.m. [9]. In patients with CD, the circadian rhythm is aberrant and cortisol levels remain consistently elevated [9, 10]. The goals of pituitary surgery are to extract the ACTH-secreting adenoma and subsequently reduce cortisol levels, leading to improvements in the signs and symptoms of CD.\nSurgical success is confirmed by subnormal levels of early morning serum cortisol measured within a few days of surgery. Typically, early morning serum cortisol levels of either \u003c2 µg/dL (~50 nmol/L) or \u003c5 µg/dL within a few days after surgery are considered to be indicative of remission [3]. However, reported results are mixed and difficult to interpret since some studies measure basal serum cortisol levels while others use serum cortisol following dexamethasone suppression, or some combination of these measures [5, 11–13]. While clinical practice guidelines provide recommendations for testing in the context of initial diagnosis of CD [10], there is no expert consensus with regard to post-operative testing for surgical success.\nThe timing of biochemical measurements differs among treatment centers and can vary considerably within the same center. Intervals between surgery and biochemical measurement range from 1 to 2 days [14, 15], up to several weeks [16, 17], and even months [14]. As a result, the definition of post-surgical remission is unclear.","divisions":[{"label":"title","span":{"begin":0,"end":35}},{"label":"p","span":{"begin":36,"end":602}},{"label":"p","span":{"begin":603,"end":1341}}],"tracks":[{"project":"2_test","denotations":[{"id":"24980037-9793762-63233405","span":{"begin":316,"end":317},"obj":"9793762"},{"id":"24980037-9793762-63233406","span":{"begin":424,"end":425},"obj":"9793762"},{"id":"24980037-18334580-63233407","span":{"begin":427,"end":429},"obj":"18334580"},{"id":"24980037-18413427-63233408","span":{"begin":893,"end":894},"obj":"18413427"},{"id":"24980037-20556520-63233409","span":{"begin":1123,"end":1124},"obj":"20556520"},{"id":"24980037-15579802-63233410","span":{"begin":1126,"end":1128},"obj":"15579802"},{"id":"24980037-16474220-63233410","span":{"begin":1126,"end":1128},"obj":"16474220"},{"id":"24980037-22120352-63233410","span":{"begin":1126,"end":1128},"obj":"22120352"},{"id":"24980037-18334580-63233411","span":{"begin":1248,"end":1250},"obj":"18334580"},{"id":"24980037-23393167-63233412","span":{"begin":1541,"end":1543},"obj":"23393167"},{"id":"24980037-23242860-63233413","span":{"begin":1545,"end":1547},"obj":"23242860"},{"id":"24980037-11380492-63233414","span":{"begin":1571,"end":1573},"obj":"11380492"},{"id":"24980037-22278423-63233415","span":{"begin":1575,"end":1577},"obj":"22278423"},{"id":"24980037-23393167-63233416","span":{"begin":1597,"end":1599},"obj":"23393167"}],"attributes":[{"subj":"24980037-9793762-63233405","pred":"source","obj":"2_test"},{"subj":"24980037-9793762-63233406","pred":"source","obj":"2_test"},{"subj":"24980037-18334580-63233407","pred":"source","obj":"2_test"},{"subj":"24980037-18413427-63233408","pred":"source","obj":"2_test"},{"subj":"24980037-20556520-63233409","pred":"source","obj":"2_test"},{"subj":"24980037-15579802-63233410","pred":"source","obj":"2_test"},{"subj":"24980037-16474220-63233410","pred":"source","obj":"2_test"},{"subj":"24980037-22120352-63233410","pred":"source","obj":"2_test"},{"subj":"24980037-18334580-63233411","pred":"source","obj":"2_test"},{"subj":"24980037-23393167-63233412","pred":"source","obj":"2_test"},{"subj":"24980037-23242860-63233413","pred":"source","obj":"2_test"},{"subj":"24980037-11380492-63233414","pred":"source","obj":"2_test"},{"subj":"24980037-22278423-63233415","pred":"source","obj":"2_test"},{"subj":"24980037-23393167-63233416","pred":"source","obj":"2_test"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"2_test","color":"#a193ec","default":true}]}]}}