PMC:4143611 / 7424-9665 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":"Predicting recurrence\nThere are conflicting data relating to whether it is possible to identify patients who may be at greater risk for recurrence of CD following pituitary surgery. For instance, there is some evidence that tumor size, age, and gender may predict long-term outcome following surgery, and that the likelihood of recurrence may be higher in patients with macroadenomas [22–25], and patients who are younger [26]. However, a thorough review and meta-analysis of various predictive factors of recurrence found that age, gender, tumor size, and macroscopic tumor invasion were not associated with CD recurrence, whereas low levels of cortisol immediately following surgery appeared to be a positive predictor of long-term remission in more reports than not [27]. Therefore, it is unclear to what extent recurrence can be predicted, highlighting the importance of regular post-surgical patient monitoring.\nWhether consideration of post-surgical adrenal insufficiency in conjunction with other parameters predicts recurrence better than post-surgical cortisol levels alone is also unclear. In one study, recovery from transient post-surgical adrenal insufficiency (2–34 months) followed by normalized hypothalamus–pituitary–adrenal (HPA) axis function predicted a low recurrence rate (13 %), whereas lack of a diurnal rhythm of cortisol secretion after normalized adrenal function predicted significantly higher recurrence rates (50–65 %) [28]. In contrast, results from another study showed that the time to complete normalization of the HPA axis following surgery was the only positive indicator of recurrence; all patients who recurred had recovered their HPA axis function within 3 years of surgery [29]. Yet others report that a lower risk of recurrence was associated with normal cortisol suppression by low-dose dexamethasone [30, 31]. Similarly, high levels of ACTH in response to corticotrophin-releasing hormone (CRH) or desmopressin stimulation better predicted relapse than post-operative serum cortisol levels alone [32–36]. As such, it is plausible that patients with subtle abnormalities of the HPA axis following surgery may be at risk for persistent or recurrent hypercortisolemia, which may be mild yet insidious.","divisions":[{"label":"title","span":{"begin":0,"end":21}},{"label":"p","span":{"begin":22,"end":916}}],"tracks":[{"project":"2_test","denotations":[{"id":"24980037-9435417-63233424","span":{"begin":385,"end":387},"obj":"9435417"},{"id":"24980037-16304985-63233424","span":{"begin":385,"end":387},"obj":"16304985"},{"id":"24980037-2843068-63233424","span":{"begin":385,"end":387},"obj":"2843068"},{"id":"24980037-10366371-63233424","span":{"begin":385,"end":387},"obj":"10366371"},{"id":"24980037-8675592-63233425","span":{"begin":423,"end":425},"obj":"8675592"},{"id":"24980037-21918830-63233426","span":{"begin":770,"end":772},"obj":"21918830"},{"id":"24980037-11739423-63233427","span":{"begin":1450,"end":1452},"obj":"11739423"},{"id":"24980037-23371975-63233428","span":{"begin":1714,"end":1716},"obj":"23371975"},{"id":"24980037-12744355-63233429","span":{"begin":1844,"end":1846},"obj":"12744355"},{"id":"24980037-8382119-63233430","span":{"begin":1848,"end":1850},"obj":"8382119"},{"id":"24980037-7593411-63233431","span":{"begin":2040,"end":2042},"obj":"7593411"},{"id":"24980037-21508126-63233431","span":{"begin":2040,"end":2042},"obj":"21508126"},{"id":"24980037-10913942-63233431","span":{"begin":2040,"end":2042},"obj":"10913942"},{"id":"24980037-11453953-63233431","span":{"begin":2040,"end":2042},"obj":"11453953"},{"id":"24980037-23278711-63233431","span":{"begin":2040,"end":2042},"obj":"23278711"}],"attributes":[{"subj":"24980037-9435417-63233424","pred":"source","obj":"2_test"},{"subj":"24980037-16304985-63233424","pred":"source","obj":"2_test"},{"subj":"24980037-2843068-63233424","pred":"source","obj":"2_test"},{"subj":"24980037-10366371-63233424","pred":"source","obj":"2_test"},{"subj":"24980037-8675592-63233425","pred":"source","obj":"2_test"},{"subj":"24980037-21918830-63233426","pred":"source","obj":"2_test"},{"subj":"24980037-11739423-63233427","pred":"source","obj":"2_test"},{"subj":"24980037-23371975-63233428","pred":"source","obj":"2_test"},{"subj":"24980037-12744355-63233429","pred":"source","obj":"2_test"},{"subj":"24980037-8382119-63233430","pred":"source","obj":"2_test"},{"subj":"24980037-7593411-63233431","pred":"source","obj":"2_test"},{"subj":"24980037-21508126-63233431","pred":"source","obj":"2_test"},{"subj":"24980037-10913942-63233431","pred":"source","obj":"2_test"},{"subj":"24980037-11453953-63233431","pred":"source","obj":"2_test"},{"subj":"24980037-23278711-63233431","pred":"source","obj":"2_test"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"2_test","color":"#ec93cd","default":true}]}]}}