Analysis Of Factors Affecting And Predicting The Post-operative Remission In Patients With Cushing’s Disease

OBJECT: To investigate factors related to the post-operative remission inpatients with Cushing’s disease; to investigate factors affecting and predicting thesurgical remission in patients with Cushing’s disease.METHOD: We retrospectively analyzed the data between2010and2013of allpatients with Cushing’s disease, who underwent trans-sphenoid surgery (TSS)operated on by a single surgical group in our center. The patients were divided intoremission group and non-remission group. We compared with the two groups of theirbiochemical and radiological results in order to find the difference in before and afterthe surgery and between two groups, and to see if the difference affects the remission.By using survival analysis and making Kaplan-Meier curves, we compared differentfactors affecting the surgical remission. The Cox proportional hasards model allowedus to determine factors who would predict the remission.RESULTS: There were82patients with Cushing’s disease operated on in ourcenter between2010and2013,1was eliminated since lack of information. Theaverage age is39.19±11.62years old, where67were females and14were males,and the male/female ratio is1:4.8. The median follow-up time is363days, duringwhich69got remitted while other12were not, and the remission rate was85.19%. The median remission time was1day,58(71.60%) patients got remitted within1week after the surgery. There was no difference in age, gender between the remissiongroup and the non-remission group. Though no difference before the surgery, thepost-operative serum hormone levels were significantly reduced in remission group ascompared to non-remission group. However as for BIPSS, discovery on pituitaryMRI, accordance in BIPSS and pituitary MRI, DST, and histology, none of theseaffect the post-operative remission. Male patient (p=0.038) and accordance in BIPSSand pituitary MRI (p=0.015) are favorable factors for post-op remission. Furthermore, post-operative serum cortisol level (p=1.4x10-4) and post-operative serumACTH (p=0.031) may predict surgical remission.CONCLUSION: Reduced hormone levels on post-operative D1, especially forreduced serum cortisol and serum ACTH may suggest surgical remission. However ifthe hormone level is not decreased or even an increased hormone level may indicatenon-remission. Male patient, reduced post-operative serum cortisol, reducedpost-operative ACTH and reduced post-operative24h UFC may suggest highersurgical remission. Male gender and accordance of BIPSS and pituitary MRIlateralization are favorable factors for remission.