This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Graham, K. E. Articles by Cook, D. M. Search for Related Content PubMed PubMed Citation Articles by Graham, K. E. Articles by Cook, D. M.

Intraoperative Adrenocorticotropin Levels During Transsphenoidal Surgery for Cushing’s Disease Do Not Predict Cure

Division of Endocrinology (K.E.G., D.M.C., M.H.S.), Oregon Health Sciences University, Portland, Oregon 97201; Endocrine Research Laboratory (H.R.), St. Luke’s Medical Center, and Department of Medicine (H.R.), Medical College of Wisconsin, Milwaukee, Wisconsin 53215; Department of Radiology (S.L.B.), Dotter Interventional Institute and Division of Neurosurgery (S.L.B.),Oregon Health Sciences University, Portland, Oregon 97201

Address all correspondence and requests for reprints to: Kathryn E. Graham, M.D., Division of Endocrinology L-607, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97201.

Recently, intraoperative rapid immunochemiluminometric assay (ICMA) ACTH measurements have been used to evaluate the completeness of resection of ectopic ACTH-secreting tumors. This study evaluates whether this method can be applied to patients undergoing transsphenoidal surgery (TSS) for Cushing’s disease to predict complete pituitary tumor resection.

Eighteen patients with Cushing’s disease undergoing TSS had plasma ACTH concentrations measured by a standard ICMA every 10 min for 1 h immediately after pituitary tumor removal. Patients were evaluated postoperatively for cure by standard criteria. ACTH levels were evaluated for percentage decrease from baseline at each time point.

Patients who were cured (n = 11) had statistically greater decreases in ACTH levels (mean decrease 54%) than patients who were not (n = 7; 26% mean decrease, P < 0.04). By Receiver-Operator Characteristic (ROC) analysis, a reduction of at least 40% best predicted which patients were cured and which were not cured. This level of reduction was observed in 82% of cured patients, and a reduction of less than 40% was observed in 71% of those not cured. The analysis misclassified 4 of the 18 patients, resulting in a diagnostic accuracy of 78%.

Although the mean maximal decrease in ACTH concentrations after tumor removal was significantly different between cured and not cured patients with Cushing’s disease, it was less dramatic than results in the previous ectopic ACTH study. This may relate to incomplete suppression and/or surgical manipulation of normal pituitary corticotrophs in patients with pituitary disease. In summary, in contrast to the ectopic ACTH syndrome, decline of plasma ACTH during TSS does not accurately predict complete tumor resection.

This article has been cited by other articles:

				L. J. Sokoll, F. H. Wians Jr, and A. T. Remaley Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing Clin. Chem., July 1, 2004; 50(7): 1126 - 1135. [Abstract] [Full Text] [PDF]

				H. Raff, J. L. Raff, and J. W. Findling Late-Night Salivary Cortisol as a Screening Test for Cushing's Syndrome J. Clin. Endocrinol. Metab., August 1, 1998; 83(8): 2681 - 2686. [Abstract] [Full Text]