Recovery of hypothalamic-pituitary-adrenal axis in paediatric Cushing disease.
Cushing
HPA axis
adrenal function
pituitary
recovery
transsphenoidal surgery
Journal
Clinical endocrinology
ISSN: 1365-2265
Titre abrégé: Clin Endocrinol (Oxf)
Pays: England
ID NLM: 0346653
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
10
06
2020
revised:
21
07
2020
accepted:
22
07
2020
pubmed:
30
7
2020
medline:
19
8
2021
entrez:
30
7
2020
Statut:
ppublish
Résumé
The postoperative period of Cushing disease (CD) is complicated by a phase of adrenal insufficiency (AI). Factors that influence the duration of AI and its prognostic significance for CD recurrence in children have not been extensively studied. We investigated whether clinical or biochemical factors contribute to the duration of AI, and the correlation of the recovery process with the risk for recurrence. Patients with paediatric-onset CD who were followed up for at least 3 months after transsphenoidal surgery (TSS) (n = 130) were included in the study. Multivariable Cox proportional hazards analysis was used to assess the association of biochemical and clinical factors with the duration of AI. Overall, 102 patients recovered adrenal function during their follow-up. Median time to recovery was 12.7 months [95% confidence intervals (CI): 12.2-13.4]. On multivariable analysis, clinical (age, gender, disease duration, puberty stage, BMI z-score, tumour size, invasion of the cavernous sinus and year of surgery) and biochemical (midnight cortisol and morning ACTH) factors did not correlate with the time to recovery, except for increase in recovery time noted with increase in urinary free cortisol (UFC) [hazard ratio (HR): 0.94; 95% CI: 0.89-0.99]. Among patients who eventually recovered adrenal function, the risk for CD recurrence was associated with the time to recovery (HR: 0.86; 95% CI: 0.75-0.99). Recovery of adrenal function in patients with CD after TSS may not be associated with most clinical and biochemical factors in the preoperative period except for total cortisol excretion. Earlier recovery is associated with higher risk for recurrence, which has implications for the patients' follow-up and counselling.
Substances chimiques
Hydrocortisone
WI4X0X7BPJ
Types de publication
Journal Article
Research Support, N.I.H., Intramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
40-47Informations de copyright
© 2020 John Wiley & Sons Ltd.
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