Diurnal Range and Intra-patient Variability of ACTH Is Restored With Remission in Cushing's Disease.

Humans Pituitary ACTH Hypersecretion / diagnosis Treatment Outcome Retrospective Studies Adenoma / surgery Adrenocorticotropic Hormone
ACTH Cushing's disease circadian diurnal variation variability

Journal

The Journal of clinical endocrinology and metabolism
ISSN: 1945-7197
Titre abrégé: J Clin Endocrinol Metab
Pays: United States
ID NLM: 0375362

Informations de publication

Date de publication:
18 10 2023
Historique:
received: 18 01 2023
medline: 23 10 2023
pubmed: 1 6 2023
entrez: 1 6 2023
Statut: ppublish

Résumé

Single ACTH measurements have limited ability to distinguish patients with Cushing's disease (CD) from those in remission or with other conditions. To investigate the changes in ACTH levels before and after transsphenoidal surgery (TSS) to identify trends that could confirm remission from CD and help establish ACTH cutoffs for targeted clinical trials in CD. Retrospective analysis of CD patients who underwent TSS from 2005 to -2019. Referral center. CD patients (n = 253) with ACTH measurements before and after TSS. TSS for CD. Remission after TSS. Remission was observed in 223 patients after TSS. Those in remission had higher ACTH variability at AM (P = .02) and PM (P < .001) time points compared to nonremission. The nonremission group had a significantly narrower diurnal range compared to the remission group (P = <.0001). A decrease in plasma ACTH of ≥50% from mean preoperative levels predicted CD remission after TSS, especially when using PM values. The absolute plasma ACTH concentration and ratio of preoperative to postoperative values were significantly associated with nonremission after multivariable logistic regression (adj P < .001 and .001, respectively). Our findings suggest that ACTH variability is suppressed in CD, and remission from CD is associated with the restoration of this variability. Furthermore, a decrease in plasma ACTH by 50% or more may serve as a predictor of remission post-TSS. These insights could guide clinicians in developing rational outcome measures for interventions targeting CD adenomas.

Identifiants

DOI: 10.1210/clinem/dgad309 PMID: 37261392 PMC: PMC10584004
pubmed: 37261392
pii: 7187942
doi: 10.1210/clinem/dgad309
pmc: PMC10584004
doi:

Substances chimiques

Adrenocorticotropic Hormone 9002-60-2

Types de publication

Journal Article Research Support, N.I.H., Intramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

2812-2820

Subventions

Organisme : Intramural NIH HHS
Pays : United States
Organisme : NICHD NIH HHS
Pays : United States
Organisme : NIDDK NIH HHS
Pays : United States
Organisme : Intramural NIH HHS
ID : ZIA NS003150
Pays : United States

Informations de copyright

Published by Oxford University Press on behalf of the Endocrine Society 2023.

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Auteurs

Reinier Alvarez (R)

Neurosurgery Unit for Pituitary and Inheritable Diseases, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
Department of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA.
Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
ORCID: 0000-0003-0694-5526

Elizabeth Hogan (E)

Neurosurgery Unit for Pituitary and Inheritable Diseases, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
Department of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA.

David T Asuzu (DT)

Neurosurgery Unit for Pituitary and Inheritable Diseases, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.

Tianxia Wu (T)

Clinical Trials Unit, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA.

Gloria Oshegbo (G)

Biomedical Translational Research Information System, Clinical Center, National Institutes of Health, Bethesda, MD, USA.

Raven McGlotten (R)

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
ORCID: 0000-0001-5817-9232

Michaela Cortes (M)

Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.

Christina Hayes (C)

Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.

Constantine A Stratakis (CA)

Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.

Christina Tatsi (C)

Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
ORCID: 0000-0002-2882-4584

Lynnette K Nieman (LK)

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.

Prashant Chittiboina (P)

Neurosurgery Unit for Pituitary and Inheritable Diseases, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
ORCID: 0000-0001-9349-4756

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