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| |  Pseudocapsular Resection in Patients With Cushing's Disease Elicits Rapid Drop in Cortisol Levels: Presented at AANS By Liz Meszaros PHILADELPHIA -- May 5, 2010 -- Pseudocapsular tumour resection in patients with Cushing's Disease causes a rapid decline in serum cortisol levels post-operatively, researchers reported here at the 2010 Annual Meeting of the American Association of Neurological Surgeons (AANS). "Traditional resection techniques are associated with more delayed drops in cortisol levels, and this may represent the presence of residual tumour cells," said Stephen J. Monteith, MD, University of Virginia Health System, Charlottesville, Virginia, on May 4. "This concept is supported by long-term results from different surgical techniques. It is very important to keep following these patients even if you have a very high rate of immediate cure [because] up to 5 years, the recurrence rate can be as high as 46%." Dr. Monteith and colleagues analysed data from 101 patients from a prospectively accrued database. Post-surgical serum cortisol measurements were obtained every 6 hours until levels were <=2.0 ug/dl. Tumour resections were categorised as complete resection using the histological pseudocapsule as a surgical capsule, complete resection without using the pseudocapsule; incomplete resection; "inside-out" resection in which the tumour is cored out and a visible pseudocapsule removed; and total hypophysectomy as a control to represent the circumstance in which no residual normal corticotrophs were present. Median time to reach a cortisol level of <=2.0 ug/dl was 9.9 hours in the hypophysectomy group, 19.4 hours in the pseudocapsular group, and 29.5 hours in the remaining surgical technique groups. Pseudocapsular resection produced a faster decline in cortisol levels than other techniques (P = .0001), including the "inside out" technique (P = .007). The researchers also noted that the prompt drop in cortisol levels after hypophysectomy compared with that in patients undergoing speduocapsular resection suggests that the corticotrophs of the normal gland can secrete adrenocorticotropic hormone for 10 to 36 hours after surgery, despite prolonged or severe hypercortisolism. [Presentation title: Use of the Histological Pseudocapsule in Surgery for Cushing's Disease (CD): Rapid Post-Operative Cortisol Decline Predicts Complete Tumor Resection]
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