Evaluation of Cushing's disease remission after transsphenoidal surgery based on early serum cortisol dynamics

Objective To evaluate the ability of post‐transsphenoidal pituitary surgery (TSS) serum cortisol levels (s‐cortisol) to predict surgical remission and recurrence of Cushing's disease (CD). Design One hundred and three patients with CD from a tertiary referral centre were prospectively analysed over 6·0 ± 4·8 years of follow‐up. Twenty patients received perioperative glucocorticoids as routine care and had s‐cortisol measured 10–12 days after TSS (Protocol I). Eighty‐six patients (91 surgeries) had s‐cortisol measured at 6, 12, 18, 24, 48 h, and 10–12 days after TSS, and received glucocorticoids only in case of adrenal insufficiency (Protocol II). Main outcomes Remission [clinical signs and symptoms of adrenal insufficiency (or hypocortisolism) plus cortisol