- Author: Alicia Diaz-Thomas, MD, MPH; Chief Editor: Stephen Kemp, MD, PhD more...
Inpatient & Outpatient Medications
After surgical treatment of Cushing disease, patients require daily hydrocortisone replacement therapy (8-10 mg/m2/d and education about stress dosing) from the time of surgery until their hypothalamic-pituitary-adrenal functions recover, which usually occurs 6-12 months after surgery.
The incidence of post-operative hypopituitarism is about 3% in patients with microadenomas and increases slightly with invasiveness of tumor.
Parasellar radiotherapy can lead to panhypopituitarism, optic nerve and optic chiasm injury, delayed radiation injury of the brain, or increased risk of a second brain tumor and epilation (loss of facial or scalp hair).
The postoperative PRL value, obtained 1-2 days after surgery, accurately predicts outcome. Undetectable level (< 2 µg/L) predicts cure with more than 90% probability, whereas higher values within the reference range indicate incomplete removal of the adenoma. Surgery has a good outcome, with a long-term surgical cure rate approaching 82% for all prolactinomas with very low morbidity and no mortality.
The criteria for cure of Cushing disease are undetectable plasma cortisol concentration in the morning (< 1 µg/mL) and corticotropin concentration of less than 5 pg/mL over 24 consecutive hours measured 4-7 days after surgery (at least 24 h after withdrawal of exogenous hydrocortisone or 48 h after exogenous prednisone). Initial remission rates (1-y) of 70-98% and long-term (10-y) success rates of 50-98% have been reported.
The preferred primary treatment for the patient with acromegaly is surgery, with the surgical cure rate approaching 83% in the largest series. Basal serum GH levels obtained immediately after surgery indicate the risk of tumor recurrence in children with GH-releasing adenomas. One recent series reported that immediate postoperative GH values of approximately 50 ng/mL were more likely to be associated with tumor recurrence than values near 15 ng/mL.
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