The corticotropin-releasing hormone test in the postoperative evaluation of patients with Cushing's syndrome

P. C. Avgerinos, G. P. Chrousos, L. K. Nieman, E. H. Oldfield, Donald (Lynn) Loriaux, G. B. Cutler

Research output: Contribution to journalArticle

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Abstract

After surgical cure of Cushing's syndrome most patients develop transient secondary adrenal insufficiency that lasts for approximately 1 yr. Since ACTH-secreting pituitary adenomas generally respond to ovine CRH (oCRH), we tested the hypothesis that an early postoperative response to oCRH may indicate the presence of residual pituitary tumor and, therefore, predict recurrence. We also assessed the usefulness of oCRH for monitoring the recovery of the hypothalamic-pituitary adrenal axis and for clarifying the pathophysiology of this condition. Thirty-four patients cured of Cushing's syndrome (29 with Cushing's disease, 3 with adrenal adenomas, and 2 with the ectopic ACTH syndrome) had an evening oCRH test 1-2 weeks after surgery. Nine patients (6 with Cushing's disease, 2 with adrenal adenomas, and 1 with the ectopic ACTH syndrome) participated in a longitudinal evaluation and had repeated oCRH and 1-h ACTH tests at 2-month intervals for a year after surgery. Patients were considered to be cured on the basis of at least 3 subnormal urinary [2 analysis). Surgically cured patients with adrenal adenomas or ectopic ACTH secretion also had subnormal plasma ACTH and cortisol responses to oCRH during the early postoperative period. During longitudinal evaluation for 12 months after surgery, the ACTH and cortisol responses to oCRH increased progressively (regardless of the cause of Cushing's syndrome). Cortisol responses to oCRH correlated significantly with the cortisol responses to exogenous ACTH (r = 0.89; P <0.00001). We conclude that most patients with Cushing's syndrome have suppressed responses to oCRH during the early postoperative period. A normal early postoperative response in the patients with Cushing's disease may identify a subgroup of patients who are at increased risk of recurrence.

Original languageEnglish (US)
Pages (from-to)906-913
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume65
Issue number5
StatePublished - 1987
Externally publishedYes

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Cushing Syndrome
Corticotropin-Releasing Hormone
Adrenocorticotropic Hormone
Sheep
Hydrocortisone
Pituitary ACTH Hypersecretion
Ectopic ACTH Syndrome
Surgery
Adenoma
Postoperative Period
ACTH-Secreting Pituitary Adenoma
Recurrence
Adrenal Insufficiency
Residual Neoplasm
Pituitary Neoplasms
Tumors
Plasmas
Recovery
Monitoring

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

The corticotropin-releasing hormone test in the postoperative evaluation of patients with Cushing's syndrome. / Avgerinos, P. C.; Chrousos, G. P.; Nieman, L. K.; Oldfield, E. H.; Loriaux, Donald (Lynn); Cutler, G. B.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 65, No. 5, 1987, p. 906-913.

Research output: Contribution to journalArticle

Avgerinos, P. C. ; Chrousos, G. P. ; Nieman, L. K. ; Oldfield, E. H. ; Loriaux, Donald (Lynn) ; Cutler, G. B. / The corticotropin-releasing hormone test in the postoperative evaluation of patients with Cushing's syndrome. In: Journal of Clinical Endocrinology and Metabolism. 1987 ; Vol. 65, No. 5. pp. 906-913.
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