Undetectable postoperative XXXX does not always predict long-term remission in @entity699 : a single centre audit.

@entity1 @entity2013 @entity1220 @entity5 @entity699 @entity2012 @entity619 @entity701 @entity86 @entity7961 @entity6192
OBJECTIVE: An undetectable postoperative serum @entity701 has been regarded as a definition of cure in @entity699 . However, we noted disease recurrence amongst @entity1 with @entity699 despite undetectable postoperative @entity701 levels, and this led us to audit our data. We have also previously assessed surgical outcome for @entity2012 and @entity2013 for a single surgeon. The aims of this study were two-fold: (i) to investigate the treatment and surgical outcome of @entity1 with @entity699 . In particular, we wished to compare the data with outcome for other @entity5 in our centre; and (ii) to determine whether undetectable @entity701 following surgery is predictive of long-term cure for @entity699 . @entity1 AND METHODS: We performed a retrospective audit of 97 @entity1 ; mean age 39.1 (range: 14-82) years, 78/97 (80.4%) female, mean follow-up 92 months (range: 6 months to 29 years), with @entity699 seen in our unit between 1969 and 1998. We documented diagnostic investigation, immediate surgical outcome and disease recurrence in these @entity1 . RESULTS: All @entity1 had elevated urinary free @entity701 (mean 1270.6 nmol/l, range: 327-3245 nmol/l). In total, 95.5% of @entity1 did not suppress with low-dose @entity619 suppression testing. Hypokalaemia (K < 3.2 mmol/l) was present in 15.6% of @entity1 ; 17.5% of @entity1 did not show @entity701 suppression with high-dose @entity619 and 15.8% of @entity1 did not show an ACTH rise of > 50% following corticotrophic releasing hormone ( @entity6192 ) administration. There was no significant (> 3) gradient in ACTH or @entity701 following @entity6192 during inferior petrosal sinus sampling in 27.3% of @entity1 who had the test. A @entity5 was demonstrated on imaging in 55.8% of @entity1 ; 10.3% were macroadenomas. Mortality rate following trans-sphenoidal surgery was 1%. Following surgery, the immediate postoperative remission rate (undetectable postoperative @entity701 ) was 68.5%. However, 11.5% of these @entity1 developed disease recurrence during a mean follow-up period of 36.3 months. Considering microadenomas, @entity699 @entity1 had an immediate postoperative remission rate of 63.2% which is significantly lower (P < 0.05) compared to a remission rate of 91.1% in @entity2012 . Additionally, new @entity86 (13.9%) and @entity1220 (25.8%) was higher in @entity1 with @entity699 compared to @entity1 with @entity2012 or @entity2013 . Immediate postoperative remission rates improved from 50% in the first decade of a surgeon's career to consistently above 60% in the second and third decades, demonstrating a trend which may be attributed to surgical experience. CONCLUSIONS: (i) Despite strict criteria for immediate postoperative remission and recurrence, undetectable postoperative @entity701 is not always predictive of long-term remission. (ii) Despite an aggressive surgical approach, immediate postoperative remission rates for @entity699 are lower compared to other microadenomas. The development of new @entity7961 following surgery is also commoner than that seen amongst other microadenomas. These data have important implications for the follow-up of @entity1 with @entity699 .
