Diurnal Range and Intra-patient Variability of ACTH Is Restored With Remission in Cushing's Disease
Authors' conclusion
Our findings suggest that ACTH variability is suppressed in CD, and remission from CD is associated with the restoration of this variability. Furthermore, a decrease in plasma ACTH by 50% or more may serve as a predictor of remission post-TSS. These insights could guide clinicians in developing rational outcome measures for interventions targeting CD adenomas.
Study context
- Population
- Cushing's disease (CD) patients with ACTH measurements before and after transsphenoidal surgery (TSS), 2005–2019, referral center
- Participants
- 253 patients
- Exposure
- Remission vs nonremission after TSS
- Remissionn = 223
- Outcome
- Remission after TSS
Methodological detailssingle referral centre
- Single referral centre
Main finding
As reported in the abstract
Remission
223
events
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| ACTH variability · AM and PMRemission vs Nonremission · higher with remission | P = 0.02 |
| ACTH variability · AM and PMRemission vs Nonremission · higher with remission | P < 0.001 |
| ACTH diurnal rangeSignificantly narrower with nonremission | P = <.0001 |
Predictors of remission/nonremission
- Absolute plasma ACTH concentration associated with nonremission (multivariable logistic regression)
- adj P < .001
- Ratio of preoperative to postoperative ACTH associated with nonremission (multivariable logistic regression)
- adj P .001
- Decrease in plasma ACTH ≥50% from mean preoperative levels predicted CD remission after TSS, especially with PM values
Original publication
Diurnal Range and Intra-patient Variability of ACTH Is Restored With Remission in Cushing's Disease. J Clin Endocrinol Metab. Published 1 June 2023. doi:10.
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