BASAL CORTISOL AND ACTH DURING IMMEDIATE POSTOPERATION OF ACTH-PRODUCING HYPOPHYSEAL ADENOMAS

Background: Evaluate the usefulness of basal cortisol and ACTH during the immediate postoperative period following hypophyseal surgery, as e arly indicators of remission in pacients with Cushing's disease. Metho ds: Nine patients with Cushing's disease and on whom selective transph enoidal adenomectomy was performed were included in the study. Basal c ortisol and ACTH levels were compared the first week after surgery, wi th definitive results being obtained after a month's time during which basal cortisol levels below 165 nmol/l indicated patients cured of Cu shing's disease. Results: Cortisol levels determined post-op, in five patients in remission, were found to be lower than those in patients w ho were not cured (63 +- 55.8 versus 606 +- 267 nmol/l, p<0.01). Howev er, ACTH levels were not lower. All the patients in remission had init al cortisol levels lower than 182 nmol/l, whereas the uncured patients had levels higher than 404 nmol/l. There was a correlation between co rtisol measured in the first week and the definitive value (r=0.81, p< 0.01). Conclusion: Cortisol in the immediate postoperative period foll owing hypophyseal surgery is a good indicator of definitive adrenocort icotropic function and permits the identification of those patients in remission.