The Role of Late-Night Salivary Cortisol in the Assessment of Endocrine Remission in Patients With Cushing's Disease After Pituitary Radiotherapy

IF 2.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Clinical Endocrinology Pub Date : 2025-05-11 DOI:10.1111/cen.15270

Ukasha Habib, Helen A. Shih, Beverly M. K. Biller, Nicholas A. Tritos

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引用次数: 0

Abstract

Context

Pituitary radiotherapy (RT) is used for persistent/recurrent Cushing's disease (CD) after pituitary surgery. The utility of late-night salivary cortisol (LNSC) in evaluating endocrine remission after RT is unclear.

Objective

To identify the clinical characteristics and outcomes of patients with CD after RT, in endocrine remission based on normal LNSC (group 1) or 24 h urinary free cortisol (UFC; group 2).

Design and Setting

Retrospective cohort, observational study in academic medical centre. Patients (16−86 years old, n = 75) with CD who underwent RT were studied; group 1 (n = 16), group 2 (n = 18), and 41 patients not in remission. Outcome measures included within-group and between-group changes (group 1 vs. group 2) in clinical characteristics, endocrine data and time to remission.

Results

Seventy-five patients with CD, aged (median [range]: 50 years [16, 86], 71% female, BMI: 34.7 kg/m² [19.1, 62.5], 63% with macroadenomas) underwent RT and 34 (45.3%) entered endocrine remission, including 16 (21.3%) in group 1 and 18 (24%) in group 2 (median: 56 months). From RT to remission, there were decreases in BMI (group 1: −3.9 ± 0.7 kg/m², p = 0.0001; group 2: −5.2 ± 1.9 kg/m², p = 0.0123) and systolic blood pressure (group 1: −7.9 ± 3.9 mmHg, p = 0.03; group 2: −10.1 ± 4.5 mmHg (p = 0.008). There were no between-group differences in BMI, blood pressure, HbA1c, number of antihypertensive or antihyperglycemic agents, UFC, median time to remission, recurrence risk.

Conclusion

In patients with CD following RT, LNSC appears to be clinically equivalent to UFC in the assessment of endocrine remission. These patients can be followed with LNSC, which is easier for patients to collect.

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深夜唾液皮质醇在库欣病患者垂体放疗后内分泌缓解评估中的作用

背景：垂体放疗（RT）用于垂体手术后持续/复发库欣病（CD）。深夜唾液皮质醇（LNSC）在评估放疗后内分泌缓解中的作用尚不清楚。目的：探讨基于正常LNSC（1组）或24小时尿游离皮质醇(UFC；组2)。设计和背景：在学术医疗中心进行回顾性队列观察性研究。研究了接受放射治疗的CD患者（16-86岁，n = 75）；组1 (n = 16)，组2 （n = 18）和41例未缓解患者。结果测量包括临床特征、内分泌数据和缓解时间的组内和组间变化（1组与2组）。结果：75例CD患者，年龄（中位[范围]:50岁[16,86]，女性71%，BMI: 34.7 kg/m2[19.1, 62.5]， 63%伴有大腺瘤）接受了RT治疗，34例（45.3%）进入内分泌缓解，其中1组16例（21.3%），2组18例（24%）（中位：56个月）。从放疗到缓解，BMI下降(1组：-3.9±0.7 kg/m2, p = 0.0001；2组：-5.2±1.9 kg/m2, p = 0.0123)，收缩压(1组：-7.9±3.9 mmHg, p = 0.03；2组：-10.1±4.5 mmHg （p = 0.008）。在BMI、血压、HbA1c、降压或降糖药物数量、UFC、中位缓解时间、复发风险等方面，组间无差异。结论：在放疗后的CD患者中，LNSC在评估内分泌缓解方面的临床意义与UFC相当。这些患者可以进行LNSC随访，这对患者更容易收集。

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来源期刊

Clinical Endocrinology 医学-内分泌学与代谢

CiteScore

6.40

自引率

3.10%

发文量

192

审稿时长

1 months

期刊介绍： Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.