Patient selection: Cushing's disease (with ACTH-secreting pituitary adenoma)
Surgical remission - one or more of the following:
(1) serum cortisol after surgery < 5 µg/dL after surgery
(2) need for postoperative glucocorticoid therapy to prevent symptoms of adrenal insufficiency
(3) urine free cortisol low or in normal range if not receiving glucocorticoid replacement therapy
Remission may be immediate (within 1-2 days of surgery up to 3 months after surgery) or late (after 3 months). Remission could be achieved with or without additional therapy (radiation, surgical, etc).
Recurrent disease - one or more of the following after initial remission:
(1) elevated 24 hour urine free cortisol
(2) serum cortisol > 5 µg/dL after low-dose (1 mg) dexamethasone (unsuppressed)
(3) elevated serum cortisol concentration with clinical symptoms of Cushing's disease
Persistent disease - does not meet criteria for remission or recurrence and has one of the following:
(1) elevated postoperative serum cortisol level (> 5 µg/dL)
(2) does not require postoperative glucocorticoid therapy
(3) elevated urine free cortisol in a 24 hour urine
(4) requires medical therapy to suppress cortisol production (steroidogenesis inhibitors, other)
