Gupta et al reported a simple clinical score for predicting long-term remission for a patient with Cushing disease. This can help to identify a patient who may require more aggressive management. The authors are from PGIMER in Chandigarh, India.
Patient selection: Cushing's disease due to pituitary adenoma, status post adenoma resection
Predictive factors for remission in Cushing's disease:
(1) recovery of hypothalamus-pituitary-adrenal (HPA) axis (97% remission)
(2) duration of glucocorticoid replacement > 90 days (97% remission)
(3) resolution of diabetes (86% remission)
(4) resolution of hypertension (86% remission)
(5) 3-month (presumably after surgery) serum cortisol < 350 mmol/L (77% remission)
(6) new onset of hypogonadism (75% remission)
(7) proximal muscle weakness at presentation (71% remission)
(8) histopathological confirmation of tumor (70% remission)
(9) follow-up imaging shows no residual tumor (non-visualization; 64% remission)
(10) short duration of symptoms prior to presentation (less than 2 years)
(11) 8 AM serum cortisol on post-operative day 1-7 <= 138 mmol/L
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Finding
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Points
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absent
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0
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present
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1
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total score =
= SUM(points for predictors)
Interpretation:
• minimum number of predictors: 0
• maximum number of predictors: 11
• The study population showed scores from 0 to 7
• A score >= 3 is associated with remission (80% have remission vs 16% if < 3)
• A score >=5 had a 100% remission.
Performance:
• The area under the ROC curve was 0.82.
