Evidence mapPaperPMID 40257708Full record

ArticleEndocrine2025

The prevalence and predictors of Cushing disease recurrence: a 10-year experience of a pituitary tumor center of excellence.

Elisa Lamback, Leandro Kasuki, Renan Lyra Miranda, Camila Saggioro de Figueiredo, Luiz Eduardo Wildemberg, Mônica R Gadelha

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Article in Endocrine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Elisa LambackNeuroendocrinology Research Center, Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Leandro KasukiNeuroendocrinology Research Center, Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Renan Lyra MirandaNeuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil.
Camila Saggioro de FigueiredoNeuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil.
Luiz Eduardo WildembergNeuroendocrinology Research Center, Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Mônica R GadelhaNeuroendocrinology Research Center, Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. mgadelha@hucff.ufrj.br.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeIdentifying predictors of recurrence in Cushing disease (CD) guides monitoring strategies. We aimed at analyzing the frequency and predictive factors of recurrence in CD.

methodsPatients with CD operated between August/2013-December/2023 were included. Retrospective data on biochemical, radiological, histopathological and genetic data were collected. Remission was defined as post-operative cortisol concentrations below 2 mcg/dL within the first week of surgery or normalized cortisol values post-operatively. Recurrence was defined as new onset of hypercortisolism confirmed biochemically.

resultsSurgical remission was achieved in 81% of patients, but recurrence occurred in 27.4% of cases after a median follow up period of 38 months (range 16-101). Lower cortisol concentrations on the first and second post-operative days, and longer duration of glucocorticoid replacement (2.5 months vs 8-10 months, p = 0.045) were identified as protective factors for recurrence. Nadir cortisol concentrations ≤3 mcg/dL during the first post-operative week predicted long-term remission with 74% sensitivity, 85% specificity, 94% positive predictive value, and 50% negative predictive value (area under the curve 0.808, p = 0.001). Recurrence rates were lower in patients with microadenomas/no visible lesion compared to those with macroadenomas (19% vs 45%; p = 0.03). Age, gender, tumor diameter, USP8 and USP48 mutational status, cortisol on the 7th post-operative day and, ACTH immuno-positivity in histology were not associated with recurrence.

conclusionRecurrence in CD was seen in 27.4% of cases. Immediate post-operative cortisol concentrations and the duration of glucocorticoid use were predictors of recurrence. Recurrence was more frequent in patients with macroadenomas compared to those with microadenomas/no visible adenomas.

Indexed as

ACTH-Secreting Pituitary AdenomaAdenomaNeoplasm Recurrence, LocalPituitary ACTH HypersecretionPituitary NeoplasmsAdolescentAdultAgedFemaleHumansHydrocortisoneMaleMiddle AgedPrevalencePrognosisRecurrenceHydrocortisoneCortisolCushing diseaseRecurrenceRemission

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PMID40257708

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.