The Prognostic Value of Perioperative Profiles of ACTH and Cortisol for Recurrence after Transsphenoidal Hypophysectomy in Dogs with Corticotroph Adenomas

Background: Transsphenoidal hypophysectomy is an effective treatment for dogs with pituitary-dependent hypercortisolism (PDH). However, long-term recurrence of hypercortisolism is a well-recognized problem, indicating the need for reliable prognostic indicators.  Objectives: The aim of this study was to evaluate the prognostic value of perioperative plasma ACTH and cortisol concentrations for identifying recurrence of hypercortisolism after transsphenoidal hypophysectomy. Animals A total of 112 dogs with PDH that underwent transsphenoidal hypophysectomy met the inclusion criteria of the study. Methods: Hormone concentrations were measured preoperatively and 1–5hours after surgery. Both absolute hormone concentrations and postoperative concentrations normalized to preoperative concentrations were included in analyses. The prognostic value of hormone concentrations was studied with Cox's proportional hazard analysis. Results: Median follow-up and disease-free period were 1096days and 896days, respectively. Twenty-eight percent of patients had recurrence, with a median disease-free period of 588days. Both absolute and normalized postoperative cortisol concentrations were significantly higher in dogs with recurrence than in dogs without recurrence. High ACTH 5hours after surgery, high cortisol 1 and 4hours after surgery, high normalized ACTH 3hours after surgery, high normalized cortisol 4hours after surgery and the random slope of cortisol were associated with a shorter disease-free period.  Conclusions and clinical importance: Individual perioperative hormone curves provide valuable information about the risk of recurrence after hypophysectomy. However, because no single cutoff point could be identified, combination with other variables, such as the pituitary height/brain area (P/B) ratio, is still needed to obtain a good estimate of the risk for recurrence of hypercortisolism after hypophysectomy.