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"<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Association of peripheral neuropathy with skeletal muscle mass and function in type two diabetes mellitus patients: A cross-sectional study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "591" "paginaFinal" => "599" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Asociación de neuropatía periférica con masa muscular esquelética y función en pacientes con diabetes mellitus tipo 2: Un estudio transversal" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => 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"apellidos" => "Nanda" ] 5 => array:2 [ "nombre" => "Sujata" "apellidos" => "Devi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016422001495?idApp=UINPBA00004N" "url" => "/25300164/0000006900000008/v1_202209160915/S2530016422001495/v1_202209160915/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2530016421002457" "issn" => "25300164" "doi" => "10.1016/j.endinu.2021.08.003" "estado" => "S300" "fechaPublicacion" => "2022-10-01" "aid" => "1230" "copyright" => "SEEN y SED" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Endocrinol Diabetes Nutr. 2022;69:576-83" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Alteraciones del metabolismo hidrocarbonado en niños y adolescentes afectos de fibrosis quística" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "576" "paginaFinal" => "583" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Carbohydrate metabolism impairment in children and adolescents with cystic fibrosis" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1626 "Ancho" => 2917 "Tamanyo" => 250281 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparación entre los grupos establecidos, según alteración del metabolismo hidrocarbonado presentada por los pacientes (excluyendo alteración de la glucemia en ayunas [n = 1]).</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AIG: alteración indeterminada de glucosa; AUC: área bajo la curva; DRFQ: diabetes relacionada con fibrosis quística; IHC: intolerancia a los hidratos de carbono; TNG: tolerancia normal a glucosa.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Janire Escudero García, Álvaro Martín Rivada, Amalia Uribe Posada, Verónica Sanz Santiago, Jesús Argente, Gabriel Ángel Martos-Moreno" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Janire" "apellidos" => "Escudero García" ] 1 => array:2 [ "nombre" => "Álvaro" "apellidos" => "Martín Rivada" ] 2 => array:2 [ "nombre" => "Amalia" "apellidos" => "Uribe Posada" ] 3 => array:2 [ "nombre" => "Verónica" "apellidos" => "Sanz Santiago" ] 4 => array:2 [ "nombre" => "Jesús" "apellidos" => "Argente" ] 5 => array:2 [ "nombre" => "Gabriel Ángel" "apellidos" => "Martos-Moreno" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2530018022001500" "doi" => "10.1016/j.endien.2021.08.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018022001500?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016421002457?idApp=UINPBA00004N" "url" => "/25300164/0000006900000008/v1_202209160915/S2530016421002457/v1_202209160915/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Presurgical predictive factors of surgical remission in Cushing's disease. Study of 32 cases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "584" "paginaFinal" => "590" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marta Araujo-Castro, Marta Marchán Pinedo, María Fernández-Argüeso, María Pérez Pérez, Estrella Barrero Ruíz, Héctor Pian, Víctor Rodríguez Berrocal, Eider Pascual-Corrales" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Marta" "apellidos" => "Araujo-Castro" "email" => array:1 [ 0 => "marta.araujo@salud.madrid.org" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Marta" "apellidos" => "Marchán Pinedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "María" "apellidos" => "Fernández-Argüeso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "María" "apellidos" => "Pérez Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Estrella" "apellidos" => "Barrero Ruíz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Héctor" "apellidos" => "Pian" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 6 => array:3 [ "nombre" => "Víctor" "apellidos" => "Rodríguez Berrocal" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 7 => array:3 [ "nombre" => "Eider" "apellidos" => "Pascual-Corrales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Neuroendocrinology Unit, Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad de Alcalá, Departamento de Ciencias de la Salud, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Neuroendocrinology Unit, Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Endoscopic Skull Base Unit, Department of Neurosurgery, Hospital Universitario HM Puerta del Sur, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores prequirúrgicos predictivos de remisión quirúrgica en la enfermedad de Cushing. Estudio de 32 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1695 "Ancho" => 1500 "Tamanyo" => 293453 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Histopathological sample of ACTH-secreting pituitary adenoma not visible on preoperative MRI. (A) Coronal T2 preoperative MRI; (B) Coronal T2 postoperative MRI (reduction of glandular parenchyma was observed after surgery); (C) Material sent HE (macro) where the small fragment of 1<span class="elsevierStyleHsp" style=""></span>mm in diameter corresponding to the tumour is observed); (D) Adenoma HE 4×; (E) Immunohistochemical staining with 4× ACTH antibody.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cushing's disease (CD) is usually caused by an overproduction of adrenocorticotropin hormone (ACTH) arising from pituitary corticotroph adenomas.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Hypercortisolism state in patients with CD is associated with an increased risk of cardiometabolic comorbidities and mortality.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Thus, treatment is mandatory in these patients, being transsphenoidal surgery (TSS) the first-line therapeutic option.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> However, surgical remission rates are frequently below desired, primarily when surgery is performed in centres and surgeons with low experience.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> In this way, surgical remission is reported from 40 to 50% in some series<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5,6</span></a> to up to 90–96% in others.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Identifying presurgical predictors of surgical remission would allow us to plan better surgery in patients with CD. Several studies have identified postoperative predictors of surgical remission, such as immediate postoperative morning cortisol, ACTH, or urinary free cortisol (UFC).<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6,7</span></a> However, information about presurgical predictive factors of remission is scarce. A recent study found that the number of operations, duration of disease, tumour invasion, tumour size, and preoperative ACTH concentration could be predictors of surgical remission,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> but others have found similar rates of remission between patients with microadenomas and no visible pituitary tumours<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>; no differences based on preoperative ACTH levels have been shown,<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> and several studies have not analysed the impact of disease duration on surgical outcomes.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of our study was to identify presurgical factors associated with surgical remission in CD. This information would be helpful in planning surgery more carefully, submit the patient to a pituitary reference centre and/or consider complementary promising intraoperative techniques like intraoperative fluorescence imaging<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> in those cases with a lower probability of surgical remission</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">Data were collected from a retrospective database of all patients with ACTH dependent Cushing's Syndrome in follow-up at our centre between 2014 and 2021 (Registry of patients with Neuroendocrine Neoplasms, approved by the local Ethical Committee, approval date: 10th November 2020 ACTA 402). Out of 40 patients with ACTH-dependent Cushing's syndrome, 32 presented CD and were operated by endoscopic transsphenoidal approach by the same neurosurgeon and were included. CD diagnosis was based on patient history and results of a physical examination, laboratory tests, magnetic resonance imaging (MRI), and histopathology.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Laboratory determinations and assays</span><p id="par0025" class="elsevierStylePara elsevierViewall">All anterior pituitary hormones were measured pre-and postoperatively following our protocol.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> Presurgical measurements were performed at the time of diagnosis before any medical or surgical treatment. Other determinations included two determinations of 24<span class="elsevierStyleHsp" style=""></span>h UFC, 1-mg cortisol post dexamethasone suppression test (DST) and late-night salivary cortisol (LNSC) or 23pm-serum cortisol. Moreover, low (LDDST) and high-dose dexamethasone suppression test (HDDST) in 6 and 5 patients, and CRH test in 3 patients.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Serum and urine cortisol were measured by immunochemiluminescence assays in an Architect i2000 systems Abbott Diagnostics platform, with an intra-assay coefficient of variation (CV)<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>10%; the reference range was 102.1–535.2<span class="elsevierStyleHsp" style=""></span>nmol/L (3.7–19.4<span class="elsevierStyleHsp" style=""></span>μg/dl) for serum cortisol and less than 3862.1<span class="elsevierStyleHsp" style=""></span>nmol/24<span class="elsevierStyleHsp" style=""></span>h (140<span class="elsevierStyleHsp" style=""></span>μg/24<span class="elsevierStyleHsp" style=""></span>h) for 24-h urine cortisol (UFC). ACTH was measured by immunochemiluminescence assays (Immulite 2000 Siemens before 2019 and Liaison XL Diasorin after that), with an intra-assay CVs<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>10%. The reference range for ACTH was 2.0–10.1<span class="elsevierStyleHsp" style=""></span>pmol/L (9–46<span class="elsevierStyleHsp" style=""></span>pg/ml) for the Immulite assay and 1.0–10.7<span class="elsevierStyleHsp" style=""></span>pmol/L (4.7–48.8)<span class="elsevierStyleHsp" style=""></span>pg/ml for the Liaison XL assay. LNSC was measured by electroimmunochemiluminescence in a Cobas 6000 Roche autoanalyser, with an intra-assay coefficient of variation (CV)<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>10% and a reference range lower than 157<span class="elsevierStyleHsp" style=""></span>nmol/L.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Clinical definitions</span><p id="par0035" class="elsevierStylePara elsevierViewall">The diagnosis of endogenous hypercortisolism was confirmed by increased UFC, loss of circadian rhythm (evidenced by high serum or salivary midnight cortisol levels) and lack of suppression of cortisol secretion after either a single 1<span class="elsevierStyleHsp" style=""></span>mg dose or 0.5<span class="elsevierStyleHsp" style=""></span>mg/6<span class="elsevierStyleHsp" style=""></span>h/48<span class="elsevierStyleHsp" style=""></span>h dexamethasone. Diagnosis of ACTH-dependent Cushing's syndrome was based on ACTH levels<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>pg/ml and of CD based on MRI combined with HDDST and CRH test, including bilateral petrosal sinus sampling (BPSS) in 5 patients. A visual evaluation was performed using our protocol,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> and visual involvement was defined as the presence of any degree of visual acuity compromise, from mild visual acuity involvement to severe and from partial to complete field conditions. To diagnose hypopituitarism, we have employed the same definition as we have previously reported in previous studies.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Surgical remission was defined as morning serum cortisol values<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>1.8<span class="elsevierStyleHsp" style=""></span>μg/dL and normal or low UFC within 4–5 days after surgery, as described previously in our protocol.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> Long-term surgical remission was defined as normal UFC at least six months after surgery. Recurrence was defined as high UFC after at least 3 months of normocortisolemia.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Radiological assessment and other studies</span><p id="par0045" class="elsevierStylePara elsevierViewall">Magnetic resonance imaging (MRI) studies were performed with 1.5T, GE 450w. MRI, sagittal and coronal T1, T2-weighted and dynamic sequences, with gadolinium contrast being performed preoperatively and before any medical or surgical treatment, and 3–6 months postoperatively. Based on the largest diameter of the adenoma, pituitary adenomas were categorised into microadenoma (<10<span class="elsevierStyleHsp" style=""></span>mm) and macroadenoma (≥10<span class="elsevierStyleHsp" style=""></span>mm). BPSS was performed in 5 patients. ACTH secretion was stimulated by administering 100<span class="elsevierStyleHsp" style=""></span>μg of CRH. If the inferior petrosal sinus/peripheral plasma ACTH ratio was ≥2.0 at baseline, or the post-CRH stimulation ratio was ≥3.0, the diagnosis of CD was established.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Surgical procedure</span><p id="par0050" class="elsevierStylePara elsevierViewall">Surgeries were performed by an experienced endoscopic pituitary surgeon (VRB), with more than 300 endoscopic pituitary surgeries performed and an average of 35 pituitary surgeries/year during the last ten years. A conventional endoscopic endonasal approach was used in all surgeries. In the case of the cavernous sinus, invasion expanded transcavernous approach was added. Following Oldfield surgical description,<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> an extracapsular dissection was attempted whenever possible. If no clear pseudocapsule was found, a thin portion of pituitary tissue surrounding the lesion was additionally removed (enlarged adenomectomy).<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> The entire gland was explored with several (1–2<span class="elsevierStyleHsp" style=""></span>mm interval) vertical incisions (from one internal carotid artery to the other) if no tumour was clearly visible in preoperative MRI, mainly guided by the lateralisation of inferior petrosal sinus sampling. If no tumour could be identified during surgery, hemihypophysectomy was performed according to preoperative inferior petrosal sinus sampling lateralisation. If the IPSS did not lateralise, subtotal hypophysectomy was performed.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">The statistical analysis was performed with STATA.15. In the descriptive analysis, categorical variables were expressed as absolute and relative (%) frequencies; quantitative variables were expressed as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation or median and range if the normal assumption was not fulfilled. The normality assumption was studied with the Shapiro–Wilk test and the variance homogeneity assumption with the Levene test. For comparing differences in continuous parameters, Student's <span class="elsevierStyleItalic">t</span>-tests and linear regression analysis were performed, and for the comparison of categorical variables between independent samples, the chi-squared test and the logistic regression analysis were performed. In all cases, a two-tailed <span class="elsevierStyleItalic">P</span> value<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 was considered statistically significant.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Baseline characteristics</span><p id="par0060" class="elsevierStylePara elsevierViewall">A total of 32 patients with CD were included. Six patients had macroadenomas, 17 had microadenomas, and in the other 9 patients, no pituitary lesion was identified on the MRI. Three macroadenomas had cavernous sinus invasion (two patients Knosp III and one patient Knosp IV). Moreover, three macroadenomas had suprasellar extension (two of the macroadenomas with cavernous sinus invasion). Seven patients were previously operated in another centre. 13 patients received treatment with ketoconazole and 4 metopirone before surgery. The baseline characteristics of the patients are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Surgical remission and complications</span><p id="par0065" class="elsevierStylePara elsevierViewall">Immediate surgical remission was achieved in 75% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>24), 100% in macroadenomas, 82.4% in microadenomas and 44.4% in patients with no visible tumour. Patients with previous surgery achieved remission in 42.9% % and patients operated on for the first time in 81.8%. After a median follow-up of 4.9 [1.86–11.72] years, only three patients experienced recurrence during follow-up. The other patients remained with normal UFC. Two patients experienced surgical complications (1 patient cerebrospinal (CSF) leakage, 1 CSF leakage and meningitis). There were eight cases of diabetes insipidus (DI), only 1 case of permanent DI. Five patients with normal presurgical pituitary function developed new anterior pituitary deficiencies (different from ACTH deficit) after surgery. TSH deficiency was the most common (4/5), followed by FSH/LH deficiency (3/5).</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Predictors of surgical remission</span><p id="par0070" class="elsevierStylePara elsevierViewall">No association between presurgical demographic or hormonal characteristics and the probability of surgical remission were observed (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The only variable associated with a greater probability of remission was the visualisation of the adenoma on MRI (OR 8.3 95% CI 1.39–48.87, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02). Only in 7 of the 9 patients with no visible tumour on MRI, pathological results confirmed the presence of a pituitary tumour. Positive immunostaining for ACTH was demonstrated in all patients with microadenomas and macroadenomas, but only in 4 patients with no visible tumour (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). It was also observed that patients with a history of previous surgery had a lower tendency to achieve remission, although statistical significance was not reached (OR 0.17 [95% CI 0.02–1.42], <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.09) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">In this series of patients with CD operated by a single surgeon at one experienced tertiary centre over a 7-year period, we have demonstrated that TSS, as the initial treatment for CD, achieved cure in 75% of the patients. Only 2 out of 32 patients experienced complications (all of them mild complications). The most important finding of our study was that those patients with presurgical MRI that locates the pituitary adenoma had an 8-fold higher probability of curing after surgery than those with unlocated tumours.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The most commonly used remission criteria in recent publications have been defined as a post-surgical baseline plasma cortisol value<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>1.8<span class="elsevierStyleHsp" style=""></span>μg/dL or <5<span class="elsevierStyleHsp" style=""></span>μg/dL. In our study, we used the threshold of 1.8<span class="elsevierStyleHsp" style=""></span>μg/dL to increase the sensitivity to detect recurrence. Surgical remission was achieved in 75% of our patients, similar to what was reported in other series describing rates between 70 and 80%.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9,19</span></a> However, the reported remission rate is as low as 50–60% in other studies.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">20,21</span></a> Overall, as expected, the highest remission rates were seen when using the criterium of baseline post-surgical cortisol <5<span class="elsevierStyleHsp" style=""></span>μg/dl, rather than <1.8<span class="elsevierStyleHsp" style=""></span>μg/dl. Besides, remission was higher when surgical resection was performed by an experienced neurosurgeon with a high number of patients, as in our centre, where an average of 35 endoscopic pituitary surgeries is performed per year. The predominant postoperative complication was transient DI which occurred in 22% of the patients, a rate similar to reported in other series.<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19–21</span></a> Similarly, 16% developed adenohypophyseal deficiencies, with rates similar or lower than reported in other studies.<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19,20</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">We identified the location of the pituitary adenoma on the presurgical MRI as the unique variable associated with surgical remission. It is not surprising that MRI-visible adenoma is an independent predictor factor since it is easier to resect a microadenoma once it is located or visible, as confirmed previously by other authors.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5,11,18</span></a> However, other studies have found no difference in remission rates between negative or positive preoperative MRI CD patients. Starker et al.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> found no significant difference in remission among patients with microadenoma, MRI-negative or macroadenoma, but these results may be subject to type II error due to inadequate sample size in each subgroup. Cebula et al.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> found a recurrence rate for negative preoperative MRI higher (71.41%) but not statistically significant compared to positive (OR 1.89, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.077). This may be explained by the fact that 77.1% of the negative-pituitary adenoma were identified during the hypophyseal exploration.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In relation to second surgeries, the remission rate after a second surgery is reported around 54–64%, with high variability between centres (38–90%) due to the lack of homogeneity in the definitions of remission/recurrence/persistence and the potentially different goals of repeat surgery.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">24–26</span></a> Our series also found a lower tendency to surgical remission rate in patients who have already undergone surgery, although no statistical significance was reached. The lower chance of cure after second surgery could be due to inherent qualities of a recurrent tumour (the lesions may present more aggressive characteristics in these cases like a greater degree of invasion of adjacent structures with a lower degree of resectability or a higher mitotic index in the pathological anatomy), and the distortion of the anatomy and the presence of scar tissue that makes surgery more difficult. Despite a lower tendency to remission in these patients and a higher rate of hypopituitarism due to the aggressiveness of the surgeries, a second transsphenoidal surgery remains an effective and safe treatment option, especially in cases where adenoma is evident on complementary imaging tests.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">24–26</span></a> The lack of statistical significance in our series could be related to the small sample size of our study.</p><p id="par0095" class="elsevierStylePara elsevierViewall">No association was found between the presurgical hormonal status and surgical remission in our cohort. In contrast to our results, Dai et al.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> found that a higher preoperative ACTH level was associated with a lower biochemical remission rate. Similarly, Cannavó et al.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> demonstrated that mean preoperative ACTH values were significantly higher in the not cured patients. Kuo et al.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> showed that higher ACTH concentrations before treatment predicted a recurrence of CD. However, the predictive value of preoperative ACTH levels has not been widely accepted and remains controversial. In addition, no correlation between remission and preoperative 24-h UFC levels was detected in our study, consistent with previous studies’ results.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9,29</span></a> Interestingly, Schernthaner-Reiter et al.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> reported that lower baseline UFC was associated with a higher number of long-term comorbidities, possibly due to the,more prolonged exposure to excess glucocorticoids in milder CD.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The main limitations of our study are its retrospective nature and the small sample size that could limit the formulation of a conclusion with high strength of recommendation. Moreover, the data on long-term follow-ups and further treatments of a large proportion of patients were not available. However, we consider that the information provided in our study could be helpful to orientate new multicentric prospective studies focused on surgical remission in CD.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">In our experience, 75% of patients with CD achieved biochemical cure after endoscopic transsphenoidal surgery. Surgical remission was up to eight times more frequent in those patients whose pituitary adenoma was visualized before the intervention, but no other presurgical predictive factors of cure were identified.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Ethical approval</span><p id="par0110" class="elsevierStylePara elsevierViewall">All procedures performed on the study participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Informed consent</span><p id="par0115" class="elsevierStylePara elsevierViewall">Abstention of consent has been requested to the Ethical Committee due to the study's retrospective nature.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Financial support</span><p id="par0120" class="elsevierStylePara elsevierViewall">This work has not received any financial support.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflict of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1771506" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1556283" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1771507" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1556284" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Laboratory determinations and assays" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical definitions" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Radiological assessment and other studies" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Surgical procedure" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Baseline characteristics" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Surgical remission and complications" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Predictors of surgical remission" ] ] ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Ethical approval" ] 10 => array:2 [ "identificador" => "sec0080" "titulo" => "Informed consent" ] 11 => array:2 [ "identificador" => "sec0085" "titulo" => "Financial support" ] 12 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflict of interest" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-06-19" "fechaAceptado" => "2021-07-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1556283" "palabras" => array:4 [ 0 => "Cushing's disease" 1 => "Surgical remission" 2 => "Pituitary adenoma" 3 => "Transsphenoidal surgery" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1556284" "palabras" => array:4 [ 0 => "Enfermedad de Cushing" 1 => "Remisión quirúrgica" 2 => "Adenoma hipofisario" 3 => "Cirugía transesfenoidal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Identify presurgical factors associated with surgical remission in Cushing's disease (CD).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">All the patients with ACTH-dependent Cushing's Syndrome in follow-up at our centre between 2014–2021 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>40) were identified. Those patients with CD diagnosis who underwent transsphenoidal surgery by the same neurosurgeon (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>32) were included. Surgical remission was defined as plasma cortisol <1.8<span class="elsevierStyleHsp" style=""></span>μg/dl and normal or low urinary free cortisol (UFC) after surgery.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sixty-three per cent (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>20) were women, and the mean age at diagnosis was 42.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17.9 years. Six patients had macroadenomas, 17 had microadenomas, and in the other 9 patients, no pituitary lesion was identified on the MRI. Seven patients were previously operated on in another centre. Surgical remission was achieved in 75% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>24). Only three patients experienced recurrence. No association between pre-surgical demographic (age, sex, comorbidities) or hormonal (UFC, ACTH, late-night salivary cortisol levels) characteristics and the probability of surgical remission was observed. The only variable associated with a greater chance of remission was the presurgical visualisation of the adenoma on MRI (OR 8.3, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02). It was also observed that patients with a history of a previous pituitary surgery had a lower tendency to achieve remission, although statistical significance was not reached (OR 0.17, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.09).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In our experience, 75% of patients with CD achieved biochemical cure after the intervention. Surgical remission was up to eight times more frequent in those patients in whom the adenoma was visualised before the intervention, but no other presurgical predictive factors of cure were identified.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Identificar factores prequirúrgicos asociados a curación en la enfermedad de Cushing.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">De todos los pacientes con síndrome de Cushing dependiente de ACTH en seguimiento en nuestro centro entre 2014-2021 (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>40), se estudiaron aquellos diagnosticados de enfermedad de Cushing que fueron intervenidos por vía transesfenoidal por un mismo neurocirujano (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>32). Se definió curación bioquímica como un cortisol plasmático<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>1,8<span class="elsevierStyleHsp" style=""></span>μg/dl y un cortisol libre urinario normal o bajo tras la cirugía.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El 63% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>20) fueron mujeres y la edad media al diagnóstico de 42,3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17,9 años. Seis pacientes tenían macroadenomas, 17 microadenomas y en el resto no se visualizaba lesión hipofisaria. En 7 pacientes existían antecedentes de una cirugía hipofisaria previa en otro centro. Se alcanzó la remisión quirúrgica en el 75% (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>24). Entre ellos, 3 presentaron recidiva durante el seguimiento. No se observó asociación entre las características demográficas (edad, sexo, comorbilidades) ni hormonales (niveles de cortisol libre urinario, ACTH, cortisol salival nocturno) prequirúrgicas y la probabilidad de curación. La única variable asociada a una mayor probabilidad de curación fue la visualización prequirúrgica del adenoma en la RMN (OR 8,3; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,02). También se observó que los pacientes con antecedentes de cirugía previa presentaban una menor tendencia a la curación, aunque no se alcanzó la significación estadística (OR 0,17; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,09).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En nuestra experiencia, el 75% de los pacientes con enfermedad de Cushing alcanzó la curación bioquímica tras la intervención. La curación fue hasta 8 veces más frecuente en aquellos en los que se visualizaba el adenoma antes de la intervención, pero no se identificaron otros factores prequirúrgicos predictivos de curación.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1695 "Ancho" => 1500 "Tamanyo" => 293453 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Histopathological sample of ACTH-secreting pituitary adenoma not visible on preoperative MRI. (A) Coronal T2 preoperative MRI; (B) Coronal T2 postoperative MRI (reduction of glandular parenchyma was observed after surgery); (C) Material sent HE (macro) where the small fragment of 1<span class="elsevierStyleHsp" style=""></span>mm in diameter corresponding to the tumour is observed); (D) Adenoma HE 4×; (E) Immunohistochemical staining with 4× ACTH antibody.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Reference ranges: serum cortisol (3.7–19.4<span class="elsevierStyleHsp" style=""></span>μg/dl); urinary -free cortisol (<140<span class="elsevierStyleHsp" style=""></span>μg/24<span class="elsevierStyleHsp" style=""></span>h); ACTH (9–46<span class="elsevierStyleHsp" style=""></span>pg/ml); late-night salivary cortisol (<4.2<span class="elsevierStyleHsp" style=""></span>μg/dL), serum glucose (70–110<span class="elsevierStyleHsp" style=""></span>mg/dL), serum potassium (3.5–5.5<span class="elsevierStyleHsp" style=""></span>mEq/mL).</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Global (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>32) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.5% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.0% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.4% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.0% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Visual involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.7% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Headache \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.7% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypopituitarism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.3% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>am serum cortisol (μg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>77.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urinary free cortisol (μg/24<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">256 (range 74.4–1903) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Late-night salivary cortisol (μg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.2 (range 3.2–32.61) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23<span class="elsevierStyleHsp" style=""></span>pm-serum cortisol (μg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.2 (range 8.7–21.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ACTH (pg/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.9 (range 20.9–444) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>mg-dexamethasone suppression test (μg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.3 (range 5.4–28.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glucose (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">113.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>47.93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serum potassium (mEq/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.46 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Population study, baseline characteristics.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">DST, dexamethasone suppression test; LNSC, late-night salivary cortisol; MRI, magnetic resonance imaging; UFC, urinary free cortisol; * per each unit. Presurgical medical treatment makes reference to metopyrone or ketoconazole treatment before surgery. Categorical variables were compared with logistic regression model, considering the non-cured the reference group. Continuous variables were compared with Student's <span class="elsevierStyleItalic">t</span>-test.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cured (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>24) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Not cured (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Odds ratio, 95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>19.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 [0.96–1.04] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.996 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.5% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.5% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 [0.96–1.04] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.979 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ACTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>89.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>41.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.01 [0.99–1.02]* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.469 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>am serum cortisol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>88.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.02 [0.94–1.12]* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.269 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UFC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">510.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>638.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">329.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>123.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 [1.00–1.00]* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.482 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LNSC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.83 [0.61–1.11]* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.093 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DST \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.13 [0.90–1.42]* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.285 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Visible tumour on MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.3% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.5% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.33 [1.39–49.87] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.0% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.17 [0.02–1.42] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.087 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Presurgical medical treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.8% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.85 [0.17–4.20] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.838 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Predictors of surgical remission in Cushing disease.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current management of Cushing's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.A. Tritos" 1 => "B.M.K. Biller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/joim.12975" "Revista" => array:6 [ "tituloSerie" => "J Intern Med" "fecha" => "2019" "volumen" => "286" "paginaInicial" => "526" "paginaFinal" => "541" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31512305" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0160" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cushing's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N. 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Bertherat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2007-2734" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2008" "volumen" => "93" "paginaInicial" => "2454" "paginaFinal" => "2462" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18413427" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0170" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of biochemical remission and recurrence after surgical and radiation treatments of cushing disease: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.M.A. Dabrh" 1 => "N.M.S. Ospina" 2 => "A. Al Nofal" 3 => "W.H. Farah" 4 => "P. Barrionuevo" 5 => "M. Sarigianni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4158/EP15922.RA" "Revista" => array:6 [ "tituloSerie" => "Endocr Pract" "fecha" => "2016" "volumen" => "22" "paginaInicial" => "466" "paginaFinal" => "475" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26789343" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0175" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome of transsphenoidal surgery for Cushing's disease: a high remission rate in ACTH-secreting macroadenomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Fomekong" 1 => "D. Maiter" 2 => "C. Grandin" 3 => "C. Raftopoulos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clineuro.2008.12.011" "Revista" => array:6 [ "tituloSerie" => "Clin Neurol Neurosurg" "fecha" => "2009" "volumen" => "111" "paginaInicial" => "442" "paginaFinal" => "449" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19200645" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0180" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transsphenoidal resection in Cushing's disease: undetectable serum cortisol as the definition of successful treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.J. Trainer" 1 => "H.S. Lawrie" 2 => "J. Verhelst" 3 => "T.A. Howlett" 4 => "D.G. Lowe" 5 => "A.B. 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Original article
Presurgical predictive factors of surgical remission in Cushing's disease. Study of 32 cases
Factores prequirúrgicos predictivos de remisión quirúrgica en la enfermedad de Cushing. Estudio de 32 casos
Marta Araujo-Castroa,b,
, Marta Marchán Pinedoa, María Fernández-Argüesoa, María Pérez Pérezc, Estrella Barrero Ruízc, Héctor Piand, Víctor Rodríguez Berrocalc,e, Eider Pascual-Corralesa
Autor para correspondencia
a Neuroendocrinology Unit, Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal, Madrid, Spain
b Universidad de Alcalá, Departamento de Ciencias de la Salud, Madrid, Spain
c Neuroendocrinology Unit, Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
d Department of Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain
e Endoscopic Skull Base Unit, Department of Neurosurgery, Hospital Universitario HM Puerta del Sur, Madrid, Spain