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Gupta N, Konsam BD, Walia R, Bhadada SK, Chhabra R, Dhandapani S, Singh A, Ahuja CK, Sachdeva N, Saikia UN. An objective way to predict remission and relapse in Cushing disease using Bayes' theorem of probability. J Endocrinol Invest 2024:10.1007/s40618-024-02336-z. [PMID: 38619729 DOI: 10.1007/s40618-024-02336-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 02/12/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE In this study on patients with Cushing disease, post-transsphenoidal surgery (TSS), we attempt to predict the probability of remaining in remission, at least for a year and relapse after that, using Bayes' theorem and the equation of conditional probability. The number of parameters, as well as the weightage of each, is incorporated in this equation. DESIGN AND METHODS The study design was a single-centre ambispective study. Ten clinical, biochemical, radiological and histopathological parameters capable of predicting Cushing disease remission were identified. The presence or absence of each parameter was entered as binary numbers. Bayes' theorem was applied, and each patient's probability of remission and relapse was calculated. RESULTS A total of 145 patients were included in the study. ROC plot showed a cut-off value of the probability of 0.68, with a sensitivity of 82% (range 73-89%) and a specificity of 94% (range 83-99%) to predict the probability of remission. Eighty-one patients who were in remission at 1 year were followed up for relapse and 23 patients developed relapse of the disease. The Bayes' equation was able to predict relapse in only 3 out of 23 patients. CONCLUSIONS Using various parameters, remission of Cushing disease can be predicted by applying Bayes' theorem of conditional probability with a sensitivity and a specificity of 82% and 94%, respectively. This study provided an objective way of predicting remission after TSS and relapse in patients with Cushing disease giving a weightage advantage to every parameter.
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Affiliation(s)
- N Gupta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), 1010, Nehru Extension Block, Chandigarh, 160012, India
| | - B D Konsam
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), 1010, Nehru Extension Block, Chandigarh, 160012, India
| | - R Walia
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), 1010, Nehru Extension Block, Chandigarh, 160012, India.
| | - S K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), 1010, Nehru Extension Block, Chandigarh, 160012, India
| | - R Chhabra
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S Dhandapani
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - A Singh
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - C K Ahuja
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - N Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), 1010, Nehru Extension Block, Chandigarh, 160012, India
| | - U N Saikia
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Dutta A, Gupta N, Walia R, Bhansali A, Dutta P, Bhadada SK, Pivonello R, Ahuja CK, Dhandapani S, Hajela A, Simeoli C, Sachdeva N, Saikia UN. Remission in Cushing's disease is predicted by cortisol burden and its withdrawal following pituitary surgery. J Endocrinol Invest 2021; 44:1869-1878. [PMID: 33453019 DOI: 10.1007/s40618-020-01495-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/26/2020] [Indexed: 12/16/2022]
Abstract
AIM To ascertain the predictors of remission and relapse in patients of Cushing's disease (CD) undergoing pituitary transsphenoidal surgery (TSS). METHODS Patients with CD subjected to TSS over 35 years at a tertiary care center were included. Patients were grouped into remission and persistent disease at 1 year after surgery, and were further followed up for relapse. Demographic, clinical, biochemical, histological, radiological and post-operative follow-up parameters were analyzed. RESULTS Of the 152 patients of CD, 145 underwent TSS. Remission was achieved in 95 (65.5%) patients at 1 year. Patients in remission had shorter duration of symptoms prior to presentation (p = 0.009), more frequent presence of proximal myopathy (p = 0.038) and a tumor size of < 2.05 cm (p = 0.016) in comparison to those with persistent disease. Post-TSS, immediate post-operative 0800-h cortisol (< 159.85 nmol/L; p = 0.001), histological confirmation of tumor (p = 0.045), duration of glucocorticoid replacement (median 90 days; p = 0.001), non-visualization of tumor on MRI (p = 0.003), new-onset hypogonadism (p = 0.001), 3-month 0800-h cortisol (< 384.9 nmol/L; p = 0.001), resolution of diabetes (p = 0.001) and hypertension (p = 0.001), and recovery of hypothalamic-pituitary-adrenal axis (p = 0.018) favored remission. In logistic regression model, requirement of glucocorticoid replacement (p = 0.033), and resolution of hypertension post-TSS (p = 0.003) predicted remission. None of the parameters could predict relapse. CONCLUSION The study could ascertain the predictors of remission in CD. Apart from the tumor characteristics, surgical aspects and low post-operative 0800-h cortisol, the results suggest that baseline clinical parameters, longer glucocorticoid replacement, and resolution of metabolic complications post-TSS predict remission in CD. Long-term follow-up is essential to look for relapse.
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Affiliation(s)
- A Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension block, Chandigarh, 160012, India
| | - N Gupta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension block, Chandigarh, 160012, India
| | - R Walia
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension block, Chandigarh, 160012, India.
| | - A Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension block, Chandigarh, 160012, India
| | - P Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension block, Chandigarh, 160012, India
| | - S K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension block, Chandigarh, 160012, India
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - C K Ahuja
- Department of Radiology, PGIMER, Chandigarh, India
| | - S Dhandapani
- Department of Neurosurgery, PGIMER, Chandigarh, India
| | - A Hajela
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension block, Chandigarh, 160012, India
| | - C Simeoli
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - N Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension block, Chandigarh, 160012, India
| | - U N Saikia
- Department of Histopathology, PGIMER, Chandigarh, India
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Ghuman M, Gupta V, Singh S, Dhandapani S, Khandelwal N. Left Common Carotid Artery Agenesis with Hypoplastic Left Internal Carotid Artery Originating from the Aortic Arch: A Rare Anomaly Presenting with Internal Carotid Artery Aneurysm and Subarachnoid Hemorrhage. J Clin Interv Radiol ISVIR 2017. [DOI: 10.1055/s-0036-1597952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractMost arch anomalies are asymptomatic and detected incidentally on imaging or on autopsy. Occasionally, such anomalies can manifest clinically when associated with another vascular pathology such as an intracranial aneurysm. In this report, we describe a rare case of agenesis of the left common carotid artery with separate origin of the left internal carotid artery and the external carotid artery from the arch discovered on digital subtraction angiography performed during the evaluation of subarachnoid hemorrhage. Knowledge of such anomalies and radiographic appearance is essential for interventional neuroradiologist in planning treatment of such cases.
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Affiliation(s)
- Mandeep Ghuman
- Department of Radiodiagnosis and Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Gupta
- Department of Radiodiagnosis and Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankhneel Singh
- Department of Radiodiagnosis and Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S. Dhandapani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - N. Khandelwal
- Department of Radiodiagnosis and Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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