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The definition of remission and recurrence of Cushing’s Disease
Best Practice & Research Clinical Endocrinology & Metabolism ( IF 7.4 ) Pub Date : 2021-01-13 , DOI: 10.1016/j.beem.2021.101485
José Miguel Hinojosa-Amaya 1 , Daniel Cuevas-Ramos 2
Affiliation  

Accurate classification of postsurgical remission, and early recognition of recurrence are crucial to timely treat and prevent excess mortality in Cushing’s Disease, yet the criteria used to define remission are variable and there is no consensus to define recurrence. Remission is defined as postsurgical hypocortisolemia, but delayed remission may occur. Recurrence is the return of clinical manifestations with biochemical evidence of hypercortisolism. The proper combination of tests and their timing are controversial.

Reliable predicting tools may lead to earlier diagnosis upon recurrence. Many factors have been studied independently for prediction with variable performance. Novel artificial intelligence approaches seek to integrate these variables into risk calculators and machine-learning algorithms with an acceptable short-term predictive performance but lack longer-term accuracy. Prospective studies using these approaches are needed.

This review summarizes the evidence behind the definitions of remission and recurrence and provide an overview of the available tools to predict and/or diagnose them.



中文翻译:

库欣病缓解和复发的定义

术后缓解的准确分类以及对复发的早期识别对于及时治疗和预防库欣病的过度死亡至关重要,但是用于定义缓解的标准是可变的,并且对于定义复发尚无共识。缓解定义为术后皮质醇缺乏症,但可能会出现延迟缓解。复发是具有皮质醇增生的生化证据的临床表现的恢复。测试的正确组合及其时间安排是有争议的。

可靠的预测工具可在复发时导致早期诊断。对于可变性能的预测,已经独立研究了许多因素。新颖的人工智能方法试图将这些变量集成到具有可接受的短期预测性能但缺乏长期准确性的风险计算器和机器学习算法中。需要使用这些方法进行前瞻性研究。

这篇综述总结了缓解和复发定义背后的证据,并提供了预测和/或诊断它们的可用工具的概述。

更新日期:2021-01-13
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