Question: Is there a way to tell shortly after pituitary surgery if the surgery was successful? Also, how often should a patient be tested and with what tests after pituitary surgery?
 
Answer: We can tell shortly after pituitary surgery whether a patient has been cured with considerable certainty. At our center we measure plasma and urinary free cortisol 4 to 5 days after surgery. Very low or undetectable levels mean that most likely the patient has been cured. One week to 10 days after surgery, we also perform a CRH test to confirm a cure. Absence of a response to CRH is compatible with cure and a very low probability of recurrence. Presence of a normal response to CRH is compatible with cure but may suggest a high probability of recurrence (about 50%). After pituitary surgery, we closely monitor cured patients for up to a year by serially (every 3 months) performing ACTH stimulation tests to define the time of discontinuation of glucocorticoid replacement therapy. In cases where a cure was not obtained by surgery, patients are followed by periodic MRI's.