Perioperative Cortisol can predict hypothalamus-pituitary-adrenal status in clinically non-functioning pituitary adenomas

Cozzi, Renato; Lasio, Giovanni; Cardia, Andrea; Felisati, Giovanni; Montini, M; Attanasio, Roberto

doi:10.1007/bf03346486

Cited by 35 publications

(30 citation statements)

References 37 publications

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“…However, the long study period and logistic restraints forced us to simplify classification of adrenal function by considering morning basal cortisol level and clinical response to glucocorticoid replacement in doubtful cases rather than the response to stimulation tests. Other authors reported that morning basal cortisol level using a cutoff of 80 ng/ml was well correlated to the low-dose ACTH test response in patients undergoing surgery for NFPA (32). Even though misclassification of adrenal function may have occurred in some cases, we think it is unlikely to affect our main results.…”

Section: Surgery For Pituitary Incidentalomasmentioning

confidence: 67%

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Losa

Donofrio

Barzaghi

et al. 2013

European Journal of Endocrinology

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Objective: Few data are available on the surgical results in patients with incidentally discovered nonfunctioning pituitary adenoma (NFPA). We investigated the efficacy and safety of surgery in patients with incidentally discovered NFPA. Design: Retrospective analysis of prospectively recorded outcomes. Methods: From 1990 to 2011, of 804 consecutive patients undergoing surgery for NFPA, 212 cases had an incidentally discovered tumor (26.4%). Among them, 117 patients were asymptomatic, while 95 had some visual and/or hormonal deficit. The main outcome of the study was to evaluate the frequency of radical resection as judged on the first postoperative neuroimaging study and detection of recurring disease during long-term follow-up. Results: Postoperative residual tumor was detected in 8.9% of patients with asymptomatic incidentalomas as compared with 31.2% of patients with symptomatic incidentalomas (P!0.001) and 41.2% of patients in the control group (P!0.001). Multivariate analysis confirmed that having an asymptomatic incidentaloma was independently associated with a better outcome. The 5-year recurrence-free survival in patients with incidentaloma was 86.8% (95% CI 80.2-92.4%) as compared with 77.9% (95% CI 73.6-82.2%; P!0.01) in the control group. This difference was almost completely due to a lower frequency of relapse in asymptomatic patients. Multivariate analysis confirmed the independent lower risk of tumor recurrence in asymptomatic NFPA. Conclusion: Our study shows for the first time that surgically treated patients with asymptomatic NFPA have a better early and long-term outcome that is independent from all the other demographic, clinical, and morphologic characteristics of the patients.

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Section: Surgery For Pituitary Incidentalomasmentioning

confidence: 67%

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Losa

Donofrio

Barzaghi

et al. 2013

European Journal of Endocrinology

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“…In our institution, full-dose steroid (10 mg/kg methylpredonisolone) was used preemptively from postoperative day 5 to postoperative day 7 to prevent acute cellular rejection. This early full-dose steroid therapy might have had an effect on this nonfunctioning adenoma [8]. Cozzi et al [8] reported that hypothalamic-pituitary-adrenal function might be preserved by perioperative full-dose steroid for patients with clinically nonfunctioning pituitary macroadenoma.…”

Section: Discussionmentioning

confidence: 99%

Pituitary apoplexy precipitating diabetes insipidus after living donor liver transplantation

et al. 2011

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Pituitary apoplexy occurring after surgery is a rare but life-threatening acute clinical condition that follows extensive hemorrhagenous necrosis within a pituitary adenoma. Pituitary apoplexy has been reported to occur spontaneously in the majority of cases or in association with various inducing factors. Reported is a case of pituitary apoplexy complicated by diabetes insipidus following living donor liver transplantation (LDLT). To the best of our knowledge, this has not been previously reported. A 56-year-old woman with nonalcoholic steatohepatitis underwent LDLT from her daughter. The patient also required dopamine support and transfusions because of massive intraoperative bleeding. Postoperatively, her coagulopathy continued, and she underwent a second laparotomy because of unknown bleeding on postoperative day 7, when she needed transfusions and dopamine support to maintain her vital signs. She complained of severe headache, excessive thirst, frequent urination, and diplopia from postoperative day 10. She also had polyuria greater than 300 ml/h and was diagnosed with pituitary apoplexy precipitating diabetes insipidus on postoperative day 13. She was treated conservatively without surgery because of the hormonally inactive status and slight mass effect of her tumor. It is important for anesthesiologists and critical care personnel in LDLT settings to take into consideration this complication as a differential diagnosis.

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“…En 22 pacientes, sólo se contó con un cortisol plasmático basal, medido en ayunas antes de las 9:00 am y se consideró normal un cortisol plasmático basal ≥ 15 µg/dl 2,[13][14][15][16] . Los pacientes fueron clasificados en dos grupos según los siguientes criterios.…”

Section: Protocolo De Administración De Glucocorticoidesunclassified

“…Nosotros decidimos adoptar una conducta más conservadora y considerar como eucortisolicos a los pacientes con un cortisol basal > 15 µg/dl 2,[13][14][15][16] . Respecto a la ausencia de hipocortisolismo post operatorio, nuestra población incluyó 17% de macroadenomas mayores de 3 cm, con función cortisolica pre operatoria conservada.…”

Section: Seguridad De Protocolos De Administración Selectivaunclassified

“…Esta complicación está determinada por le experiencia del neurocirujano, el número de cirugías previas y el tamaño tumoral 1 . La incidencia reportada es variable, con cifras que van desde 1% hasta 10,3% [2][3][4][5] . En el caso de resección de macroadenomas gigantes (mayores de 3 cm), el compromiso de más de un eje hipofisiario producto del acto quirúrgico puede alcanzar hasta 13% 1 .…”

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Criterios para la indicación selectiva de glucocorticoides en pacientes con tumores hipofisiarios sometidos a cirugía transesfenoidal

Carrasco

2014

Rev. méd. Chile

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Perioperative Cortisol can predict hypothalamus-pituitary-adrenal status in clinically non-functioning pituitary adenomas

Cited by 35 publications

References 37 publications

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Pituitary apoplexy precipitating diabetes insipidus after living donor liver transplantation

Criterios para la indicación selectiva de glucocorticoides en pacientes con tumores hipofisiarios sometidos a cirugía transesfenoidal

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