Prospective evaluation of a week one overnight metyrapone test with subsequent dynamic assessments of hypothalamic‐pituitary‐adrenal axis function after pituitary surgery

English, Katherine; Inder, Warrick J.; Weedon, Zara; Dimeski, Goce; Sorbello, Jane; Russell, Anthony; Duncan, Emma L.; Cuneo, Ross C.

doi:10.1111/cen.13334

Cited by 11 publications

(5 citation statements)

References 38 publications

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“…We acknowledge that one or two cases of adrenal insufficiency may have been missed using this approach. We used standard HPA axis stimulation tests in routine clinical use in our department, which have been recently compared with the ITT and validated in the setting of pituitary surgery (36). While the insulin tolerance test is considered the gold standard, this would not be the test that the average practising clinician would order for a patient on opioids, and we wanted the study to have clinical relevance.…”

Section: :6 359 Clinical Studymentioning

confidence: 99%

Secondary adrenal insufficiency and pituitary dysfunction in oral/transdermal opioid users with non-cancer pain

Lamprecht

Sorbello

Jang

et al. 2018

European Journal of Endocrinology

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ObjectiveTo evaluate pituitary function, sexual function and quality of life (QoL) in patients on oral or transdermal opioids.Design and methodsCross-sectional study comparing pituitary function, QoL and sexual function in people on long-term opioid therapy (n = 40) vs an age- and sex-matched control group (n = 25). Baseline pituitary function was assessed on blood samples collected prior to 0900 h. Further testing with corticotropin (250 µg IV) and metyrapone (30 mg/kg) stimulation tests was undertaken on participants with serum cortisol <250 nmol/L. Validated questionnaires completed to assess QoL, fatigue and sexual function.ResultsSecondary adrenal insufficiency (SAI) was identified on the basis of a failed stimulation test in 22.5% of opioid users vs no controls (P = 0.01). Opioid users with SAI had a higher median morphine-equivalent daily dose (MEDD),P = 0.037 – 50% with MEDD >200 mg and 0% with MEDD <60 mg had SAI. Among male participants, testosterone was inversely associated with BMI (P = 0.001) but not opioid use. A non-significant trend to low testosterone <8 nmol/L in male opioid users (11/24 opioid users vs 2/14 control,P = 0.08) suggests a small subgroup with opioid-induced androgen deficiency. Opioid users had greater fatigue, reduced quality of life in all subsections of the SF-36 and impaired sexual function in both males and females (all scoresP < 0.001 compared to controls).ConclusionLong-term opioid therapy was associated with dose-related SAI in over 20% of chronic pain patients and is associated with poor quality of life, fatigue and sexual dysfunction. Obesity confounds the interpretation of opioid-induced male androgen deficiency.

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Section: :6 359 Clinical Studymentioning

confidence: 99%

Secondary adrenal insufficiency and pituitary dysfunction in oral/transdermal opioid users with non-cancer pain

Lamprecht

Sorbello

Jang

et al. 2018

European Journal of Endocrinology

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“…In Volume 87, Issue 1 (July 2017) of Clinical Endocrinology , the co‐authors Emma L. Duncan and Ross Cuneo should be acknowledged as joint Senior Authors. The authors regret this error …”

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confidence: 98%

Prospective evaluation of a week one overnight metyrapone test with subsequent dynamic assessments of hypothalamic‐pituitary‐adrenal axis function after pituitary surgery

English¹,

Inder²,

Weedon³

et al. 2017

Clinical Endocrinology

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“…De Vries et al reported a cortisol cut-off value of 325 nmol/L with 100% sensitivity [6] (compared to ITT after a mean of 8 months), measured on an electrochemiluminescent immunoassay (Roche cobas 8000 module e602). English et al reported an optimal cut-off value of 320 nmol/L (determined on a Beckman DxI800 immunoassay analyser) with a sensitivity of 84% (CI 60-97) (cortisol measured on POD3 or POD4, compared to glucocorticoid requirement after 6 months) [8]. Application of a cut-off of 325 nmol/L in our study would result in 5 patients with adrenal insufficiency that would have been missed (leading to a sensitivity of 78%).…”

Section: Discussionmentioning

confidence: 67%

“…The metyrapone test has been established as a safe and reliable test to determine adrenal insufficiency [8]. In our pituitary center there is long-term experience with this test which was internally validated within our center [9].…”

Section: Introductionmentioning

confidence: 99%

Basal cortisol in relation to metyrapone confirmation in predicting adrenal insufficiency after pituitary surgery

Huisman,

Siegelaar,

Hoogmoed

et al. 2024

Pituitary

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Purpose Pituitary surgery can lead to post-surgical adrenal insufficiency with the need for glucocorticoid replacement and significant disease related burden. In patients who do not receive hydrocortisone replacement before surgery, at our center, an early morning plasma cortisol concentration using a cut-off value of 450 nmol/L 3 days after surgery (POD3) is used to guide the need for hydrocortisone replacement until dynamic confirmatory testing using metyrapone. The aim of this study was to critically assess the currently used diagnostic and treatment algorithm in patients undergoing pituitary surgery in our pituitary reference center. Methods Retrospective analysis of all patients with a POD3 plasma cortisol concentration < 450 nmol/L who received hydrocortisone replacement and a metyrapone test after 3 months. Plasma cortisol concentration was measured using an electrochemiluminescence immunoassay (Roche). All patients who underwent postoperative testing using metyrapone at Amsterdam UMC between January 2018 and February 2022 were included. Patients with Cushing’s disease or those with hydrocortisone replacement prior to surgery were excluded. Results Ninety-five patients were included in the analysis. The postoperative cortisol concentration above which no patient had adrenal insufficiency (i.e. 11-deoxycortisol > 200 nmol/L) was 357 nmol/L (Sensitivity 100%, Specificity 31%, PPV:32%, NPV:100%). This translates into a 28% reduction in the need for hydrocortisone replacement compared with the presently used cortisol cut-off value of 450 nmol/L. Conclusion Early morning plasma cortisol cut-off values lower than 450 nmol/L can safely be used to guide the need for hydrocortisone replacement after pituitary surgery.

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Prospective evaluation of a week one overnight metyrapone test with subsequent dynamic assessments of hypothalamic‐pituitary‐adrenal axis function after pituitary surgery

Cited by 11 publications

References 38 publications

Secondary adrenal insufficiency and pituitary dysfunction in oral/transdermal opioid users with non-cancer pain

Secondary adrenal insufficiency and pituitary dysfunction in oral/transdermal opioid users with non-cancer pain

Prospective evaluation of a week one overnight metyrapone test with subsequent dynamic assessments of hypothalamic‐pituitary‐adrenal axis function after pituitary surgery

Basal cortisol in relation to metyrapone confirmation in predicting adrenal insufficiency after pituitary surgery

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