Use of morning serum cortisol level after transsphenoidal resection of pituitary adenoma to predict the need for long-term glucocorticoid supplementation

Abstract

A morning total cortisol level>or=15 microg/dl in the early postoperative period after transsphenoidal surgery for pituitary adenomas is a good predictor of normal HPA function. This test has good sensitivity and accuracy and correlates well with the results of additional, definitive assays of HPA function (CST, ITT, and MTT) performed at 1-3 months postoperatively. Accordingly, it is the authors' practice to avoid exogenous perioperative glucocorticoid supplementation in patients with normal preoperative HPA function and postoperative morning total cortisol levels>or=15 microg/dl 1-2 days after transsphenoidal pituitary adenomectomy.

Can basal cortisol measurement be an alternative to the insulin tolerance test in the assessment of the hypothalamic–pituitary–adrenal axis before and after pituitary surgery?

“…They performed an ITT or metyrapone test on only 12 patients with abnormal ACTH stimulation test results. Since the number of patients on whom ITTs were performed were limited (8,31) and lower cut-off values for sufficient cortisol response to ITT (equal or higher than 500 nmol/l) were used (8), it is difficult to make a comparison between these studies and the present study.…”

Immediate postoperative cortisol levels accurately predict postoperative hypothalamic–pituitary–adrenal axis function after transsphenoidal surgery for pituitary tumors

“…Our findings demonstrated, in patients with a normal HPA axis pre-operatively, and who did not receive peri-operative glucocorticoid coverage, that this assay reliably and accurately discriminates between patients with normal HPA axes and those with HPA axis dysfunction [11]. A serum cortisol level C15 lg/dL correlated well with long-term preservation of normal HPA axis function after surgery [11,12].…”

“…We recently reported a separate cohort of 84 patients in whom we used a single, 7 am serum cortisol level obtained on the morning of the first postoperative day (POD1) to predict the need for long-term glucocorticoid supplementation after transsphenoidal pituitary surgery [11,12]. Our findings demonstrated, in patients with a normal HPA axis pre-operatively, and who did not receive peri-operative glucocorticoid coverage, that this assay reliably and accurately discriminates between patients with normal HPA axes and those with HPA axis dysfunction [11].…”

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

“…Nuestro estudio concuerda con lo planteado por otros autores en el sentido de que valores sobre 15 µg/dl permiten predecir con alta seguridad la preservación del eje corticotropico post cirugía 5,12,21,28 . Si bien encontramos que pacientes con cortisol de 10 a 14,9 µg/dl también muestran preservación del eje, no es posible sacar conclusiones definitivas debido al número limitado de pacientes en este grupo (n = 5).…”

“…Sin embargo, esto no invalida nuestros resultados respecto a la seguridad del protocolo en la identificación de pacientes que pueden ser dados de alta sin corticoides ni al valor predictor del cortisol post operatorio. La ausencia de hipocortisolismo post quirúrgico nos impidió además el cálculo de los falsos negativos del cortisol post operatorio, reportado en el 1 a 4,7% de los casos en estudios previos 5,21,28 . En conclusión, la aplicación de un protocolo de administración selectiva de glucocorticoides en el peri-operatorio de la cirugía transesfenoidal de adenomas hipofisiarios es segura.…”