Serum cortisol in the early post operative period after transphenoidal surgery to predict adrenal insufficiency

Authors

I. Gonzalez Molero, L. Gonzalez, J. Garcia Arnes, S. Maraver, G. Olveira, M.A. Arraez, F. Tinahones

Affiliations

Malaga Regional Hospital, Malaga, Spain

Abstract

Background. Adrenal insufficiency is a common complication of transsphenoidal surgery (TSS) for pituitary adenoma. It is very important to identify patients requiring glucocorticoid replacement, minimising risks of adrenal insufficiency.

Aim: to assess the performance of early (3º day) post-TSS 08: 00 a.m. cortisol measurement to detect and exclude secondary adrenal insufficiency.

Methods. We selected patients undergoing TSS in our hospital during 12 months and performed a 3º day postoperative 08: 00 a.m. cortisol measurement and cortisol+/-Synachten 6 months post-surgery. All patients received perioperative glucocorticoid replacement (First and second days postsurgery) unless basal cortisol was > 10 microg/dl and cortisol after Synachten > 23 microg/dl previous to surgery. We excluded patients with previous diagnosed and treated adrenal insuficiency. In patients with 3º day cortisol lower than 10 microg/dl we maintained glucocorticoid treatment until reevaluation with cortisol/Synachten 6 months post-surgery.In patients with 3º day cortisol higher than 10 microg/dl glucocorticoids were discontinued.

Results. Data were reviewed from 20 patients (9 males, mean age 52, 8 years), 18 with macroadenomas, 8 patients with cushing disease. Patients with adenomas no cushing: all patients with 3º day cortisol > 15 microg/dl had normal cortisol/Synachten 6 months post-surgery. 2 patients with 3º day cortisol between 10 and 15 microg/dl had adrenal insufficiency 6 months postsurgery.1 patient with 3º day cortisol< 10 microg/dl mantained adrenal insuficiency 6 months postsurgery. Cushing disease: all patients with 3º day cortisol > 10 microg/dl had not adrenal insuficiency 6 months postsurgery, all except one with recurrence. All patients with 3º day cortisol < 10 microg/dl had not recurrences, all except one with adrenal insufficiency.

Conclusion. A 3º day post-TSS cortisol > 15 microg/dl is a safe cutt off to discarge adrenal insufficiency. In cushing disease, a level < 10 microg/dl predict a low likelihood of recurrences.

Keywords

pituitary; cortisol; surgery

Название

Уровень кортизола в сыворотке как предиктор развития надпочечниковой недостаточности у пациентов в раннем послеоперационном периоде после проведения нейрохирургического вмешательства транссфеноидальным доступом

Авторы

I. Gonzalez Molero, L. Gonzalez, J. Garcia Arnes, S. Maraver, G. Olveira, M.A. Arraez, F. Tinahones