Use of day 1 early morning cortisol to predict the need for glucocorticoid replacement after pituitary surgery
| Autor: | Christopher Campbell, J Stephen Davies, Caroline Hayhurst, Sharmistha Roy Chowdhury, D Aled Rees, L N Rao Bondugulapati, Pablo Goetz |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Hypothalamo-Hypophyseal System medicine.medical_specialty Hydrocortisone Pituitary Diseases medicine.medical_treatment Pituitary-Adrenal System 030209 endocrinology & metabolism Young Adult 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Pituitary adenoma medicine Humans Glucocorticoids Aged Retrospective Studies Morning Postoperative Care Transsphenoidal surgery business.industry Pituitary apoplexy Retrospective cohort study General Medicine Middle Aged medicine.disease Surgery Predictive value of tests Anesthesia Female Neurology (clinical) business 030217 neurology & neurosurgery Glucocorticoid Follow-Up Studies medicine.drug |
| Zdroj: | British Journal of Neurosurgery. 30:76-79 |
| ISSN: | 1360-046X 0268-8697 |
| DOI: | 10.3109/02688697.2015.1071325 |
| Popis: | Assessment of adrenal reserve in patients who have undergone pituitary surgery is crucial. However, there is no clear consensus with regards to the type and timing of the test that should be used in the immediate post-operative period. Recently, there has been increased interest in measuring post-operative cortisol levels. We present our data utilising day 1 post-operative early morning cortisol as a tool to assess adrenal reserve in steroid-naive patients.A retrospective analysis of endoscopic pituitary surgery undertaken over a 2-year period. 82 patients underwent 84 surgeries in total. Patients who were already on glucocorticoids pre-operatively and patients with Cushing's disease, pituitary apoplexy and those without follow-up data were excluded, leaving a study group of 44 patients with 45 operations. A 9am day 1 post-operative cortisol value of400 nmol/L was taken as an indicator of adequate adrenal reserve. All the patients were reassessed at 6 weeks with a standard short synacthen test (SST) using 250 micrograms of intravenous synacthen.22 out of 45 patients had a cortisol value of400 nmol/L on day 1 post-operatively and were discharged without glucocorticoid supplementation. Of these, only 2 patients subsequently failed the SST when reassessed at 6-8 weeks. The remaining 23 patients had a cortisol value of400 nmol/L on day 1 post-operatively and were discharged on hydrocortisone 10 mg twice daily. At 6-8 weeks, nine continued to show suboptimal stimulated cortisol levels whereas the remaining fourteen patients showed adequate adrenal reserve. The 9 am cortisol value had high specificity (81.8%) and positive predictive value (90.9%) for integrity of the HPA axis. Sensitivity was 58.8% and negative predictive value was 39.1%.A day 1 post-operative early morning cortisol is a useful tool to predict adrenal reserve post-pituitary surgery, enabling clinicians to avoid unnecessary blanket glucocorticoid replacement. |
| Databáze: | OpenAIRE |
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