Selective perioperative steroid supplementation protocol in patients undergoing endoscopic transsphenoidal surgery for pituitary adenomas
| Autor: | Simon Rajaratnam, Shireen R Chacko, Nitin Kapoor, Ananth P Abraham, Ari G Chacko, Hesarghatta Shyamasunder Asha |
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| Rok vydání: | 2020 |
| Předmět: |
Adenoma
Adult Male Hypothalamo-Hypophyseal System medicine.medical_specialty Pituitary gland Hydrocortisone Hormone Replacement Therapy medicine.medical_treatment Pituitary-Adrenal System Neurosurgical Procedures Perioperative Care 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Pituitary adenoma Sphenoid Bone Adrenal insufficiency Humans Medicine Pituitary Neoplasms Aged Retrospective Studies Transsphenoidal surgery Cerebrospinal Fluid Leak Cerebrospinal fluid leak business.industry Pituitary tumors Endoscopy Perioperative Middle Aged medicine.disease Surgery medicine.anatomical_structure Female Steroids Neurology (clinical) business Hyponatremia 030217 neurology & neurosurgery |
| Zdroj: | Acta Neurochirurgica. 162:2381-2388 |
| ISSN: | 0942-0940 0001-6268 |
| Popis: | There is no consensus regarding the use of perioperative steroids for transsphenoidal pituitary surgery. We audited the effectiveness and safety of our selective perioperative steroid supplementation protocol in patients with pituitary adenomas. Two hundred ninety-seven patients underwent 306 endoscopic transsphenoidal surgeries for removal of their pituitary tumors. Steroids were given to those with an impaired hypothalamic-pituitary-adrenal (HPA) axis, age ≥ 60 years, clinical apoplexy, hyponatremia, or if the pituitary gland was not preserved at surgery. We excluded 111 patients in whom the integrity of the HPA axis could not be determined. We compared the incidence of early postoperative adrenal insufficiency and complications in 135 patients with intact HPA axes who underwent surgery without steroids (group A) with 60 patients who had compromised preoperative HPA axes and received perioperative steroids (group B). In addition, we audited the total number of protocol violations during this period. Five patients (3.7%) in group A developed postoperative hypocortisolemia. There was no significant difference in the incidence of cerebrospinal fluid leak, diabetes insipidus, or hyponatremia between both groups. There were protocol deviations in 47 (15.4%) patients. Twenty one of these patients did not receive perioperative steroids in violation of the protocol, of whom 4 (19%) developed postoperative hypocortisolemia. Our steroid sparing protocol was both safe and effective. The 15% incidence of protocol deviations is a reminder that the rigorous usage of checklists is mandatory for successful clinical practice. |
| Databáze: | OpenAIRE |
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