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

2016 ◽  
Vol 62 (5) ◽  
pp. 66-67
Author(s):  
Inmaculada González Molero ◽  
Laura Gonzalez ◽  
Juan Garcia Arnes ◽  
Silvia Maraver ◽  
Gabriel Olveira ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Adrenal Insufficiency ◽  
Transsphenoidal Surgery ◽  
Serum Cortisol ◽  
Common Complication ◽  
Cushing Disease ◽  
Glucocorticoid Treatment ◽  
Post Surgery ◽  
Post Operative Period ◽  
Basal Cortisol

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 ( 3ºday) 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.

scholarly journals Pituitary function after transsphenoidal surgery including measurement of basal morning cortisol as predictor of adrenal insufficiency

2021 ◽  
Author(s):  
Ida Staby ◽  
Jesper Krogh ◽  
Marianne Klose ◽  
Jonas Baekdal ◽  
Ulla Feldt-Rasmussen ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Predictive Value ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Tumour Size ◽  
Endocrine Function ◽  
Pituitary Function ◽  
Adrenal Axis ◽  
Post Surgery ◽  
Basal Cortisol

Introduction: Patients with pituitary adenomas undergoing transsphenoidal surgery require pre- and post-surgery examination of pituitary hormones. There is currently no consensus on how to evaluate the adrenal axis post-surgery. The aims of this study were to investigate factors that may predict postoperative adrenal insufficiency (AI) and to investigate the overall effect of transsphenoidal surgery on the pituitary function. Methods: One-hundred-and-forty-three consecutive patients who had undergone transsphenoidal surgery for pituitary adenomas were included. Data on tumour size, pituitary function pre-surgery, plasma basal cortisol measured within 48 hours post-surgery and pituitary function 6 months post-surgery were collected. Patients with AI prior to surgery, perioperative glucocorticoid treatment, Cushing’s disease and no re-evaluation after 1 month were excluded (n=93) in the basal cortisol analysis. Results: Low plasma basal cortisol post-surgery, tumour size and previous pituitary surgery were predictors of AI (all p<0.05). A basal cortisol cut-off concentration of 300 nmol/L predicted AI 6 months post-surgery with a sensitivity and negative predictive value of 100%, specificity of 81% and positive predictive value of 25%. New gonadal, thyroid and adrenal axis insufficiencies accounted for 2%, 10% and 10%, respectively. The corresponding recovery rates were 17%, 7% and 24%, respectively Conclusion: Transsphenoidal surgery had an overall beneficial effect on pituitary endocrine function. Low basal plasma cortisol measured within 48 hours after surgery, tumour size and previous surgery were identified as risk factors for AI. Measurement of basal cortisol post-surgery may help identifying patients at risk of developing AI.

scholarly journals Perioperative serum cortisol levels in ACTH sufficient and ACTH deficient patients during transsphenoidal surgery of pituitary adenoma

Endocrine ◽  
2018 ◽  
Vol 62 (1) ◽  
pp. 83-89 ◽  
Author(s):  
Henrik Borg ◽  
Peter Siesjö ◽  
Babar Kahlon ◽  
Sigridur Fjalldal ◽  
Eva Marie Erfurth
Keyword(s):  
Pituitary Adenoma ◽  
Transsphenoidal Surgery ◽  
Serum Cortisol ◽  
Cortisol Levels

scholarly journals Reduced epinephrine reserve in response to insulin-induced hypoglycemia in patients with pituitary adenoma

2007 ◽  
Vol 157 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Shinya Morita ◽  
Michio Otsuki ◽  
Maki Izumi ◽  
Nobuyuki Asanuma ◽  
Shuichi Izumoto ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Adrenal Insufficiency ◽  
Serum Cortisol ◽  
Tolerance Test ◽  
Secondary Adrenal Insufficiency ◽  
Counterregulatory Hormones ◽  
Insulin Tolerance ◽  
Secondary Hypothyroidism ◽  
Severe Impairment ◽  
Plasma Gh

Objective: Hypoglycemia induces rapid secretion of counterregulatory hormones such as catecholamine, glucagon, cortisol, and GH. Insulin-induced hypoglycemia is used for evaluating GH–IGF-I and ACTH–adrenal axes in patients with pituitary disorders. The aim of this study was to determine whether the response of catecholamine secretion to hypoglycemia is disrupted in patients with pituitary adenoma. Methods: The study population comprised 23 patients with pituitary adenoma (non-functioning adenoma or prolactinoma). An insulin tolerance test was performed and serum catecholamines as well as plasma GH and serum cortisol were measured. Results: The study patients showed diminished response of plasma epinephrine to insulin-induced hypoglycemia. With the cutoff level of peak epinephrine for defining severe impairment set at 400 pg/ml, more patients with secondary adrenal insufficiency showed severe impairment of the epinephrine response than did those without it. Peak epinephrine levels to insulin-induced hypoglycemia were significantly correlated with peak cortisol levels. In patients with secondary hypothyroidism, secondary hypogonadism, GH deficiency, or diabetes insipidus, the prevalence of severe impairment of the epinephrine response was similar to that in patients without these deficiencies. Conclusions: Impaired epinephrine secretion in response to insulin-induced hypoglycemia was frequently observed in patients with pituitary adenoma. This disorder was especially severe in patients with secondary adrenal insufficiency.

scholarly journals The Prevalence of Tertiary Adrenal Insufficiency in Patients Receiving Topical Glucocorticoid Treatment for Oral Lichen Planus

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A99-A99
Author(s):  
Margret J Einarsdottir ◽  
Maria Bankvall ◽  
Jairo Robledo-Sierra ◽  
Per-Olof Rödström ◽  
Penelope Trimpou ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Lichen Planus ◽  
Oral Lichen Planus ◽  
Peak Level ◽  
Serum Cortisol ◽  
Clobetasol Propionate ◽  
Stimulation Test ◽  
Glucocorticoid Treatment ◽  
Oral Lichen ◽  
Corticotropin Stimulation

Abstract Objective: Glucocorticoid (GC) treatment suppress the hypothalamic-pituitary-adrenal axis, which may lead to tertiary adrenal insufficiency. This study aimed to investigate the prevalence of tertiary adrenal insufficiency among patients with oral lichen planus treated with topical GC (clobetasol propionate) in the oral cavity, a standard treatment option for this condition. Methods: In this cross-sectional study, we included 24 patients with oral lichen planus receiving long-term (&gt; 6 weeks) clobetasol propionate treatment. Adrenal function was assessed by measuring serum cortisol between 8–9 AM, after a withdrawal of treatment for 48 hours. For patients with serum cortisol concentrations below 280 nmol/L (10 µg/dL), a 250 µg corticotropin stimulation test was performed. Results: Twenty patients had normal serum cortisol concentrations (range 280–621 nmol/L), whereas four patients had low serum cortisol concentrations (13, 45, 63, and 229 nmol/L, respectively). A corticotropin stimulation test revealed partial adrenal insufficiency in two patients (serum cortisol peak level 350 nmol/L and 360 nmol/L) and severe adrenal insufficiency in another two patients (serum cortisol peak level 150 nmol/L and 210 nmol/L). Conclusion: In this small study, approximately 20% of patients receiving chronic topical GCs treatment for oral lichen planus had tertiary adrenal insufficiency. It is essential to be aware of this potential risk and to inform patients about the need for GC stress-doses during an intercurrent illness episode.

scholarly journals Predictive factors for delayed hyponatremia after transsphenoidal surgery in patients with pituitary adenomas

2021 ◽  
Author(s):  
Kunzhe Lin ◽  
Lingling Lu ◽  
Zhijie Pei ◽  
Shuwen Mu ◽  
Shaokuan Huang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Odds Ratio ◽  
Transsphenoidal Surgery ◽  
Post Surgery ◽  
Factors Influencing ◽  
Significant Difference ◽  
Pituitary Thyroid Axis ◽  
Thyroid Axis

Objective: To evaluate the incidence and duration of delayed hyponatremia and to assess the factors influencing the development of delayed hyponatremia after transsphenoidal surgery (TSS) in pituitary adenomas. Methods: We retrospectively analyzed the clinical data of patients with pituitary adenoma who underwent TSS. Univariable and multivariable statistics were carried out to identify factors independently associated with the occurrence of delayed hyponatremia. Results: Of the 285 patients with pituitary adenoma who underwent microscopic TSS, 44 (15.4%) developed postoperative delayed hyponatremia and 241 (84.6%) did not. The onset of delayed hyponatremia occurred an average of 5.84 days post-surgery and persisted for an average of 5.36 days. Logistic regression analysis showed the highest risk of delayed hyponatremia in patients with significant change in tumor cavity height (odds ratio [OR], 1.158; 95% confidence interval [CI], 1.062, 1.262; P = 0.001), preoperative hypothalamus-pituitary-thyroid axis hypofunction(OR, 3.112; 95% CI, 1.481, 6.539; P = 0.003), and significant difference in blood sodium levels before and 2 days after TSS(OR, 1.101; 95% CI, 1.005, 1.206; P = 0.039). Conclusions: Preoperative hypothyroidism, difference in blood sodium levels before and 2 days after TSS, and the change in tumor cavity height after TSS played important roles in predicting postoperative delayed hyponatremia onset in patients with pituitary adenomas.

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

2016 ◽  
Author(s):  
Inmaculada Gonzalez-Molero ◽  
Monserrat Gonzalo-Marin ◽  
Silvia Maraver Selfa ◽  
Laura Gonzalez Garcia ◽  
Rida Naghib ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Serum Cortisol ◽  
Post Operative Period

scholarly journals THE FREQUENCY OF ADRENAL INSUFFICIENCY IN ADOLESCENTS AND YOUNG ADULTS WITH THALASSEMIA MAJOR VERSUS THALASSEMIA INTERMEDIA IN IRAN

2014 ◽  
Vol 7 ◽  
pp. e2015005 ◽  
Author(s):  
Sara Matin ◽  
Masoud Ghanei Jahromi ◽  
Zohreh Karemizadeh ◽  
Sezaneh Haghpanah ◽  
Vincenzo De Sanctis ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Standard Dose ◽  
Serum Cortisol ◽  
Thalassemia Major ◽  
Cross Sectional Study ◽  
Cortisol Response ◽  
Acth Stimulation ◽  
Cross Sectional ◽  
Basal Cortisol ◽  
The Mean

Background: Endocrine dysfunction is not uncommon complication in patients with transfusion dependent thalassemia and is thought to occur as a consequence of excessive iron overload. The main objective of this study is to determine the frequency of adrenal insufficiency in patients with thalassemia major and thalassemia intermediate. Methods: This cross-sectional study was done at the Shiraz University of Medical Sciences, Shiraz, Southern Iran, in 2013. One hundred and ninety patients were divided into two groups; thalassemia major(TM) and thalassemia intermediate (TI) groups. We measured 8 AM serum cortisol, ACTH and ferritin concentrations in all patients. Results: The mean age of the TM and TI group were 22.5±5.7 and 23.8±6 years, respectively. 90 patients (47.4%) were splenectomized,  34 (36.2%) with TM and  56 (58.2%) with TI (p : 0.001). The mean serum ferritin levels were 3056.5±2306 and 666.2±616.5 in TM and TI respectively (p: 0.001).  Three patients with TM (1.6%) had low basal cortisol and ACTH levels. However their cortisol response to ACTH stimulation was normal. Conclusions: Low basal concentrations of cortisol and ACTH occurred in 1.6% of our adolescents young adult patients with TM suggesting a central defect of cortisol secretion at the basal state. However, cortisol response to standard – dose ACTH was normal in all patients with TM and TI.

Pituitary gland recovery following fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenoma: results of a prospective multicenter study

2020 ◽  
Vol 133 (6) ◽  
pp. 1732-1738 ◽  
Author(s):  
Andrew S. Little ◽  
Paul A. Gardner ◽  
Juan C. Fernandez-Miranda ◽  
Michael R. Chicoine ◽  
Garni Barkhoudarian ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Adrenal Insufficiency ◽  
Transsphenoidal Surgery ◽  
Pituitary Surgery ◽  
Male Hypogonadism ◽  
Endoscopic Transsphenoidal Surgery ◽  
Gland Function

OBJECTIVERecovery from preexisting hypopituitarism after transsphenoidal surgery for pituitary adenoma is an important outcome to investigate. Furthermore, pituitary function has not been thoroughly evaluated after fully endoscopic surgery, and benchmark outcomes have not been clearly established. Here, the authors characterize pituitary gland outcomes with a focus on gland recovery following endoscopic transsphenoidal removal of clinically nonfunctioning adenomas.METHODSThis multicenter prospective study was conducted at 6 US pituitary centers among adult patients with nonfunctioning pituitary macroadenomas who had undergone endoscopic endonasal pituitary surgery. Pituitary gland function was evaluated 6 months after surgery.RESULTSThe 177 enrolled patients underwent fully endoscopic transsphenoidal surgery; 169 (95.5%) of them were available for follow-up. Ninety-five (56.2%) of the 169 patients had had a preoperative deficiency in at least one hormone axis, and 20/95 (21.1%) experienced recovery in at least one axis at the 6-month follow-up. Patients with adrenal insufficiency were more likely to recover (10/34 [29.4%]) than were those with hypothyroidism (8/72 [11.1%]) or male hypogonadism (5/50 [10.0%]). At the 6-month follow-up, 14/145 (9.7%) patients had developed at least one new deficiency. The study did not identify any predictors of gland recovery (p ≥ 0.20). Permanent diabetes insipidus was observed in 4/166 (2.4%) patients. Predictors of new gland dysfunction included a larger tumor size (p = 0.009) and Knosp grade 3 and 4 (p = 0.051).CONCLUSIONSFully endoscopic pituitary surgery resulted in improvement of pituitary gland function in a substantial minority of patients. The deficiency from which patients were most likely to recover was adrenal insufficiency. Overall rates of postoperative permanent diabetes insipidus were low. This study provides multicenter benchmark neuroendocrine clinical outcome data for the endoscopic technique.

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