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.

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 Endocrine function and gland volume after endoscopic transsphenoidal surgery for nonfunctional pituitary macroadenomas

2019 ◽  
Vol 131 (4) ◽  
pp. 1142-1151 ◽  
Author(s):  
Maya Harary ◽  
Aislyn C. DiRisio ◽  
Hassan Y. Dawood ◽  
John Kim ◽  
Nayan Lamba ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Tumor Size ◽  
Transsphenoidal Surgery ◽  
Endocrine Function ◽  
Pituitary Function ◽  
Pituitary Hormone ◽  
Tumor Diameter ◽  
Endoscopic Transsphenoidal Surgery ◽  
Gland Volume ◽  
The Relationship

OBJECTIVELoss of pituitary function due to nonfunctional pituitary adenoma (NFPA) may be due to compression of the pituitary gland. It has been proposed that the size of the gland and relative perioperative gland expansion may relate to recovery of pituitary function, but the extent of this is unclear. This study aims to assess temporal changes in hormonal function after transsphenoidal resection of NFPA and the relationship between gland reexpansion and endocrine recovery.METHODSPatients who underwent endoscopic transsphenoidal surgery by a single surgeon for resection of a nonfunctional macroadenoma were selected for inclusion. Patients with prior pituitary surgery or radiosurgery were excluded. Patient characteristics and endocrine function were extracted by chart review. Volumetric segmentation of the pre- and postoperative (≥ 6 months) pituitary gland was performed using preoperative and long-term postoperative MR images. The relationship between endocrine function over time and clinical attributes, including gland volume, were examined.RESULTSOne hundred sixty eligible patients were identified, of whom 47.5% were female; 56.9% of patients had anterior pituitary hormone deficits preoperatively. The median tumor diameter and gland volume preoperatively were 22.5 mm (interquartile range [IQR] 18.0–28.8 mm) and 0.18 cm3 (IQR 0.13–0.28 cm3), respectively. In 55% of patients, endocrine function normalized or improved in their affected axes by median last clinical follow-up of 24.4 months (IQR 3.2–51.2 months). Older age, male sex, and larger tumor size were associated with likelihood of endocrine recovery. Median time to recovery of any axis was 12.2 months (IQR 2.5–23.9 months); hypothyroidism was the slowest axis to recover. Although the gland significantly reexpanded from preoperatively (0.18 cm3, IQR 0.13–0.28 cm3) to postoperatively (0.33 cm3, IQR 0.23–0.48 cm3; p < 0.001), there was no consistent association with improved endocrine function.CONCLUSIONSRecovery of endocrine function can occur several months and even years after surgery, with more than 50% of patients showing improved or normalized function. Tumor size, and not gland volume, was associated with preserved or recovered endocrine function.

scholarly journals NCOG-53. PREDICTORS OF ENDOCRINE OUTCOME AFTER ENDOSCOPIC TRANSSPHENOIDAL SURGERY FOR NON-FUNCTIONING PITUITARY ADENOMAS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii141-ii141
Author(s):  
Jenie Hwang ◽  
Diane Yum ◽  
Michael Chicoine ◽  
Ralph Dacey ◽  
Joshua Osbun ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
De Novo ◽  
Postoperative Recovery ◽  
Endocrine Function ◽  
Male Hypogonadism ◽  
Endoscopic Transsphenoidal Surgery ◽  
Thyroid Axis ◽  
Negative Predictor ◽  
New Onset

Abstract BACKGROUND Although endoscopic transsphenoidal surgery (ETSS) is an established treatment for patients with nonfunctioning pituitary adenomas (NFPAs), data are limited regarding the rates and predictors of pituitary dysfunction and recovery in a large cohort of NFPA patients undergoing ETSS. OBJECTIVE To analyze the comprehensive changes in hormonal function and identify factors that predict recovery or worsening of hormonal axes following ETSS for NFPA. METHODS Among a cohort of 601 consecutive patients who underwent ETSS for NFPA between 2010 and 2018 at Washington University in Saint Louis, recovery or development of new hypopituitarism was retrospectively analyzed in 209 patients. RESULTS Preoperative endocrine deficits were observed in 59.8% of patients (125/209), and the deficit rates were 76.8% for male gonadal axis (86/112), 42.5% for thyroid axis, 25.8% for growth hormone axis, and 15.8% for cortisol axis. Recovery of preoperative pituitary deficit was noted in all four axes, with highest recovery in the cortisol axis with a 1-year cumulative recovery rate of 44.3%. New-onset postoperative hypopituitarism occurred most frequently in the thyroid axis (24.3%, 27/111) and least frequently in the cortisol axis (9.7%, 16/165). Multivariate analyses revealed axis-specific predictors of postoperative recovery and de novo deficiency. Older age was a negative predictor for recovery of both male hypogonadism (P= 0.04) and adrenal insufficiency (P=0.046), and a larger tumor volume was a negative predictor for recovery of hypothyroidism (P=0.043). Although higher body mass index was generally associated with any new postoperative pituitary deficit (P=0.03), most predictors of new onset deficits also differed by hormone axis. CONCLUSIONS Dynamic changes in pituitary hormonal levels were observed in a significant fraction of patients following ETSS in NFPA patients. The specific hormonal axis dictated postoperative endocrine vulnerability, recovery, and predictors of recovery or loss of endocrine function.

Recovery of the hypothalamus-pituitary-adrenal axis after transsphenoidal surgery for pituitary adenomas

2017 ◽  
Author(s):  
Eck J P van ◽  
S J C M M Neggers ◽  
J A M J L Janssen ◽  
Rijke Y B de ◽  
A H G Dallenga ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Adrenal Axis ◽  
Hypothalamus Pituitary Adrenal Axis ◽  
Pituitary Adrenal Axis

Recovery of visual and endocrine function following transsphenoidal surgery of large nonfunctioning pituitary adenomas

1994 ◽  
Vol 17 (9) ◽  
pp. 703-707 ◽  
Author(s):  
M. Marazuela ◽  
B. Astigarraga ◽  
A. Vicente ◽  
J. Estrada ◽  
C. Cuerda ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Endocrine Function ◽  
Nonfunctioning Pituitary Adenomas

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 Testing of Adrenal Axis Function in Patients With Combined Pituitary Hormone Deficiency Caused by PROP1 Mutation

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A635-A635
Author(s):  
Aleksandra Gilis-Januszewska ◽  
Damian Rogoziński ◽  
Andrzej Jerzy Nowak ◽  
Beata Piwońska-Solska ◽  
Agata Zygmunt-Górska ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Underlying Mechanism ◽  
Pituitary Function ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Maximal Concentration ◽  
Maximal Increase ◽  
Adrenal Axis ◽  
Morning Cortisol ◽  
The Mean

Abstract Background: The mechanism of adrenal axis deterioration in PROP1 mutation remains uncertain and challenging. Aim: The aim of the project was to investigate the adrenal axis function in patients with combined pituitary function deficiency and PROP1 mutation. Methods: We performed the corticotrophin (CRH) stimulation test in 15 patients ((8W/7M) with confirmed CPHD due to the PROP1 mutation. 9/15 were familial cases from four families. Time of observation (ToO) was calculated since the first pituitary axis/ACTH insufficiency has occurred. The results were reported in the group with confirmed Adrenal Insufficiency (AI) and without AI defined as cortisol &gt;18 ug/dl at any point during CRH test. ACTH is reported in pg/ml and cortisol in ug/dl, time of test is given in minutes (0‘, 15’,30’,45’,60’,120’). Results: The mean age of the group was 40,6 ± 12,1 years with mean 34,7 ± 10,3 years of CPHD observation (range 18 – 54 years). The In 5/15 the cortisol response met the criteria excluding AI. Among siblings there were patients both with/without AI. Both subgroups had similar ToO (without AI 35,6 ± 10,0 years vs 34,2 ± 10,3 years with AI). Mean time of AI duration was 15,0 ± 9,3 years. In the group of 5 patients without AI the mean morning cortisol was 12,48 ± 4,31 and ACTH was 31,26 ± 5,43. The mean maximal concentration of cortisol and ACTH were 24,94 ± 3,6 and 123,6 ± 39,9 respectively; Mean increase of cortisol was 12,46 ±4,04 and 92,34±34,48 for ACTH. In 10 patients with AI the mean morning cortisol was 3,33±1,39 and ACTH 22,71±6,75. The mean maximal concentration of cortisol and ACTH were 10,15±4,47 and 97,05 ± 59,15 respectively; Mean increase of cortisol was 6,83 ± 3,41 and 74,35 ± 53,72 for ACTH. For two patients high ACTH increase from 36,7 to 260 and from 28,65 to 112,0 was observed. Analysis of cortisol and ACTH response in both groups revealed that in group without AI the time of peak of ACTH was observed in 15’ (2/5) and 30’ (3/5) vs. in 15’(3/10), 30’(6/10) and 45’ in group with AI. The peak cortisol was observed in 30’, 45’ and 60’ (3/5) in group without AI vs 60’(6/10) or 120’ (4/10) in AI group. The mean maximal increase of ACTH was by 4,09±1,46 and 4,12±1,58 in AI group vs no AI group respectively. Conclusions: In patients with PROP1 mutation the adrenal axis can deteriorate long after other axis insufficiencies, however there are patients with no adrenal insufficiency even during lifelong observation. There is no specific order of deterioration even among affected siblings. In the vast majority of patients independently of cortisol increase there is ACTH response after CRH. Further studies on the pituitary function deterioration in patients with PROP1 mutation should be carried out to understand better the underlying mechanism and to set up the diagnostic timing and procedures.

Optimal Surgical Approaches for Rathke Cleft Cyst With Consideration of Endocrine Function

2011 ◽  
Vol 70 (suppl_2) ◽  
pp. ons250-ons258 ◽  
Author(s):  
Jeong Kyung Park ◽  
Eun Jig Lee ◽  
Sun Ho Kim
Keyword(s):  
Visual Field ◽  
Transsphenoidal Surgery ◽  
Endocrine Function ◽  
Pituitary Function ◽  
Female Ratio ◽  
Rathke Cleft Cyst ◽  
Function Test ◽  
The Mean ◽  
Pituitary Function Test

ABSTRACT BACKGROUND: Surgical indications for Rathke cleft cyst are not clear. OBJECTIVE: To evaluate postoperative outcomes in terms of endocrine function. METHODS: The study analyzed a total 73 patients who underwent transsphenoidal surgery. All patients underwent a visual field test, combined pituitary function test, and magnetic resonance imaging before and after surgery. A follow-up combined pituitary function test was performed at 1.5-year intervals. RESULTS: The mean age at the time of surgery was 35 ± 14 years, and the male/female ratio was 1:1.25 (33/40). The mean follow-up duration after surgery was 59 ± 39 months. The most common symptoms were headache (84%), visual disturbance (48%), and polyuria (38%). After transsphenoidal surgery, 75% of polyuria and 96% of visual field defects were resolved, and pituitary function improved in 42% of patients. The mean age of patients who exhibited worsened hypopituitarism was significantly higher than that of patients who exhibited unchanged or improved hypopituitarism (44 ± 15.7 vs 33 ± 13.5 years; P = .02). Twelve patients (16%) experienced recollection of cyst, but none required reoperation. Five of the recollected cysts presented with characteristics that were different from those of the initial lesions, and 2 recollected cysts underwent spontaneous regression. CONCLUSION: Minimal incision with radical removal of cyst content is reasonable to prevent the development of endocrine disturbances and other complications. Individualized risks and benefits must be assessed before a decision is reached regarding surgery and surgical method. Patients with recurrent Rathke cleft cyst require careful follow-up with special attention rather than a hasty operation.

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