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. 2021 Jul 14;10(7):750-757.
doi: 10.1530/EC-21-0155.

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

Ida Staby  1 , Jesper Krogh  1 , Marianne Klose  1 , Jonas Baekdal  1 , Ulla Feldt-Rasmussen  1   2 , Lars Poulsgaard  3 , Jacob Bertram Springborg  3 , Mikkel Andreassen  1   2
Affiliations

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

Ida Staby et al. Endocr Connect. .

Abstract

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 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 h 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 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 h after surgery, tumour size and previous surgery were identified as risk factors for AI. Measurement of basal cortisol post-surgery may help to identify patients at risk of developing AI.

Keywords: adrenal insufficiency; basal cortisol; central hypothyroidism; hypogonadotropic hypogonadism; pituitary endocrine function; pituitary surgery; transsphenoidal surgery.

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Figures

Figure 1
Figure 1
Summary of patients evaluated both pre- and post-surgery for each of the three investigated axes (adrenal axis, thyroid axis and gonad axis). AI, adrenal insufficiency; NFPAs, non-functioning pituitary adenomas; TSH, thyroid-stimulating hormone; LH, luteinizing hormone; FSH, follicle-stimulating hormone; T4, thyroxine.
See this image and copyright information in PMC

References

    1. Ostrom QT, Patil N, Cioffi G, Waite K, Kruchko C, Barnholtz-Sloan JS. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2013–2017. Neuro-Oncology 2020. 22 (Supplement 2) iv, 1–iv. (10.1093/neuonc/noaa200) - DOI - PMC - PubMed
    1. Fernández-Balsells MM, Murad MH, Barwise A, Gallegos-Orozco JF, Paul A, Lane MA, Lampropulos JF, Natividad I, Perestelo-Pérez L, De León-Lovatón PGPet al. Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. Journal of Clinical Endocrinology and Metabolism 2011. 96 905–912. (10.1210/jc.2010-1054) - DOI - PubMed
    1. Prete A, Corsello SM, Salvatori R. Current best practice in the management of patients after pituitary surgery. Therapeutic Advances in Endocrinology and Metabolism 2017. 8 33–48. (10.1177/2042018816687240) - DOI - PMC - PubMed
    1. Stack BC, Bimston DN, Bodenner DL, Brett EM, Dralle H, Orloff LA, Pallota J, Snyder SK, Wong RJ, Randolph GW. American Association of Clinical Endocrinologists and American College of Endocrinology disease state clinical review: postoperative hypoparathyroidism – definitions and management. Endocrine Practice 2015. 21 674–685. (10.4158/EP14462.DSC) - DOI - PubMed
    1. Murad MH, Fernández-Balsells MM, Barwise A, Gallegos-Orozco JF, Paul A, Lane MA, Lampropulos JF, Natividad I, Perestelo-Pérez L, De León-Lovatón PGPet al. Outcomes of surgical treatment for nonfunctioning pituitary adenomas: a systematic review and meta-analysis. Clinical Endocrinology 2010. 73 777–791. (10.1111/j.1365-2265.2010.03875.x) - DOI - PubMed

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