Comparison of one week 0900 h serum cortisol, low and standard dose Synacthen tests with a 4 to 6 week insulin hypoglycaemia test after pituitary surgery in assessing HPA axis

Courtney, C. H.; McAllister, Andrew; McCance, David R.; Bell, P. M.; Hadden, D. R.; Leslie, Hilary; Sheridan, B.; Atkinson, A. B.

doi:10.1046/j.1365-2265.2000.01106.x

Cited by 91 publications

(127 citation statements)

References 17 publications

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“…Morning serum cortisol a week after pituitary surgery is suggested as a screening test. If serum cortisol is %100 nmol/l (3.6 mg/dl), HPA axis insufficiency is present (6,(22)(23)(24). If the serum cortisol level is R400 or 450 nmol/l (14.5-16 mg/dl), the HPA axis is thought to be sufficient (6,(23)(24)(25).…”

Section: Discussionmentioning

confidence: 99%

“…Although controversy exists regarding the optimal test and optimal time for conducting tests in the postoperative period, the ITT is considered to be the gold standard test and is used as reference in clinical trials (6,7,9,12,13).…”

Section: Discussionmentioning

confidence: 99%

“…If serum cortisol is %100 nmol/l (3.6 mg/dl), HPA axis insufficiency is present (6,(22)(23)(24). If the serum cortisol level is R400 or 450 nmol/l (14.5-16 mg/dl), the HPA axis is thought to be sufficient (6,(23)(24)(25). The minimum cortisol levels which would allow us to predict adrenal insufficiency with 100% specifity in the very early (2nd and 3rd) postoperative days were found to be higher than the minimum cortisol levels found on the 6th day.…”

Section: Discussionmentioning

confidence: 99%

“…Different cortisol cut-off levels have been suggested for the 5th or 6th-7th postoperative days according to the ITT at the 4th or 6th postoperative week (6)(7)(8). In one study, the concordance of low and standard dose ACTH stimulation tests and ITT in the early postoperative period with a third month postoperative ITT was examined in 19 patients, and early postoperative dynamic tests were considered to be useless (9).…”

Section: Introductionmentioning

confidence: 99%

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Can basal cortisol measurement be an alternative to the insulin tolerance test in the assessment of the hypothalamic–pituitary–adrenal axis before and after pituitary surgery?

Karaca

Tanrıverdi²,

Atmaca³

et al. 2010

European Journal of Endocrinology

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Background: The aims of this study were to evaluate the validity of preoperative basal serum cortisol levels measured in predicting preoperative adrenal insufficiency and also the validity of basal serum cortisol levels and early postoperative insulin tolerance test (ITT) in predicting postoperative adrenal insufficiency. Methods: The study was prospectively designed and included 64 patients who underwent pituitary surgery for conditions other than Cushing's disease. An ITT was performed preoperatively, on the 6th postoperative day and at the 1st postoperative month. Basal serum cortisol levels were measured on the 2nd, 3rd, 4th, 5th, and 6th postoperative days. Results: Patients with a preoperative basal cortisol level of !165 nmol/l (6 mg/dl) showed insufficient cortisol response and those with levels higher than 500 nmol/l (18 mg/dl) had sufficient cortisol response to the preoperative ITT. The positive predictive value of the ITT performed on the 6th postoperative day was 69.7%, and the negative predictive value in predicting adrenal insufficiency at the 1st postoperative month was 58%. Patients were considered to have an insufficient cortisol response to ITT at the 1st postoperative month if their basal cortisol levels were !193 nmol/l (7 mg/dl) or 220 nmol/l (8 mg/dl) or 193 nmol/l (7 mg/dl) or 165 nmol/l (6 mg/dl) or 83 nmol/l (3 mg/dl) on the 2nd-6th postoperative days respectively. Conclusion: Serum basal cortisol levels may be used as the first-line test in the assessment of the hypothalamic-pituitary-adrenal axis both preoperatively and postoperatively. Dynamic testing should be limited to the patients with indeterminate basal cortisol levels.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Can basal cortisol measurement be an alternative to the insulin tolerance test in the assessment of the hypothalamic–pituitary–adrenal axis before and after pituitary surgery?

Karaca

Tanrıverdi²,

Atmaca³

et al. 2010

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…A basal morning cortisol can be used under certain circumstances, since a concentration less or equal to 100 nmol/L is highly indicative of HPA deficiency (Courtney et al, 2000;Watts & Tindall, 1988), whereas a concentration higher than 400 nmol/L is 52 indicative of HPA sufficiency (Gleeson et al, 2003;Watts & Tindall, 1988). Most commonly basal morning cortisol concentrations are in-between, highly overlapping those of healthy subjects, and dynamic testing is therefore required eventually.…”

Section: Acth Deficiencymentioning

confidence: 99%