Cortisol Levels as Predictors of Short- and Long-Term Adrenal Function After Endonasal Transsphenoidal Surgery for Pituitary Adenomas and Rathke's Cleft Cyst

Loyo-Varela, Mauro; Ayala-Ruiz, Aquiles R.; Manrique-Guzman, Salvador

doi:10.1016/j.wneu.2012.10.039

Cited by 2 publications

(4 citation statements)

References 3 publications

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“…Most important is the preservation of an intact hypothalamic-pituitary-adrenal-axis (HPA) regulating in a circadian rhythm and depending on physical stress levels cortisol release through the stimulation of ACTH [15]. Therefore, patients need to be monitored closely for symptoms of hypocortisolism, the most dangerous and life-threatening complication of pituitary deficiency [28], presenting with impaired metabolism such as anorexia, fatigue, hypotension and nausea, and potentially leading to the lethal adrenal crisis including shock and volume depletion called Addison's crisis [18,33]. Many studies have focused on the optimal serum cortisol threshold (or cut-off value) to determine whether a patient suffers from hypocortisolism or not, and to prevent patients from adrenal corticotropic deficiency by substituting hydrocortisone [3,17,29,31,43].…”

Section: Introductionmentioning

confidence: 99%

“…Oral hydrocortisone, the generic pharmaceutical name of cortisol, has a plasma half-life of 1.5 h, a biologic half-life of 8–12 h, and a glucocorticoid potency of 0.8 [ 13 , 36 ]. Minimum serum values range from 4 to 20 μg/dl (morning serum level, 1 µg/dl = 27,59 nmol/l), but only few conducted studies have been performed and published with a long enough follow-up to establish cortisol supplementation criteria [ 24 , 28 , 43 ].…”

Section: Introductionmentioning

confidence: 99%

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Transsphenoidal pituitary adenoma resection: do early post-operative cortisol levels predict permanent long-term hypocortisolism?

et al. 2021

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Transsphenoidal surgery provides a minimal invasive treatment for pituitary adenoma. Our aim is to evaluate the endocrinological outcomes after adenoma resection focusing on the corticotroph function, and to identify prognostic factors for an impaired hypothalamic–pituitary–adrenal-axis function (HPA) and the reliability of postoperative early morning serum cortisol measurements. We performed a retrospective analysis of all patients treated for pituitary adenoma from April 2006 to January 2019 in our neurosurgical department. Pituitary function was assessed pre- and postoperatively as well as at 6 weeks to 12 weeks and at 1-year follow-up. Two hundred eleven patients were included. Nine percent of the patients recovered from a preoperative adrenal insufficiency, 10.4% developed a new need for hormone substitution, and a long-term deficiency of the hypothalamic–pituitary–adrenal-axis was observed in 30.9%. Cortisol measurements 5 days after surgery had a lower area under the curve (AUC) than cortisol levels detected after 6 to 12 weeks (AUC 0.740 vs. AUC 0.808) in predicting an intact corticotrope function. The cut-off value determined for cortisol measured after 6 weeks was 6.95 µg/dl (sensitivity of 94%, specificity of 68%). Postoperative early morning cortisol levels seem to be less sensitive and specific in predicting long-term corticotroph function than measurements after 6 weeks and 1 year, emphasizing the importance of endocrine follow-up testing.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transsphenoidal pituitary adenoma resection: do early post-operative cortisol levels predict permanent long-term hypocortisolism?

et al. 2021

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show abstract

“…Many studies have focused on the optimal serum cortisol threshold (or cut-off value) to determine whether a patient suffers from hypocortisolism or not, and to prevent patients from adrenal corticotropic de ciency by substituting hydrocortisone [37,26,27,14,3]. Minimum values range from 4 to 20 μg/dl (morning serum level, 1 µg/dl = 27,59 nmol/l), but only few conducted studies have been performed and published with a long enough follow-up to establish cortisol supplementation criteria [37,24,20].…”

Section: Introductionmentioning

confidence: 99%

“…Most important is the preservation of an intact hypothalamic-pituitary-adrenal-axis (HPA) regulating in a circadian rhythm and depending on physical stress levels cortisol release through the stimulation of ACTH [12]. Therefore, patients need to be monitored closely for symptoms of hypocortisolism, the most dangerous and life-threatening complication of pituitary de ciency [24], presenting with impaired metabolism such as anorexia, fatigue, hypotension and nausea and potentially leading to the lethal adrenal crisis including shock and volume depletion called Addison's crisis [29,15]. Many studies have focused on the optimal serum cortisol threshold (or cut-off value) to determine whether a patient suffers from hypocortisolism or not, and to prevent patients from adrenal corticotropic de ciency by substituting hydrocortisone [37,26,27,14,3].…”

Section: Introductionmentioning

confidence: 99%

Transsphenoidal Pituitary Adenoma Resection: Do Early Post-Operative Cortisol Levels Predict Permanent Long-Term Hormone Deficiency?

Butenschoen¹,

A²,

Bette³

et al. 2021

Preprint

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Objective: Transsphenoidal surgery provides a minimal invasive treatment for pituitary adenoma. Our aim is to evaluate the endocrinological outcomes after adenoma resection, and to identify prognostic factors for an impaired hypothalamic-pituitary-adrenal- axis function -(HPA) and the reliability of postoperative early morning serum cortisol measurements.Methods: Retrospective analysis of all patients treated for pituitary adenoma from April 2006 to January 2019 in our neurosurgical department. Pituitary function was assessed pre- and postoperatively as well as at 6 weeks to 12 weeks and at 1-year follow-up.Results: 211 patients were included. 9% of the patients recovered from a preoperative adrenal insufficiency, 10.4% developed a new need for hormone substitution, and a long-term deficiency of the hypothalamic-pituitary-adrenal-axis was observed in 30.9%. Cortisol measurements 5 days after surgery had a lower area under the curve (AUC) than cortisol levels detected after 6 to 12 weeks (AUC 0.740 vs. AUC 0.808) in predicting a secondary adrenal insufficiency. The cut-off value determined for cortisol measured after 6 weeks was 6.95 µg/dl (sensitivity of 94%, specificity of 68%).Conclusion: Postoperative early morning cortisol levels seem to be less sensitive and specific in predicting long-term hormone deficiency than measurements after 6 weeks and 1 year, emphasizing the importance of endocrine follow-up testing.

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Cortisol Levels as Predictors of Short- and Long-Term Adrenal Function After Endonasal Transsphenoidal Surgery for Pituitary Adenomas and Rathke's Cleft Cyst

Cited by 2 publications

References 3 publications

Transsphenoidal pituitary adenoma resection: do early post-operative cortisol levels predict permanent long-term hypocortisolism?

Transsphenoidal pituitary adenoma resection: do early post-operative cortisol levels predict permanent long-term hypocortisolism?

Transsphenoidal Pituitary Adenoma Resection: Do Early Post-Operative Cortisol Levels Predict Permanent Long-Term Hormone Deficiency?

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