Day 5 Morning Serum Cortisol Predicts Hypothalamic-Pituitary-Adrenal Function after Transsphenoidal Surgery for Pituitary Tumors

Abstract

BACKGROUND:Adrenal insufficiency is a complication of transsphenoidal surgery (TSS) for pituitary adenoma, and correct identification of patients requiring glucocorticoid replacement is important. Controversy exists over which early postoperative 9 AM cortisol concentration reliably predicts hypothalamic-pituitaryadrenal (HPA) axis reserve, as defined by the insulin tolerance test (ITT).

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?

“…They performed an ITT or metyrapone test on only 12 patients with abnormal ACTH stimulation test results. Since the number of patients on whom ITTs were performed were limited (8,31) and lower cut-off values for sufficient cortisol response to ITT (equal or higher than 500 nmol/l) were used (8), it is difficult to make a comparison between these studies and the present study.…”

“…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).…”

Criterios para la indicación selectiva de glucocorticoides en pacientes con tumores hipofisiarios sometidos a cirugía transesfenoidal

“…variable según los estudios 5,[21][22][23][24][25][26][27] . Un meta-análisis concluyó que valores bajo 5 µg/dl y superiores a 13 µg/dl son altamente predictores de deficiencia e indemnidad del eje corticotrópico, respectivamente 15 , cifras inferiores a las propuestas en las guías clínicas 12 .…”

“…Un trabajo retrospectivo en el cual se indicó en forma rutinaria corticoides mostró una especificidad de 69,2% para predecir eucortisolismo 26 , cifra inferior a nuestros resultados y a lo publicado en estudios prospectivos 5 . Esto podría explicarse por la supresión de los corticotropos normales frente a los corticoides exógenos y la dificultad en la recuperación espontánea del eje adrenal.…”

Determination of Cortisol in Human Serum Using Ultrasonic Extraction Coupled With Isotope Dilution Liquid Chromatography–mass Spectrometry

“…[1] Cortisol is a steroid hormone that is important for the regulation of both metabolic rates and growth. [2] Abnormal cortisol levels are an indication of a wide variety of diseases, such as Addison's disease, Cushing's syndrome, and the onset of diabetes. Therefore, accurate measurement of cortisol is important for monitoring the production of steroid hormones and adrenal function.…”