Evaluation of different hydrocortisone treatment strategies in transsphenoidal pituitary surgery

Fridman-Bengtsson, Ola; Höybye, Charlotte; Porthén, Laura; Stjärne, Pär; Hulting, Anna‐Lena; Sunnergren, Ola

doi:10.1007/s00701-019-03885-6

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…An interesting finding in our study is the fact that a fairly large group of patients increased their need for postoperative hormonal substitution after surgery. The majority of these patients were treated with postoperative hydrocortisone as additional hormonal substitution and we know from a previous study that hydrocortisone treatment is more commonly used in our institution compared to international standards [10]. This fact may very well influence the true need for postoperative hormonal substitution, and should perhaps be analyzed in detail separately.…”

Section: Discussionmentioning

confidence: 97%

Remission, complications, and overall survival in transsphenoidal pituitary surgery—a Swedish single-center experience of 578 patients

et al. 2023

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Background Surgical treatment of pituitary lesions causing hormonal overproduction or mass effect is standard procedure. There are few reports on the results and complications related to these surgeries from Northern Europe. Our aim was to evaluate the outcome and complications of a single tertiary surgical center over more than a decade. Methods This was a retrospective study on all patients that underwent pituitary surgery from 1st of January 2005 to 31st of December 2017. The analysis included type of lesion, surgical method, pre- and postoperative need for hormonal substitution, hormonal outcome, complications to surgery, survival, need for revision surgery, or stereotactic radiation. Appropriate statistical analyses were made to evaluate surgical results, complications, and survival. Results Five hundred seventy-eight patients were included in the study. Remission was achieved in 58% of patients with GH-producing and 94% of ACTH-releasing adenomas. Sixty-six percent had no preoperative hormonal substitution compared to 39% postoperatively. Rhinosinusitis (10%) was the most commonly reported postoperative complication followed by leakage of cerebrospinal fluid (8%) and meningitis (4%). Standardized mortality rate for the study population was higher (p = 0.18) when compared to the general population. Conclusion Our results regarding remission rates and complications are in comparison with previous studies. Surgery of pituitary lesion can be considered a safe and efficient surgery. We noted lower rates of CSF leakage in the later part of the study period and believe that this, in part, was an effect by the introduction of a multidisciplinary surgical skull base team and increased surgical experience.

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Section: Discussionmentioning

confidence: 97%

Remission, complications, and overall survival in transsphenoidal pituitary surgery—a Swedish single-center experience of 578 patients

et al. 2023

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“…Therefore, they concluded that there is no necessity to receive routine cortisol replacement for patients with normal morning serum cortisol levels. Fridman-Bengtsson et al 32 evaluated different hydrocortisone treatment strategies in transsphenoidal pituitary surgery. The authors compared three groups: high dose, intermediate dose and low dose hydrocortisone substitution.…”

Section: Discussionmentioning

confidence: 99%

Endocrinological aspects of pituitary adenoma surgery in Europe

Netuka

Grotenhuis

Foroglou

et al. 2022

Sci Rep

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Hormone-secreting adenomas are treated in many neurosurgical centers within Europe. The goal of the survey is to understand variance in practice management of pituitary tumors amongst neurosurgical centers. A list of departments performing pituitary surgery was created. The survey consisted of 58 questions. This study focuses on neurosurgical care of hormone-secreting adenomas. For analysis, the departments were divided into four subgroups: academic/non-academic, high-volume/low-volume, “mainly endoscopic/mainly microscopic practice” and geographical regions. Data from 254 departments from 34 countries were obtained. Most centers surgically treat 1–5 hormone-secreting adenomas per year. In prolactinomas this is the case in 194 centers, (76.4%), in GH-secreting adenomas: 133 centers, (52.4%), ACTH-secreting adenomas: 172 centers, (69.8%). Surgery as a primary treatment of prolactinomas is considered in 64 centers (25.2%). In 47 centers (18.8%), GH-secreting microadenomas are often treated pharmacologically first. Debulking surgery for an invasive GH-secreting adenoma in which hormonal remission is not a realistic goal of the surgery and the patient has no visual deficit surgery is always or mostly indicated in 156 centers (62.9%). Routine postoperative hydrocortisone replacement therapy is administered in 147 centers (58.6%). Our survey shows that in most centers, few hormone-secreting adenomas are treated per year. In about 25% of the centers, prolactinoma surgery may be regarded as first-line treatment; in about 20% of the centers, medical treatment is the first-line treatment for GH-secreting adenomas. Pretreatment for ACTH-secreting adenomas is routinely used in 21% of centers. This survey may serve as plea for neurosurgical care centralization of hormone-secreting adenomas.

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“…Therefore, they concluded that there is no necessity to receive routine cortisol replacement for patients with normal morning serum cortisol levels. Fridman-Bengtsson et al evaluated different hydrocortisone treatment strategies in transsphenoidal pituitary surgery [31].…”

Section: Discussionmentioning

confidence: 99%

Endocrinological Aspects of Pituitary Adenoma Surgery in Europe

Netuka

Grotenhuis

Foroglou

et al. 2021

Preprint

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Purpose:Hormone-secreting adenomas are treated in many neurosurgical centers within Europe. The goal of the survey is to shed light on different endocrinological aspects of hormone-secreting adenomas surgery.Methods: A list of departments performing pituitary surgery was created. The survey consisted of 58 questions. This study focuses on neurosurgical care of hormone-secreting adenomas. For analysis, the departments were divided into four subgroups: academic/non-academic, high-volume/low-volume, “mainly endoscopic/mainly microscopic practice” and geographical regions. Results: Data from 254 departments from 34 countries were obtained. Most centers surgically treat 1-5 hormone-secreting adenomas per year. In prolactinomas this is the case in 194 centers, (76.4%), in GH-secreting adenomas: 133 centers, (52.4%), ACTH-secreting adenomas: 172 centers, (69.8%). Surgery as a primary treatment of prolactinomas is considered in 64 centers (25.2%). In 47 centers (18.8%), GH-secreting microadenomas are often treated pharmacologically first. Debulking surgery for an invasive GH-secreting adenoma in which hormonal remission is not a realistic goal of the surgery and the patient has no visual deficit surgery is always or mostly indicated in 156 centers (62.9%). Routine postoperative hydrocortisone replacement therapy is administered in 147 centers (58.6%). Conclusions:Our survey shows that in most centers, few hormone-secreting adenomas are treated per year. In about 25% of the centers, prolactinoma surgery may be regarded as first-line treatment; in about 20% of the centers, medical treatment is the first-line treatment for GH-secreting adenomas. Pretreatment for ACTH-secreting adenomas is routinely used in 21% of centers. This survey may serve as plea for neurosurgical care centralization of hormone-secreting adenomas.

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Evaluation of different hydrocortisone treatment strategies in transsphenoidal pituitary surgery

Cited by 8 publications

References 26 publications

Remission, complications, and overall survival in transsphenoidal pituitary surgery—a Swedish single-center experience of 578 patients

Remission, complications, and overall survival in transsphenoidal pituitary surgery—a Swedish single-center experience of 578 patients

Endocrinological aspects of pituitary adenoma surgery in Europe

Endocrinological Aspects of Pituitary Adenoma Surgery in Europe

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