Peri-operative glucocorticoid replacement therapy in transsphenoidal pituitary adenoma surgery: a prospective controlled study

Kristof, Rudolf A.; Wichers, M.; Haun, Dorothee; Redel, L.; Klingmüller, Dietrich; Schramm, Johannes

doi:10.1007/s00701-008-1517-x

Cited by 16 publications

(21 citation statements)

References 12 publications

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“…As mentioned above, the continuation of increased cortisol secretion in some patients after pituitary surgery may limit the ability to define a cut-off value for HPA axis sufficiency (21,30). The sensitivity of the cut-off levels determined in the present study was found to be very low.…”

Section: Discussionmentioning

confidence: 56%

“…Patients with pituitary adenomas other than Cushing's disease, with an intact HPA axis, have previously been shown to have higher daily urinary free cortisol levels in the postoperative period than patients undergoing surgery for lumbar disc disease (30). The highest levels of urinary cortisol were found on the day of surgery, these declined steadily but remained elevated for a longer period of time than in patients with lumbar disc disease (30). In another study, morning serum cortisol levels were shown to double on the day of pituitary surgery, dropping to normal ranges on the 4th postoperative day (21).…”

Section: Discussionmentioning

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: 56%

Section: Discussionmentioning

confidence: 99%

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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“…Two different head motion strategies, translational movement [7], [8] and bidirectional rotation [9], have been applied clinically. Since in these studies head motion was combined with an intensified lumboventricular lavage [9], the contribution of bidirectional rotation to the clearance of the subarachnoid space is difficult to dissect from the effect of increased CSF flow.…”

Section: Introductionmentioning

confidence: 99%

In Vitro Study of Cerebrospinal Fluid Dynamics in a Shaken Basal Cistern after Experimental Subarachnoid Hemorrhage

et al. 2012

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BackgroundCerebral arterial vasospasm leads to delayed cerebral ischemia and constitutes the major delayed complication following aneurysmal subarachnoid hemorrhage. Cerebral vasospasm can be reduced by increased blood clearance from the subarachnoid space. Clinical pilot studies allow the hypothesis that the clearance of subarachnoid blood is facilitated by means of head shaking. A major obstacle for meaningful clinical studies is the lack of data on appropriate parameters of head shaking. Our in vitro study aims to provide these essential parameters.Methodology/Principal FindingsA model of the basal cerebral cistern was derived from human magnetic resonance imaging data. Subarachnoid hemorrhage was simulated by addition of dyed experimental blood to transparent experimental cerebrospinal fluid (CSF) filling the model of the basal cerebral cistern. Effects of various head positions and head motion settings (shaking angle amplitudes and shaking frequencies) on blood clearance were investigated using the quantitative dye washout method. Blood washout can be divided into two phases: Blood/CSF mixing and clearance. The major effect of shaking consists in better mixing of blood and CSF thereby increasing clearance rate. Without shaking, blood/CSF mixing and blood clearance in the basal cerebral cistern are hampered by differences in density and viscosity of blood and CSF. Blood clearance increases with decreased shaking frequency and with increased shaking angle amplitude. Head shaking facilitates clearance by varying the direction of gravitational force.Conclusions/SignificanceFrom this in vitro study can be inferred that patient or head shaking with large shaking angles at low frequency is a promising therapeutic strategy to increase blood clearance from the subarachnoid space.

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“…Adequate replacement of corticotrophic and thyrotrophic axes deficiencies before surgery is indicated, or at least, the glucocorticoid immediately before surgery in emergency cases to reduce surgical risk (66). The replacement should be kept in the postoperative period until further evaluation of all pituitary function is made.…”

Section: Surgerymentioning

confidence: 99%

A review on the diagnosis and treatment of patients with clinically nonfunctioning pituitary adenoma by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

Neto

Boguszewski

Araújo

et al. 2016

Arch. Endocrinol. Metab.

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Clinically nonfunctioning pituitary adenomas (NFPA) are the most common pituitary tumors after prolactinomas. The absence of clinical symptoms of hormonal hypersecretion can contribute to the late diagnosis of the disease. Thus, the majority of patients seek medical attention for signs and symptoms resulting from mass effect, such as neuro-ophthalmologic symptoms and hypopituitarism. Other presentations include pituitary apoplexy or an incidental finding on imaging studies. Mass effect and hypopituitarism impose high morbidity and mortality. However, early diagnosis and effective treatment minimizes morbidity and mortality. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism is to provide a review of the diagnosis and treatment of patients with NFPA, emphasizing that the treatment should be performed in reference centers. This review is based on data published in the literature and the authors' experience. Arch Endocrinol Metab. 2016;60(4):374-90

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Peri-operative glucocorticoid replacement therapy in transsphenoidal pituitary adenoma surgery: a prospective controlled study

Cited by 16 publications

References 12 publications

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?

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?

In Vitro Study of Cerebrospinal Fluid Dynamics in a Shaken Basal Cistern after Experimental Subarachnoid Hemorrhage

A review on the diagnosis and treatment of patients with clinically nonfunctioning pituitary adenoma by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

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