Selective perioperative steroid supplementation protocol in patients undergoing endoscopic transsphenoidal surgery for pituitary adenomas

Chacko, Shireen R; Abraham, Anuja; Asha, Hesarghatta Shyamasunder; Kapoor, Nitin; Rajaratnam, Simon; Chacko, Ari G

doi:10.1007/s00701-020-04530-3

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…29 Studies evaluating the efficacy of postoperative steroid use after pituitary adenoma surgery have been limited by small sample sizes and a lack of clear correlation of steroid use and outcomes. [30][31][32][33][34] More work is needed to explore the role of a postoperative steroid regimen, specifically in patients with normal preoperative endocrine function, undergoing pituitary adenoma surgery. Furthermore, additional research specifically in this population is needed to better establish when glucocorticoid supplementation should be administered to prevent adrenal insufficiency and steroid complications.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Outcomes of a Hydrocortisone Protocol after Endonasal Surgery for Pituitary Adenoma Resection

Alexander

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et al. 2021

J Neurol Surg B Skull Base

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Introduction In pituitary adenomas (PAs), the use of postoperative steroid supplementation remains controversial, as it reduces peritumoral edema and sinonasal complaints but disrupts the detection of adrenal insufficiency (AI). It is unclear whether postoperative cortisol supplementation has a measurable effect on improving outcomes in patients with pituitary adenoma undergoing endoscopic transsphenoidal surgery (ETS). The objective of the study was to evaluate a postoperative steroid treatment protocol on various surgical outcomes in patients with PA undergoing ETS. Methods A retrospective cohort study was performed for patients undergoing ETS from 2005 to 2020 for PA at a single tertiary academic center. Patients were divided into two groups: those managed by a routine postoperative glucocorticoid supplementation protocol (steroid protocol) and those who received supplementation based on postoperative cortisol laboratory assessment (steroid sparing protocol). Management was otherwise the same between groups. Evaluation of length of stay (LOS), sinonasal outcomes, 30-day readmission, and perioperative complications, including AI, were performed. Results Among 535 patients, 21% (n = 111) received postoperative steroids, while the remainder (n = 424) did not. There were no differences in mean LOS (3 vs. 3 days, p = 0.72), sinonasal complaints (27 vs. 19%, p = 0.12), 30-day readmission (5% vs. 5%, p = 0.44), and perioperative complications (5 vs. 5%, p = 0.79) between both the groups. A multivariate model supported that both groups were comparable in predicting LOS, 30-day readmission, and complications. No reduction in readmission for AI was seen. Conclusion Routine administration of postoperative glucocorticoids did not significantly improve patient outcomes in patients with PA who underwent ETS.

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Section: Introductionmentioning

confidence: 99%

Perioperative Outcomes of a Hydrocortisone Protocol after Endonasal Surgery for Pituitary Adenoma Resection

Alexander

Collopy

et al. 2021

J Neurol Surg B Skull Base

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“…Those patients with a basal 8 AM serum cortisol ≥ 440 nmol/l and those with an intact hypothalamo-pituitary-adrenal (HPA) axis were not given glucocorticoids peri-operatively. The serum cortisol levels were measured on the first three post-operative days for those patients as per our protocol to check for post-operative hypocortisolism [14]. Patients with Cushing's disease did not receive peri-operative glucocorticoid cover; their serum cortisol was monitored every morning at 8 AM for three consecutive days following surgery and whenever they had hypocortisolaemic symptoms, to assess for remission.…”

Section: Peri-operative Protocolmentioning

confidence: 99%

Predictors of Delayed Hyponatraemia After Surgery for Pituitary Tumour

et al. 2023

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Delayed hyponatraemia(DH) is a common complication following trans-sphenoidal surgery(TSS) for pituitary tumour. We evaluated the prevalence of DH following TSS, and assessed the factors associated with DH, including early post-operative diabetes insipidus(EPDI). This retrospective study included 100 TSS for pituitary tumours in 98 patients, over a period of 26 months. Subjects were divided into two groups: those who developed hyponatraemia and those who did not develop hyponatraemia, during post-operative days 4 to 14. The clinical characteristics and peri-operative parameters were compared between the two groups, to identify factors predicting DH. The mean age of the patients was 42.0±13.6 years, 58 (59%) were females and 61 (61%) had functional tumours. Thirty-six patients(36%) developed DH following TSS of whom majority(58%) were diagnosed on post-operative days 7 and 8; only 8/36 (22%) were symptomatic. Syndrome of inappropriate antidiuretic hormone secretion(SIADH) was found to be the most common aetiology of DH. On logistic regression analysis, intra-operative cerebrospinal fluid(CSF) leak (OR 5.0; 95% CI 1.9–13.8; p=0.002), EPDI (OR 3.4; 95% CI 1.3–9.2; p=0.015) and peri-operative steroid use (OR 3.6; 95% CI 1.3–9.8; p=0.014) were found to be significantly associated with DH. In conclusion, EPDI, intra-operative CSF leak and peri-operative steroid use were significant predictors of DH. EPDI predicts moderate to severe hyponatraemia with 80% specificity but has low sensitivity(47%). As most patients have asymptomatic hyponatraemia, serum sodium measurement on POD 7 to 10 would be helpful to identify DH in patients at increased risk.

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