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

Abstract

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.

Nasal Irrigation Improves the Nasal Related Quality of Life in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma

“…Transsphenoidal pituitary adenoma resection, as a minimally invasive surgical method for the treatment of pituitary adenomas, can reduce the brain injury caused by craniotomy and accelerate postoperative recovery, but many postoperative nasal complications are of low clinical attention (Butenschoen et al, 2022;Seng & Malilay, 2023). Understanding the nasalrelated quality of life of patients after pituitary adenoma resection is of great significance to postoperative patients with pituitary adenomas.…”