Perioperative cortisol can predict hypothalamus-pituitary-adrenal status in clinically non-functioning pituitary adenomas.
BACKGROUND
Peri-operative steroids are administered routinely to patients with pituitary adenoma undergoing transsphenoidal adenomectomy (TSA).


OBJECTIVE
To evaluate hypothalamic-pituitary-adrenal (HPA) axis before and after programmed endoscopic TSA (E-TSA) in patients with clinically non-functioning pituitary macroadenoma (NFPA).


METHODS
Open prospective.


METHODS
Tertiary referral hospitals.


METHODS
Seventy-two consecutive patients (20-87 yr, 37 males).


METHODS
Adrenal steroid replacement therapy (ASRT) was given only in patients with hypocortisolism [08:00 h cortisol (F) <8 microg/dl].


METHODS
After ETSA, achieving wide (>90%) selective resection of the adenoma in all, F and clinical picture were checked at day 2. The low-dose (1 microg) ACTH test (LDACTH) was performed at 6 weeks and repeated at 12 months.


RESULTS
Hypocortisolism was present pre-operatively in 14 patients (19.4%), persisted post-operatively in all but one, and was detected de novo at the post-operative day 2 control in 6 (10.3%). In all but one the post-operative day 2 basal F and peak F during LDACTH test were concordant. No patient whose F was > 8 microg/dl was treated with ASRT or developed symptoms of adrenal failure during the follow-up (1-11 yr, median 5).


CONCLUSIONS
HPA function is usually preserved in NFPA and is infrequently impaired after complete tumor removal by E-TSA. The 08:00 h. plasma cortisol evaluation before and 2 days after surgery, using as cut-off the value of 8 microg/dl, allows full evaluation of HPA status. Peri-operative steroid treatment should be given only in patients with hypocortisolism.
Cozzi
R
R
Division of Endocrinology, Niguarda Hospital, Milan, Italy.
Lasio
G
G
Cardia
A
A
Felisati
G
G
Montini
M
M
Attanasio
R
R
D000236:Adenoma / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006304:Health Status; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011183:Postoperative Complications / Q000175:diagnosis; D011184:Postoperative Period; D057234:Preoperative Period; D011379:Prognosis; D055815:Young Adult
D006854:Hydrocortisone