title: Random postoperative day-3 cortisol concentration as a predictor of hypothalamic-pituitary-adrenal axis integrity after transsphenoidal surgery.
abstract: OBJECTIVE
  To determine whether a random postoperative day-3 cortisol value of 10 μg/dL or greater is predictive of adrenal sufficiency 3 to 10 weeks after transsphenoidal surgery (TSS) and during long-term clinical follow-up.
  
  
  METHODS
  We retrospectively reviewed the case records of patients who underwent TSS at our institution between 1991 and 2008. Inclusion criteria were as follows: random cortisol measured on the morning of postoperative day 3, adrenal dynamic testing performed 3 to 10 weeks after TSS, and clinical assessment of the hypothalamic-pituitary-adrenal (HPA) axis at least 6 months after TSS.
  
  
  RESULTS
  A total of 466 patients underwent TSS at our institution during the study period. Eighty-three patients met study inclusion criteria. Sensitivity of a random postoperative day-3 serum cortisol value of 10 μg/dL or greater for the prediction of adrenal sufficiency at a median follow-up of 42 days was 64.81% (95% confidence interval, 50.6%-77.32%), with an odds ratio of 3.1 (95% confidence interval, 1.08-8.58). Specificity was 62.1% (95% confidence interval, 42.3%-79.3%). At a median follow-up of 500 days, only 2 patients with a postoperative day-3 cortisol value of 10 μg/dL or greater required hydrocortisone replacement, both of whom had multiple anterior pituitary hormone deficiencies and evidence of pituitary dysfunction during the perioperative period.
  
  
  CONCLUSIONS
  In the appropriate clinical context, a postoperative day-3 cortisol value of 10 μg/dL or greater accurately predicts the integrity of the HPA axis. The final decision regarding corticosteroid replacement should be personalized, considering the postoperative day-3 cortisol level, the clinical context in which the measurement was obtained, and any evidence of concomitant pituitary dysfunction in the perioperative period.
authors: Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors: Maryam I
authors: MI
authors: Khan
authors: Mouhammed A
authors: MA
authors: Habra
authors: Ian E
authors: IE
authors: McCutcheon
authors: Graciela M
authors: GM
authors: Nogueras-González
authors: Jessica K
authors: JK
authors: Devin
authors: Naifa L
authors: NL
authors: Busaidy
authors: Nicholas B
authors: NB
authors: Levine
authors: Wayne
authors: W
authors: Lindstrom
authors: David
authors: D
authors: Kagan
authors: Camilo
authors: C
authors: Jimenez
authors: Steven G
authors: SG
authors: Waguespack
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000601:surgery*; D010913:Pituitary-Adrenal System / Q000378:metabolism*; D011184:Postoperative Period; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006854:Hydrocortisone