title: UTILITY OF A GLUCOCORTICOID SPARING STRATEGY IN THE MANAGEMENT OF PATIENTS FOLLOWING TRANSSPHENOIDAL SURGERY.
abstract: OBJECTIVE
  Following transsphenoidal surgery (TSS), it is important to assess for and manage adrenal insufficiency (AI). The goal of this study is to assess the efficacy and safety of a glucocorticoid (GC) sparing protocol to limit GC exposure in patients undergoing TSS.
  
  
  METHODS
  Adult patients undergoing TSS (excluding Cushing disease) with adequate adrenal function prior to surgery underwent TSS without perioperative GC coverage. Following TSS, daily morning fasting serum cortisol levels were tested. GCs were administered at stress doses for serum cortisol <5 mcg/dL, between 5 and 12 mcg/dL in the presence of clinically significant symptoms of AI, or >12 mcg/dL with severe headache, nausea or vomiting, fatigue, anorexia, or hyponatremia. The primary endpoint was the use of GCs in the immediate postoperative period.
  
  
  RESULTS
  Of 178 subjects, GCs were administered to 80 (45%) patients for the following indications: 31.3% for serum cortisol <5 mcg/dL; 36.3% for cortisol between 5 and 12 mcg/dL accompanied by symptoms or signs of AI; 8.8% for moderate to severe postoperative hyponatremia; and 7.5% for severe headache, nausea and vomiting, fatigue, or anorexia with cortisol >12 mcg/dL. Logistic regression analysis showed that longer length of hospital stay (odds ratio [OR] 1.22, confidence interval [CI] 1.02-1.45) and the presence of new postoperative anterior pituitary hormone deficiency (OR 3.3, CI 1.26-8.67) were associated with postoperative GC use. By 12 weeks, only 14% of subjects remained on GCs. There were no adverse events related to withholding GCs.
  
  
  CONCLUSIONS
  Our protocol for managing GC replacement is both safe and effective for limiting GC exposure in patients undergoing TSS.
  
  
  BACKGROUND
  AI = adrenal insufficiency CI = confidence interval FSH = follicle-stimulating hormone GC = glucocorticoid GH = growth hormone IGF-1 = insulin-like growth factor-1 IV = intravenous LH = luteinizing hormone LOS = length of hospital stay OR = odds ratio TSS = transsphenoidal surgery.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Jia
authors.forename: Arjun V
authors.initials: AV
authors.lastname: Pendharkar
authors.forename: Pooja
authors.initials: P
authors.lastname: Loftus
authors.forename: Robert L
authors.initials: RL
authors.lastname: Dodd
authors.forename: Olivia
authors.initials: O
authors.lastname: Chu
authors.forename: Merav
authors.initials: M
authors.lastname: Fraenkel
authors.forename: Laurence
authors.initials: L
authors.lastname: Katznelson
mesh_terms: D000236:Adenoma / Q000097:blood / Q000601:surgery*; D000293:Adolescent; D000309:Adrenal Insufficiency / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007018:Hypopituitarism / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010911:Pituitary Neoplasms / Q000097:blood / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy*; D011184:Postoperative Period; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D006854:Hydrocortisone