Pituitary function after transsphenoidal surgery including measurement of basal morning cortisol as predictor of adrenal insufficiency
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Pituitary function after transsphenoidal surgery including measurement of basal morning cortisol as predictor of adrenal insufficiency. / Staby, Ida; Krogh, Jesper; Klose, Marianne; Baekdal, Jonas; Feldt-Rasmussen, Ulla; Poulsgaard, Lars; Springborg, Jacob Bertram; Andreassen, Mikkel.
I: Endocrine Connections, Bind 10, Nr. 7, 2021, s. 750-757.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Pituitary function after transsphenoidal surgery including measurement of basal morning cortisol as predictor of adrenal insufficiency
AU - Staby, Ida
AU - Krogh, Jesper
AU - Klose, Marianne
AU - Baekdal, Jonas
AU - Feldt-Rasmussen, Ulla
AU - Poulsgaard, Lars
AU - Springborg, Jacob Bertram
AU - Andreassen, Mikkel
N1 - Publisher Copyright: © 2021 The authors Published by Bioscientifica Ltd.
PY - 2021
Y1 - 2021
N2 - Introduction: Patients with pituitary adenomas undergoing transsphenoidal surgery require pre-and post-surgery examination of pituitary hormones. There is currently no consensus on how to evaluate the adrenal axis post-surgery. The aims of this study were to investigate factors that may predict postoperative adrenal insufficiency (AI) and to investigate the overall effect of transsphenoidal surgery on pituitary function. Methods: One hundred and forty-three consecutive patients who had undergone transsphenoidal surgery for pituitary adenomas were included. Data on tumour size, pituitary function pre-surgery, plasma basal cortisol measured within 48 h post-surgery and pituitary function 6 months post-surgery were collected. Patients with AI prior to surgery, perioperative glucocorticoid treatment, Cushing’s disease and no re-evaluation after 1 month were excluded (n = 93) in the basal cortisol analysis. Results: Low plasma basal cortisol post-surgery, tumour size and previous pituitary surgery were predictors of AI (all P < 0.05). A basal cortisol cut-off concentration of 300 nmol/L predicted AI 6 months post-surgery with sensitivity and negative predictive value of 100%, specificity of 81% and positive predictive value of 25%. New gonadal, thyroid and adrenal axis insufficiencies accounted for 2, 10 and 10%, respectively. The corresponding recovery rates were 17, 7 and 24%, respectively Conclusion: Transsphenoidal surgery had an overall beneficial effect on pituitary endocrine function. Low basal plasma cortisol measured within 48 h after surgery, tumour size and previous surgery were identified as risk factors for AI. Measurement of basal cortisol post-surgery may help to identify patients at risk of developing AI.
AB - Introduction: Patients with pituitary adenomas undergoing transsphenoidal surgery require pre-and post-surgery examination of pituitary hormones. There is currently no consensus on how to evaluate the adrenal axis post-surgery. The aims of this study were to investigate factors that may predict postoperative adrenal insufficiency (AI) and to investigate the overall effect of transsphenoidal surgery on pituitary function. Methods: One hundred and forty-three consecutive patients who had undergone transsphenoidal surgery for pituitary adenomas were included. Data on tumour size, pituitary function pre-surgery, plasma basal cortisol measured within 48 h post-surgery and pituitary function 6 months post-surgery were collected. Patients with AI prior to surgery, perioperative glucocorticoid treatment, Cushing’s disease and no re-evaluation after 1 month were excluded (n = 93) in the basal cortisol analysis. Results: Low plasma basal cortisol post-surgery, tumour size and previous pituitary surgery were predictors of AI (all P < 0.05). A basal cortisol cut-off concentration of 300 nmol/L predicted AI 6 months post-surgery with sensitivity and negative predictive value of 100%, specificity of 81% and positive predictive value of 25%. New gonadal, thyroid and adrenal axis insufficiencies accounted for 2, 10 and 10%, respectively. The corresponding recovery rates were 17, 7 and 24%, respectively Conclusion: Transsphenoidal surgery had an overall beneficial effect on pituitary endocrine function. Low basal plasma cortisol measured within 48 h after surgery, tumour size and previous surgery were identified as risk factors for AI. Measurement of basal cortisol post-surgery may help to identify patients at risk of developing AI.
KW - Adrenal insufficiency
KW - Basal cortisol
KW - Central hypothyroidism
KW - Hypogonadotropic hypogonadism
KW - Pituitary endocrine function
KW - Pituitary surgery
KW - Transsphenoidal surgery
U2 - 10.1530/EC-21-0155
DO - 10.1530/EC-21-0155
M3 - Journal article
C2 - 34137733
AN - SCOPUS:85111935612
VL - 10
SP - 750
EP - 757
JO - Endocrine Connections
JF - Endocrine Connections
SN - 2049-3614
IS - 7
ER -
ID: 276277425