Ketoconazole before transsphenoidal surgery in Cushing’s disease patiens as a good alternative to glucocorticoids perioperatory treatment

E Venegas; A Soto; M Vazquez; R Guerrero; A Pumar; JM Montero; N Garcia; MA Mangas; A Leon; A Leal-Cerro

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Endocrine Abstracts (2007) 14 P541

ECE2007 Poster Presentations (1) (659 abstracts)

Ketoconazole before transsphenoidal surgery in Cushing’s disease patiens as a good alternative to glucocorticoids perioperatory treatment

E Venegas ¹ , A Soto ¹ , M Vazquez ¹ , R Guerrero ¹ , A Pumar ¹ , JM Montero ² , N Garcia ¹ , MA Mangas ¹ , A Leon ³ & A Leal-Cerro ¹

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Author affiliations

¹Departament of Endocrinology and Nutrition, Hospital Universitario Virgen del Rocío, Sevilla, Spain; ²Departament of Neurosurgery, Hospital Universitario Virgen del Rocío, Sevilla, Spain; ³Departament of Laboratory, Hospital Universitario Virgen del Rocío, Sevilla, Spain.

Cushing’s disease is a debilitating endocrinopathy characterized by excessive cortisol levels in the blood which may be produced from tumours of the pituitary gland. The only way to achieve long term cure of Cushing’s disease is by Transphenoidal removal of the adenoma. ketoconazole, inhibit steroid (cortisol) production in the adrenal glands.

The use of glucocorticids treatment before and after hypophisectomy is a classic management in the perioperative Cushing disease patients.

Aim: To assess if ketoconazole treatment previous to pituitary surgery could free the plasma cortisol postsurgical determination from any interference from steroid substitute treatment without clinical risks for patients. To evaluate in how many patients we can avoid systematic substitutive treatment.

Method: We have treated 38 Cushing’s disease patients with ketoconazole (400–800 mg/d) during 3–6 weeks before the pituitary surgery and we have evaluated the plasmatic cortisol levels immediately after the surgery. Neither intraoperatory nor immediately postoperatory glucocorticoids were administrated until hypocortisolims were diagnosticated.

Results: In 9 of 38 patients (23.68%) substitutive treatment was not necessary. 26 of 38 patients needs glucocorticoids treatment: 11 in the 3–7 days after the surgery, (2 of them with symptomatic hypocortisolims), and 13 about 30 days after the surgery. In 12 cases (31.58%) the substitutive treatment was iniciated because of laboratory hypocortisolims and in 14 cases (36.8%) the treatment was started because of clinical suspicious of hypocortisolims.

Conclusions: The treatment with Ketoconazole before pituitary surgery can allow us the measure of plasmatic cortisol postoperatory without the interference of de substitutive treatment in a security way, and in some patients we can avoid systematic substitutive treatment.