ECE2016 Eposter Presentations Pituitary - Clinical (83 abstracts)
“What’s the best approach to perioperative, immediate post op and 6 week post op cortisol assessment and replacement in patients undergoing transsphenoidal pituitary surgery?”
Adnan Tariq 1 , Dhruti Bhatt 1, , Alex Graveling 1 , Prakash Abraham 1 , Kamel Mahmoud 1, , Sandra MacRury 2 & John Bevan 1
1ARI, Aberdeen, UK; 2Raigmore Hospital, Inverness, UK.
Introduction: There is great variation in management of perioperative cortisol management in patient’s undergoing pituitary surgery across UK Hospitals. We evaluated safety and effectiveness of standards followed in ARI. The aim of audit was to confirm safety, improve knowledge and change practice for better patient care if needed based on information gained from the available data.
Description of methods/design: We evaluated 30 patients who have undergone pituitary surgery from 01/01/13 to 31/12/14 for Pituitary adenoma (functioning or non functioning) excluding Cushing’s disease in ARI. Data was gathered from paper notes and using electronic record system about perioperative, immediate post op and 6-week post op cortisol assessment.
Tools for pre-operative HPA Axis Assessment
Results and conclusion: 1. Short synacthen test is effective tool in assessment of perioperative cortisol sufficiency. 2. If SST is not available, basal cortisol can be used but a higher safety bar needs to be used. 3. Early morning cortisol monitoring is important in post op patients deemed steroid sufficient. 4. All patients discharged home without steroid immediately post op remained steroid sufficient at 6-week assessment (100% safety). 5. 50% of patients receiving steroids post surgery were able to discontinue them after 6-weeks review. 6. Some variability in interpretation of SST (often taking into account clinical features and variation of different assay’s used in hospitals). 7. Patients with borderline results need steroid cover for intercurrent illness.
Outcome: Developing leaflet for patients needing intercurrent steroid cover.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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