Endocrine Abstracts

Aim: To assess a perioperative glucocorticoid protocol in transsphenoidal surgery (TSS)and the performance of early post-TSS 08:00 cortisol measurement to detect/exclude secondary adrenal insufficiency.

Methods: We selected patients undergoing TSS.In patients with no cushing disease, we checked cortisol/Synachten presurgery, measured 3° postoperative 0800 a.m. cortisol(after 24 h without corticoids) and cortisol/Synachten 3-6 months post-surgery. We excluded patients with previous diagnosed and treated adrenal insuficiency.All included patients received perioperative glucocorticoid replacement (First and second days postsurgery) unless basal cortisol was >10 mcg/dL and cortisol after Synachten >23 mcg/dL previous to surgery (In these patients we measured cortisol in 1 day postsurgery). All patients with cushing disease received perioperative glucocorticoid. In patients with 1°/3° day cortisol lower than 15 we maintained glucocorticoid treatment until reevaluation with cortisol/Synachten 6 months post-surgery.In patients with 1°/3° day cortisol higher than 15 glucocorticoids were discontinued. We evaluated again patients after one year of surgery.

Results: Data were obtained from 52 patients (55,7% women, mean age 46,7+/-15,6 years), Mean tumour size:20.1+/-11.9 (5-51 mm). Diagnosis:40.4% non functioning adenomas, 17,3% acromegaly, 26,9% cushing disease, 7.7% prolactinoma, 7.7% others. 72.4% of patients were treated with glucocorticoids perioperative. Patients with adenomas no cushing: 85% of patients with 1°/3° day cortisol > 15mcg/dL had normal cortisol/Synachten 6 months post-surgery vs 20% of patients with 1°/3° day cortisol <15 (P<0.05). After one year of surgery: 88,2% of patients with 1a/3° day cortisol >15mcg/dL had adrenal sufficiency, 40% of patients with 1a/3° day cortisol between 10 and 15 and 50% of patients with <5 mcg/dL had adrenal sufficiency. 9.1% of patients with adenomas <20 mm had adrenal insufficiency vs 46.2% of patients with adenomas >20 mm (100% if patients had other presurgery deficiencies) (P<0.05). None of the patients without perioperative glucocorticoids had adrenal insufficiency symptoms during perioperative period. Cushing disease: all patients with 3° day cortisol< 5mcg/dL are in remission 1 year after surgery vs 33,3% of patients with 3° day cortisol >5 mcg/dL (P<0.05)

Conclusion: A 3° day post-TSS cortisol > 15mcg/dL is a safe cutt off to discharge adrenal insufficiency. 100% of patients with 3° post-TSS < 5 mcg/dL are in remission 1 year postsurgery. Our protocol to select patients who need or not perioperative glucocorticoids is safe to manage patients with TSS.