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Endocrine Abstracts (2018) 59 P005 | DOI: 10.1530/endoabs.59.P005

SFEBES2018 Poster Presentations Adrenal and steroids (38 abstracts)

A model to predict Hypothalamic-Pituitary-Adrenal (HPA) axis recovery at 6 weeks post trans sphenoidal adenomectomy: a single-centre retrospective analysis

Riccardo Pofi 1, , Sonali Gunatilake 1 , Andrea M Isidori 2 , Andrea Lenzi 2 , Victoria Macgregor 1 , Simon Cudlip 3 , Bahram Jafar-Mohammadi 1 , Jeremy W Tomlinson 1 & Aparna Pal 1


1Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK; 2Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; 3Department of Neurosurgery, Oxford, UK.


Background: Hypopituitarism can occur post trans-sphenoidal adenomectomy(TSA). Accurate prediction of HPA axis recovery would inform hydrocortisone replacement strategies but there are limited studies on this. In our centre, HPA axis is assessed with pre-operative short synacthen test (SST), day-8 post TSA 9am cortisol and 6-week post-TSA SST. Patients are commenced on hydrocortisone post TSA until 6 weeks review.

Methods: We performed a single-centre, longitudinal, retrospective analysis of 118 consecutive patients undergoing TSA between January 2016-March 2018. Multiple regression models were used to identify variables contributing to 6-week post-TSA HPA axis recovery. Patients with apoplexy, corticotroph adenomas, radiotherapy or incomplete data sets (pre- and post-op SST plus day 8 cortisol) were excluded.

Results: Multiple regression analysis was conducted on 64 patients. 36 were excluded due to incomplete data points, 10 as corticotrophs, 4 as apoplexy, 4 received radiotherapy. Post-op day 8 cortisol above 210 nmol/l (AUC ROC=0.78) and pre-op SST 30-minute cortisol levels above 465 nmol/l (AUC ROC=0.85) best predicted adrenal recovery: 79.3% of patients with day 8 cortisol >210 nmol/l (RR=0.189) and 71.9% of patients with pre-op 30-minute cortisol >465 nmol/l (RR=0.417) recovered HPA-axis function at 6 weeks. Combining these two measures significantly increased the ability to predict recovery (AUC ROC=0.894): 87.8% of patients with pre-op SST 30-minute and day 8 cortisol levels above the cut-offs eventually recovered at 6-weeks while none of the patients below both cut-off values recovered HPA-axis function (χ2=24.128, P<0.01).

Conclusions: There is potential to use pre-op SST 30-minute cortisol and post-op day 8 cortisol alone, or in combination to predict 6-week HPA recovery in patients undergoing TSA. This may aid clinicians to decide on treatment strategy post TSA, and inform patients regarding likelihood of restoration of HPA axis function.

Volume 59

Society for Endocrinology BES 2018

Glasgow, UK
19 Nov 2018 - 21 Nov 2018

Society for Endocrinology 

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