ECE2021 Audio Eposter Presentations Pituitary and Neuroendocrinology (113 abstracts)
Pituitary function after transsphenoidal surgery including measurement of basal morning cortisol as predictor of adrenal insufficiency
Ida Staby 1 , Jesper Krogh 1 , Marianne Klose 1 , Ulla Feldt-Rasmussen 1 , Lars Poulsgaard 2 , Jacob Bertram Springborg 2 & Mikkel Andreassen 1
1Rigshospitalet, University of Copenhagen, Department of Endocrinology; 2Rigshospitalet, University of Copenhagen, Department of Neurosurgery
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 the 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 hours 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 a 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
| Basal cortisol level | Sufficient | Insufficient | Total | Cut-off limits | Specificity | Sensitivity | NPV | PPV |
| 0–99 nmol/l | 2 | 2 | 4 | 100 nmol/l | 96% | 67% | 98% | 50% |
| 100–199 nmol/l | 2 | 0 | 2 | 200 nmol/l | 92% | 67% | 98% | 33% |
| 200–299 nmol/l | 5 | 1 | 6 | 300 nmol/l | 81% | 100% | 100% | 25% |
| 300–399 nmol/l | 9 | 0 | 9 | 400 nmol/l | 62% | 100% | 100% | 14% |
| 400–499 nmol/l | 4 | 0 | 4 | 500 nmol/l | 53% | 100% | 100% | 12% |
| 500–599 nmol/l | 4 | 0 | 4 | 600 nmol/l | 45% | 100% | 100% | 10% |
| > = 600 nmol/l | 21 | 0 | 21 | |||||
| Total | 47 | 3 | 50 | |||||
Conclusion
Transsphenoidal surgery had an overall beneficial effect on pituitary endocrine function. Low basal plasma cortisol measured within 48 hours after surgery, tumour size and previous surgery were identified as risk factors for AI. We recommend measurement of basal cortisol post-surgery to secure glucocorticoids to patients at risk of AI and to avoid unnecessary glucocorticoid treatment.
Grouping plasma basal cortisol levels according to sufficiency vs. insufficiency of the adrenal axis assessed by Synacthen-test six months post-surgery. PPV = Positive predictive value. NPV=Negative predictive value.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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