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Low-dose ACTH test for evaluation of hypothalamus-pituitary-adrenal axis preoperatively and 3-month follow-up in non-functioning pituitary adenomas.
- Source :
-
Journal of endocrinological investigation [J Endocrinol Invest] 2020 Dec; Vol. 43 (12), pp. 1769-1777. Date of Electronic Publication: 2020 May 20. - Publication Year :
- 2020
-
Abstract
- Background: Peri-operative glucocorticoids are routinely administered to patients undergoing trans-sphenoidal surgery for non-functional pituitary adenomas (NFPA) irrespective of hypothalamus-pituitary-adrenal (HPA) axis status.<br />Purpose: Evaluation of HPA axis before and 12 weeks after endoscopic trans-sphenoidal adenomectomy (E-TSA) utilizing low-dose (1 μg) ACTH stimulation test (LDACTH) to determine the need for glucocorticoid administration in patients with NFPA. We also determined the factors that can predict occurrence of hypocortisolism at 12 weeks after surgery.<br />Methods: Sixty-three consecutive patients with NFPA requiring surgical excision were enrolled in this study. Glucocorticoids were administered to patients with demonstrable hypocortisolism [preoperative peak cortisol < 16 μg/dL during LDACTH test, postoperative day 3 (POD-3) 0800 hrs Cortisol < 8 μg/dL or stimulated cortisol (LDACTH) < 16 μg/dL at 12 weeks].<br />Results: Hypocortisolism was present in 43 patients (68.2%) pre-operatively and persisted in 33 patients (52.4%) on POD-3. Thirty-three patients (52.4%) had hypocortisolism at 12 weeks after surgery. Eleven patients (17.4%) did not require glucocorticoids during the entire study period and 30 patients (47.6%) did not require glucocorticoids after 3 months. None of the patients developed adrenal crisis during the study. Hypocortisolism on the third post-operative day was the single significant predictor of hypocortisolism at 12 weeks after the surgery. There was a significant correlation between POD-3 0800 hrs cortisol ≥ 8μg/dL and stimulated cortisol (LDACTH) ≥16μg/dL at 12 weeks (r = 0.62, p < 0.0001). POD-3 0800 hrs cortisol ≥ 8 μg/dL had 73% sensitivity and 79% specificity in predicting eucortisolism at 12 weeks.<br />Conclusions: HPA function is preserved in significant proportion of NFPA patients undergoing E-TSA. Perioperative glucocorticoids should be given only in patients with demonstrable preoperative hypocortisolism on 1 μg ACTH test. Postoperative day 3 0800 hrs cortisol is a reasonable predictor of HPA axis status at 12 weeks after surgery.
- Subjects :
- Adenoma metabolism
Adenoma physiopathology
Adrenocorticotropic Hormone pharmacology
Adult
Aftercare methods
Aged
Dose-Response Relationship, Drug
Female
Humans
Hydrocortisone metabolism
Hypothalamo-Hypophyseal System drug effects
Hypothalamo-Hypophyseal System metabolism
Hypothalamo-Hypophyseal System physiopathology
India
Male
Middle Aged
Pituitary Neoplasms metabolism
Pituitary Neoplasms physiopathology
Pituitary-Adrenal System drug effects
Pituitary-Adrenal System metabolism
Pituitary-Adrenal System physiopathology
Preoperative Care methods
Preoperative Period
Prognosis
Treatment Outcome
Young Adult
Adenoma diagnosis
Adenoma surgery
Adrenocorticotropic Hormone administration & dosage
Pituitary Neoplasms diagnosis
Pituitary Neoplasms surgery
Pituitary-Adrenal Function Tests methods
Subjects
Details
- Language :
- English
- ISSN :
- 1720-8386
- Volume :
- 43
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of endocrinological investigation
- Publication Type :
- Academic Journal
- Accession number :
- 32436184
- Full Text :
- https://doi.org/10.1007/s40618-020-01292-8