Random Postoperative Day-3 Cortisol Concentration as a Predictor of Hypothalamic-Pituitary-Adrenal Axis Integrity after Transsphenoidal Surgery |
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Institution: | 1. Department of Endocrine Neoplasia and Hormonal Disorders, Houston, Texas;2. Department of Neurosurgery, Houston, Texas;3. Division of Quantitative Sciences, University of Texas M. D. Anderson Cancer Center, Houston, Texas;4. Division of Diabetes, Endocrinology, and Metabolism, Baylor College of Medicine, Houston, Texas.;1. From the Cooper University Hospital, Camden, New Jersey.;1. Department of Psychiatry, School of Medicine, University of California, San Francisco (UCSF) , San Francisco, CA, USA;2. Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA;3. Faculty of Medicine, Department of Clinical Studies, Lund University, Lund, Sweden;4. Department of OB/GYN and Reproductive Sciences, School of Medicine, University of California, San Francisco (UCSF), Box 0556, 513 Parnassus Ave, 1464G, San Francisco, CA 94143, USA |
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Abstract: | ObjectiveTo determine whether a random postoperative day-3 cortisol value of 10 μg/dL or greater is predictive of adrenal sufficiency 3 to 10 weeks after transsphenoidal surgery (TSS) and during long-term clinical follow-up.MethodsWe retrospectively reviewed the case records of patients who underwent TSS at our institution between 1991 and 2008. Inclusion criteria were as follows: random cortisol measured on the morning of postoperative day 3, adrenal dynamic testing performed 3 to 10 weeks after TSS, and clinical assessment of the hypothalamicpituitary-adrenal (HPA) axis at least 6 months after TSS.ResultsA total of 466 patients underwent TSS at our institution during the study period. Eighty-three patients met study inclusion criteria. Sensitivity of a random postoperative day-3 serum cortisol value of 10 μg/dL or greater for the prediction of adrenal sufficiency at a median follow-up of 42 days was 64.81% (95% confidence interval, 50.6%-77.32%), with an odds ratio of 3.1 (95% confidence interval, 1.08-8.58). Specificity was 62.1% (95% confidence interval, 42.3%-79.3%). At a median follow-up of 500 days, only 2 patients with a postoperative day-3 cortisol value of 10 μg/dL or greater required hydrocortisone replacement, both of whom had multiple anterior pituitary hormone deficiencies and evidence of pituitary dysfunction during the perioperative period.ConclusionsIn the appropriate clinical context, a postoperative day-3 cortisol value of 10 μg/dL or greater accurately predicts the integrity of the HPA axis. The final decision regarding corticosteroid replacement should be personalized, considering the postoperative day-3 cortisol level, the clinical context in which the measurement was obtained, and any evidence of concomitant pituitary dysfunction in the perioperative period. (Endocr Pract. 2011;17:717-726) |
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