Perioperative serum cortisol levels in ACTH sufficient and ACTH deficient patients during transsphenoidal surgery of pituitary adenoma

Purpose No previous study has analyzed serum cortisol levels during transsphenoidal endoscopic pituitary surgery in patients with and without hydrocortisone (HC) substitution. Methods A total of 15 patients undergoing surgery for a pituitary adenoma were studied. Those with normal ACTH function were...

Full description

Saved in:
Bibliographic Details
Published in:Endocrine 2018-10, Vol.62 (1), p.83-89
Main Authors: Borg, Henrik, Siesjö, Peter, Kahlon, Babar, Fjalldal, Sigridur, Erfurth, Eva Marie
Format: Article
Language:English
Subjects:
ACTH-Secreting Pituitary Adenoma - blood
ACTH-Secreting Pituitary Adenoma - surgery
Adenoma
Adenoma - blood
Adenoma - surgery
Adrenal glands
Adrenocorticotropic hormone
Adult
Aged
Aged, 80 and over
Anesthetics
Diabetes
Endocrine Surgery
Endocrinology
Female
Hormones
Humanities and Social Sciences
Humans
Hydrocortisone
Hydrocortisone - blood
Internal Medicine
Intravenous administration
Male
Medicine
Medicine & Public Health
Middle Aged
multidisciplinary
Nose
Pituitary
Pituitary Neoplasms - blood
Pituitary Neoplasms - surgery
Propofol
Remifentanil
Science
Sinus
Sphenoid Sinus - surgery
Supplements
Surgery
Tumors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Purpose No previous study has analyzed serum cortisol levels during transsphenoidal endoscopic pituitary surgery in patients with and without hydrocortisone (HC) substitution. Methods A total of 15 patients undergoing surgery for a pituitary adenoma were studied. Those with normal ACTH function were either not given HC ( n  = 7) or received 50 mg intravenous HC at the start of surgery ( n  = 4). Patients with ACTH deficiency received intravenous HC of 100 mg in the morning before surgery ( n  = 4) with the additional 50 mg for an afternoon operation ( n  = 2). Propofol and remifentanil were used as anesthetics. Serum cortisol was measured at the start of and every 30 min during surgery. Results Among 7 patients with normal ACTH function without HC substitution, cortisol levels before surgery were 126–244 nmol/L, among the 4 patients undergoing surgery in the morning, whereas the 3 who underwent surgery in the afternoon had lower levels, 38–76 nmol/L. During nose/sinus surgery cortisol levels decreased to 79–139 and 24–54 nmol/L, respectively. At intrasellar manipulation a distinct rise was noted. Also, in the 4 ACTH sufficient patients receiving HC, cortisol levels decreased during nose/sinus surgery, but only with a slight increase during intrasellar surgery. In the 4 ACTH deficient patients cortisol peaked at 1914–2582 nmol/L. Conclusions Patients with normal ACTH function without HC substitution had very low cortisol levels during the first part of surgery, likely suppressed by the anesthetics. After mechanical impact in the sella, a marked increase in cortisol was noted. Supraphysiological cortisol levels were achieved with our routine HC substitution, advising us to reduce the supplementation.
ISSN:1355-008X
1559-0100
DOI:10.1007/s12020-018-1655-8