This Article Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by HOUT, W. M. Articles by SELMAN, W. Search for Related Content PubMed PubMed Citation Articles by HOUT, W. M. Articles by SELMAN, W.

Evaluation of the Hypothalamic-Pituitary-Adrenal Axis Immediately After Pituitary Adenomectomy: Is Perioperative Steroid Therapy Necessary?^*

Division of Endocrinobgy and the Division of Neurological Surgery, Departments of Medicine and Surgery, Case Western Reserve University School of Medicine Cleveland, Ohio 44106

Address all correspondence and requests for reprints to: B. M. Arafah, M.D., Division of Endocrinology, University Hospitals of Cleveland, 2074 Abington Road, Cleveland, Ohio 44106.

Patients undergoing pituitary adenomectomy are usually given glucocorticoid therapy, although there are no data to document the need for such therapy. We prospectively studied hypothalamic-pituitary-adrenal axis (HPA) function in 88 consecutive pituitary adenoma patients before and after selective adenomectomy, excluding those with corticotroph adenomas. Preoperatively, 5 patients had adrenal insufficiency (AI); they were treated with glucocorticoids and excluded from the analysis. The remaining 83 patients had normal HPA function preoperatively and were not given glucocorticoids before, during, or immediately after surgery, but were closely monitored, and their serum cortisol levels were measured in the immediate postoperative period. Two patients were clinically suspected to have AI postoperatively and were treated accordingly. The remaining 81 patients had no clinical manifestations of AI and received no glucocorticoid therapy. Their serum cortisol levels in the immediate postoperative period were appropriately elevated. The mean serum cortisol level was 40.5 ± 11.1 (±SD) µg/ dL (1117 ± 306 nmol/L) 6 h after surgery; serum cortisol levels decreased gradually thereafter. Morning serum cortisol levels were within the normal range on the fourth, fifth, and sixth days after surgery: day 4, 15.1 ± 7.0 µg/dL (417 ± 193 nmol/L); day 5, 16.4 ± 5.6 µg/dL (453 ± 155 nmol/L); and day 6, 16.3 ± 5.7 µg/dL (450 ± 157 nmol/L). When tested 3 months after surgery, all 81 patients had normal HPA function. We conclude that HPA function is rarely compromised after selective pituitary adenomectomy. Close observation and serum cortisol measurements in the immediate postoperative period can reliably predict the integrity of the HPA after surgery. Routine glucocorticoid therapy is not needed in patients undergoing selective adenomectomy whose preoperative adrenal function is normal

^* This work was supported by a grant to the Clinical Research Center from the GCRC Branch of the NIH. Presented in part at the 69th Annual Meeting of The Endocrine Society, Indianapolis, IN, 1987.

Received September 1, 1987.

This article has been cited by other articles:

				C. N. Jayasena, K. A. Gadhvi, B. Gohel, N. M. Martin, N. Mendoza, K. Meeran, and W. S. Dhillo Day 5 Morning Serum Cortisol Predicts Hypothalamic-Pituitary-Adrenal Function after Transsphenoidal Surgery for Pituitary Tumors Clin. Chem., May 1, 2009; 55(5): 972 - 977. [Abstract] [Full Text] [PDF]

				R. N. Nawar, D. AbdelMannan, W. R. Selman, and B. M. Arafah Analytic Review: Pituitary Tumor Apoplexy: A Review J Intensive Care Med, March 1, 2008; 23(2): 75 - 90. [Abstract] [PDF]

				A. S. Dumont, E. C. Nemergut II, J. A. Jane Jr, and E. R. Laws Jr Postoperative Care Following Pituitary Surgery J Intensive Care Med, May 1, 2005; 20(3): 127 - 140. [Abstract] [PDF]

				D. H. Zayour, W. R. Selman, and B. M. Arafah Extreme Elevation of Intrasellar Pressure in Patients with Pituitary Tumor Apoplexy: Relation to Pituitary Function J. Clin. Endocrinol. Metab., November 1, 2004; 89(11): 5649 - 5654. [Abstract] [Full Text] [PDF]

				M. P. Nasrallah and B. M. Arafah The Value of Dehydroepiandrosterone Sulfate Measurements in the Assessment of Adrenal Function J. Clin. Endocrinol. Metab., November 1, 2003; 88(11): 5293 - 5298. [Abstract] [Full Text] [PDF]

				W. J. Inder and P. J. Hunt Glucocorticoid Replacement in Pituitary Surgery: Guidelines for Perioperative Assessment and Management J. Clin. Endocrinol. Metab., June 1, 2002; 87(6): 2745 - 2750. [Abstract] [Full Text] [PDF]

				H. S. Dökmetas, R. Çolak, F. Kelestimur, A. Selçuklu, K. Ünlühizarci, and F. Bayram A Comparison between the 1-{micro}g Adrenocorticotropin (ACTH) Test, the Short ACTH (250 {micro}g) Test, and the Insulin Tolerance Test in the Assessment of Hypothalamo-Pituitary-Adrenal Axis Immediately after Pituitary Surgery J. Clin. Endocrinol. Metab., October 1, 2000; 85(10): 3713 - 3719. [Abstract] [Full Text]

				B. M. Arafah, D. Prunty, J. Ybarra, M. L. Hlavin, and W. R. Selman The Dominant Role of Increased Intrasellar Pressure in the Pathogenesis of Hypopituitarism, Hyperprolactinemia, and Headaches in Patients with Pituitary Adenomas J. Clin. Endocrinol. Metab., May 1, 2000; 85(5): 1789 - 1793. [Abstract] [Full Text]