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

Borg, Henrik LU ; Siesjö, Peter LU orcid ; Kahlon, Babar LU ; Fjalldal, Sigridur LU and Erfurth, Eva Marie LU (2018) In Endocrine 62(1). p.83-89
Abstract

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... (More)

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.

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author
; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adrenal insufficiency; pituitary gland, adrenocorticotropic hormone, endoscopic transsphenoidal surgery, Hydrocortisone, remifentanil
in
Endocrine
volume
62
issue
1
pages
83 - 89
publisher
Humana Press
external identifiers
  • pmid:29968225
  • scopus:85049599882
ISSN
1355-008X
DOI
10.1007/s12020-018-1655-8
language
English
LU publication?
no
id
e162c647-09d7-406b-903d-be6c49160125
date added to LUP
2018-07-23 11:53:38
date last changed
2024-06-10 15:18:51
@article{e162c647-09d7-406b-903d-be6c49160125,
  abstract     = {{<p>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.</p>}},
  author       = {{Borg, Henrik and Siesjö, Peter and Kahlon, Babar and Fjalldal, Sigridur and Erfurth, Eva Marie}},
  issn         = {{1355-008X}},
  keywords     = {{adrenal insufficiency; pituitary gland; adrenocorticotropic hormone; endoscopic transsphenoidal surgery; Hydrocortisone; remifentanil}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{1}},
  pages        = {{83--89}},
  publisher    = {{Humana Press}},
  series       = {{Endocrine}},
  title        = {{Perioperative serum cortisol levels in ACTH sufficient and ACTH deficient patients during transsphenoidal surgery of pituitary adenoma}},
  url          = {{http://dx.doi.org/10.1007/s12020-018-1655-8}},
  doi          = {{10.1007/s12020-018-1655-8}},
  volume       = {{62}},
  year         = {{2018}},
}