Perioperative serum cortisol levels in ACTH sufficient and ACTH deficient patients during transsphenoidal surgery of pituitary adenoma
(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.
(Less)
- author
- Borg, Henrik
LU
; Siesjö, Peter
LU
; Kahlon, Babar LU ; Fjalldal, Sigridur LU and Erfurth, Eva Marie LU
- publishing date
- 2018-07-02
- 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}}, }