TY - JOUR
T1 - Immediate postoperative cortisol levels accurately predict postoperative hypothalamic-pituitary-adrenal axis function after transsphenoidal surgery for pituitary tumors
AU - Marko, Nicholas F.
AU - Hamrahian, Amir H.
AU - Weil, Robert J.
N1 - Funding Information:
Acknowledgments We wish to thank the Melvin Burkhardt chair in neurosurgical oncology and the Karen Colina Wilson research endowment within the Brain Tumor and Neuro-oncology Center at the Cleveland Clinic Foundation for partial support and funding.
PY - 2010/9
Y1 - 2010/9
N2 - Accurate assessment of the hypothalamic-pituitary-adrenal (HPA) axis is critical for the appropriate management of patients with pituitary adenoma after transsphenoidal surgery. We examine the role of immediate postoperative cortisol levels to assess hypothalamic-pituitary-adrenal axis (HPA) axis function post-operatively. We performed preoperative cortrosyn stimulation test (CST) and measured immediate postoperative serum cortisol levels in 100 patients undergoing 104 transsphenoidal surgeries. These results were compared to those of the CST at 4-6 weeks postoperatively, which served as a measure of HPA axis function. The ability of immediate postoperative, day of surgery (DOS) cortisol levels to predict normal HPA axis function was determined using standard predictive analytic methods and confusion matrix calculations. We found that postoperative, DOS cortisol level ≥15 μg/dL is a sensitive and accurate predictors of normal postoperative HPA axis function, with a sensitivity of 98%, an accuracy of 97%, and a positive predictive value of 99%. Our data suggest that an immediate, postoperative, DOS cortisol level ≥15 μg/dL predicts distant, normal, post-operative HPA axis function following transsphenoidal surgery.
AB - Accurate assessment of the hypothalamic-pituitary-adrenal (HPA) axis is critical for the appropriate management of patients with pituitary adenoma after transsphenoidal surgery. We examine the role of immediate postoperative cortisol levels to assess hypothalamic-pituitary-adrenal axis (HPA) axis function post-operatively. We performed preoperative cortrosyn stimulation test (CST) and measured immediate postoperative serum cortisol levels in 100 patients undergoing 104 transsphenoidal surgeries. These results were compared to those of the CST at 4-6 weeks postoperatively, which served as a measure of HPA axis function. The ability of immediate postoperative, day of surgery (DOS) cortisol levels to predict normal HPA axis function was determined using standard predictive analytic methods and confusion matrix calculations. We found that postoperative, DOS cortisol level ≥15 μg/dL is a sensitive and accurate predictors of normal postoperative HPA axis function, with a sensitivity of 98%, an accuracy of 97%, and a positive predictive value of 99%. Our data suggest that an immediate, postoperative, DOS cortisol level ≥15 μg/dL predicts distant, normal, post-operative HPA axis function following transsphenoidal surgery.
KW - ACTH stimulation
KW - Adrenal insufficiency
KW - Cortisol
KW - Hypothalamic-pituitary-adrenal axis
KW - Pituitary adenoma
KW - Transsphenoidal surgery
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U2 - 10.1007/s11102-010-0227-6
DO - 10.1007/s11102-010-0227-6
M3 - Article
C2 - 20339931
AN - SCOPUS:77955923160
SN - 1386-341X
VL - 13
SP - 249
EP - 255
JO - Pituitary
JF - Pituitary
IS - 3
ER -