Rapid Assessment of Corticotropin Reserve After Pituitary Surgery
Abstract
Corticotropin deficiency may occur after pituitary surgery, and, if unrecognized and untreated, it can be fatal. In this study the insulin tolerance test was used to assess hypothalamic-pituitary-adrenal reserve five to seven days after pituitary surgery, and postoperative morning serum cortisol concentration was compared with the insulin tolerance test for predicting corticotropin deficiency. In 35 patients with pituitary tumors studied prospectively, 27 had normal insulin tolerance test results five to seven days after pituitary surgery; in these patients, the morning serum cortisol concentration two to three days after surgery was 250 nmol/L (9 micrograms/dL) or greater. Eight patients had subnormal insulin tolerance test results or clinical evidence of adrenal insufficiency; the morning serum cortisol concentration in these patients was 80 nmol/L (3 micrograms/dL) or less. Postoperative adrenal insufficiency was transient (one to three months) in five of these eight patients. We retrospectively identified 45 patients whose postoperative morning serum cortisol values were 200 nmol/L (7 micrograms/dL) or greater; none of these patients had clinical evidence of adrenal insufficiency. We conclude that a morning serum cortisol level obtained two to three days after surgery and 24 hours after the discontinuation of hydrocortisone accurately predicts postoperative corticotropin reserve.
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Most primary reports detailing the 140 nmol/L cutoff value are not based on subjects with PAI.
“Unfortunately, most of the primary reports detailing this cutoff value are not based on subjects with PAI (23,24,(61)(62)(63)(64).”
From Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [61]
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“Unfortunately, most of the primary reports detailing this cutoff value are not based on subjects with PAI (23, 24, 61–64).”
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- Authors
- Watts, N. B.
- Affiliations
- Emory University (US)
- Corresponding author
- Watts, Nelson B.
- ORCID
- Watts, Nelson B.
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1988-02-05
- Volume
- 259
- Issue
- 5
- Pages
- 708
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2069133047
- Cited by
- 76
- References
- 0
- Citations by year
- 2024: 1 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 8 · 2019: 5 · 2018: 2 · 2017: 3 · 2016: 5 · 2015: 3 · 2014: 1 · 2013: 3 · 2012: 3
- FWCI
- 0.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Keywords
- postoperative adrenal insufficiency, corticotropin deficiency, hypothalamic-pituitary-adrenal axis, pituitary surgery, pituitary tumors, insulin tolerance test, cortisol
- MeSH terms
- Adenoma, Adolescent, Adrenocorticotropic Hormone, Adult, Aged, Aged, 80 and over, Cosyntropin, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Insulin, Male, Middle Aged, Pituitary Neoplasms, Pituitary-Adrenal Function Tests, Postoperative Period, Prospective Studies, Retrospective Studies
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