ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 P416

Perioperative steroid treatment is not routinely required in endoscopic transphenoidal surgery for clinically non functioning pituitary adenomas (NFPA)

Renato Cozzi1, Giovanni Lasio2, Giovanni Felisati1 & Roberto Attanasio2


1Endocrinology, Ospedale Niguarda, Milan, Italy; 2Pituitary Unit, Istituto Galeazzi, Milan, Italy; 3ENT Chair, Polo S.Paolo, University of Milan, Milan, Italy.


Steroids are still widely prescribed in pituitary trans-sphenoidal surgery (TSA). Pituitary-adrenal/thyroid/gonadal functions were prospectively evaluated in 72 consecutive NFPA pts (20–87 years, 37 M) before and after endoscopic-TSA (E-TSA) (63 at first operation, 9 at re-operation). All had macroadenoma with suprasellar extension: impinging optic chiasma in 28, extending into cavernous sinus (CS) in 23, giant in 12. Hydrocortisone was infused peri-operatively only in pts with pre-op 0800 am cortisol (F) <8 μg/dl (arbitrary cut-off). After E-TSA clinical picture, F, electrolytes, FT4 and diabetes insipidus (DI) were checked at 1–3 days, testosterone in M or menses/FSH in women at 1 month, ACTH 1 μg-induced F peak (F-ACTH) and MRI at 3 months. A wide resection (>90%) was performed in all pts, up to empty sella in 60%. Post-op follow-up lasted 1–11 years (median 5) and regrowth occurred in 5 points with CS invasion. The greater the adenoma size, the worse the pre-op and post-op pituitary function. Central hypogonadism (HypoG) and hypothyroidism (HypoT) were detected in 80.5% and 40.3% before and in 77.8% and 47.2% of pts after E-TSA. Permanent DI occurred in 13.9%. F was 11.4±3.9 before and 11.5±4.3 μg/dl after E-TSA. Pre-op hypocortisolism (HypoA) did not change in 14 points (19.4%, all had also hypoT and hypoG), and was detected in 6 (10.3% of those with previously normal adrenal function) at the first post-op control. No patient whose pre-op F was >8 μg/dl failed, and no patient but 1 whose pre-op F was <8 μg/dl achieved the required 18 μg/dl F-ACTH cut-off. In conclusion, pituitary-adrenal function is usually preserved in NFPA, and only seldom is impaired after complete tumor removal by E-TSA; the first 1–3 day post-op control reveals the few cases impaired by E-TSA. We recommend peri-operative steroid treatment only In pts with pre-op subnormal F levels, and to evaluate clinical picture and morning F on post-op day 1–3 for guidance about replacement treatment.

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