Pituitary and adrenal gland assessment, is one of the most important aspects of the management of a pituitary and adrenal adenoma.
Clinical practice varies widely with regard to assessment of pituitary and adrenal status pre- and post-operative. Pre-operative testing includes dynamic testing to assess function which is not practical in the immediate post-operative period. Instead a single morning serum total hormones are measured while a more definitive assessment is usually determined from a repeat dynamic testing 412 weeks after the surgery. What is evident from current literature is that not only is there a lack of consensus on the best test but also that the details of the most appropriate time of measurement and the correct cut-off values. Almost all hormones oscillate either under circadian or ultradian fashion and it contributes to render the interpretation of diagnostic test results more difficult since current diagnostic procedures are static and does not take into account this rhythmicity.
Frequent automated blood sampling is available but it is laborious. To overcome this we (Prof Lightman research group) have developed a novel collection device linked to a microdialysis technique that automatically collects timed dialysate samples from subcutaneous tissue for 24 h or longer. The entire system has been already validated. Its safe, easy to use and needs little time commitment from the patient or from the surgical or nursing staff. By utilizing this system we obtain a full 24 h profile of hormones without disturbing the individual.
We will be able to recognize these patients earlier and with higher sensitivity compared to current diagnostic procedures and will be in a position to decide when replacement therapy is indicated. On the basis of some pilot studies we would be able to create a national collaboration network to introduce new guidelines for management of acromegaly and Cushings disease.