SFEBES2018 Poster Presentations Adrenal and steroids (38 abstracts)
A model to predict Hypothalamic-Pituitary-Adrenal (HPA) axis recovery at 6 weeks post trans sphenoidal adenomectomy: a single-centre retrospective analysis
Riccardo Pofi 1, , Sonali Gunatilake 1 , Andrea M Isidori 2 , Andrea Lenzi 2 , Victoria Macgregor 1 , Simon Cudlip 3 , Bahram Jafar-Mohammadi 1 , Jeremy W Tomlinson 1 & Aparna Pal 1
1Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK; 2Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; 3Department of Neurosurgery, Oxford, UK.
Background: Hypopituitarism can occur post trans-sphenoidal adenomectomy(TSA). Accurate prediction of HPA axis recovery would inform hydrocortisone replacement strategies but there are limited studies on this. In our centre, HPA axis is assessed with pre-operative short synacthen test (SST), day-8 post TSA 9am cortisol and 6-week post-TSA SST. Patients are commenced on hydrocortisone post TSA until 6 weeks review.
Methods: We performed a single-centre, longitudinal, retrospective analysis of 118 consecutive patients undergoing TSA between January 2016-March 2018. Multiple regression models were used to identify variables contributing to 6-week post-TSA HPA axis recovery. Patients with apoplexy, corticotroph adenomas, radiotherapy or incomplete data sets (pre- and post-op SST plus day 8 cortisol) were excluded.
Results: Multiple regression analysis was conducted on 64 patients. 36 were excluded due to incomplete data points, 10 as corticotrophs, 4 as apoplexy, 4 received radiotherapy. Post-op day 8 cortisol above 210 nmol/l (AUC ROC=0.78) and pre-op SST 30-minute cortisol levels above 465 nmol/l (AUC ROC=0.85) best predicted adrenal recovery: 79.3% of patients with day 8 cortisol >210 nmol/l (RR=0.189) and 71.9% of patients with pre-op 30-minute cortisol >465 nmol/l (RR=0.417) recovered HPA-axis function at 6 weeks. Combining these two measures significantly increased the ability to predict recovery (AUC ROC=0.894): 87.8% of patients with pre-op SST 30-minute and day 8 cortisol levels above the cut-offs eventually recovered at 6-weeks while none of the patients below both cut-off values recovered HPA-axis function (χ2=24.128, P<0.01).
Conclusions: There is potential to use pre-op SST 30-minute cortisol and post-op day 8 cortisol alone, or in combination to predict 6-week HPA recovery in patients undergoing TSA. This may aid clinicians to decide on treatment strategy post TSA, and inform patients regarding likelihood of restoration of HPA axis function.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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