Endocrine Abstracts (2019) 65 P296 | DOI: 10.1530/endoabs.65.P296

In-hospital endocrinology consultation (IHEC) for patients undergoing transsphenoidal resection of sellar masses - is it always necessary?

Syed Ali Imran, Andrea LO Hebb, Emad Massoud, Lisa Tramble & David B Clarke

Dalhousie University, Halifax, Canada

Patients with sellar masses (SM) undergoing transsphenoidal surgery (TSS) have a significant risk of transient or permanent endocrine dysfunction; therefore, in-hospital endocrinology consultation (IHEC) is recommended for these patients. However, routine assessment of all TSS patients by a specialized team is not feasible outside select centers. We developed an IHEC guide for TSS patients in December 2015 to identify those patients who would require perioperative IHEC. We conducted a retrospective analysis of all patients who underwent TSS between January 1, 2016 and December 31, 2017 to assess the predictive value of the IHEC guide in identifying patients who required IHEC and also its impact on the in-hospital and immediate post-operative endocrine complications. Seventy seven patients (41 males; mean age: 57.9 + 1.75 years and the mean tumour volume: 7.48 + 1.02 ml) underwent TSS. Of these, 17 (22%) patients required IHEC based on the IHEC guide. The mean age, tumour volume and indications for TSS were similar in IHEC and non-IHEC patients. The primary indication for IHEC was the risk of diabetes insipidus in 12 (70%) patients and the IHEC compared with non-IHEC patients had longer hospital stay (8 days vs. 3 days), higher rate of new post-operative hormonal deficit (70% vs. 0%), higher 30-day readmission rates (23% vs. 11%) and higher rate of secondary adrenal insufficiency (70% vs. 26.7%) [P=0.001]. In the non-IHEC group, only 1 out of 60 patients developed new-onset hormonal dysfunction (NPV = 0.97; 95% CI = 0.9155–0.9918) whereas in the IHEC group 12 out of 17 developed new-onset hormonal; (PPV=0.82; 95% CI of 0.7333–0.8830) during perioperative or immediate post-operative period. Our data indicate that around three quarters of TSS patients can be managed safely without IHEC with no evidence of compromise of hormone-related care.

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