Endocrine Abstracts

JOINT1212

Introduction: Transsphenoidal surgery (TS) is the surgical treatment of choice for pituitary lesions. Postoperative involvement of the hypothalamic-pituitary-adrenal axis is associated with high morbimortality, and it is essential to identify those patients who require corticosteroid replacement therapy. Our objective is to evaluate whether basal cortisol levels in the early postoperative period are related to the presence of adrenal insufficiency (AI) at 4 weeks after surgery.

Case Report: Retrospective and observational study, with a duration of 6 months. Patients with Cushing’s disease, previous AI and treatment with preoperative corticosteroids were excluded. In total, 27 patients were studied. The postoperative hormonal assessment included ACTH and cortisol on the 3rd day and, subsequently, at 4 weeks after surgery. The necessary data were collected from the Medical History of each patient. The perisurgical management protocol with glucocorticoids after pituitary surgery published by the Spanish Society of Endocrinology (SEEN) in 2021 was used, considering AI cortisol values lower than 4.1mg/dl (sensitivity 95.1%, specificity 100%). The mean age was 35±19 years, and they were more frequent in women (56%). The majority were non-functioning pituitary adenomas (52%), functioning ones (25%) and 21% were other types of tumors, with craniopharyngiomas and hamartomas standing out (the latter as triggers of central organic precocious puberty). Macroadenomas were considered to be tumors ≥ 1cm and microadenomas < 1cm. The mean size of the lesions was 26±17mm. The mean concentration of ACTH and cortisol on the 3rd day was 24±14pg/ml (7.20-63.30) and 21±8mg/dl (6.0-18.4) respectively; while at one month they were 22±8pg/ml and 13±9mg/dl. No patient with cortisol concentrations higher than 4.1mg/dl on day 3 postoperatively developed AI at week 4. Five patients (18.5%) developed AI (3 craniopharyngiomas, 1 hamartoma, and 1 nonfunctioning adenoma, with sizes greater than 25mm). In patients with AI, mean cortisol on day 3 was 3.1±0.9mg/dl and at week 4 was 2.8±0.6mg/dl.

Discussion and conclusions: A cortisol level higher than 4.1mg/dl on the 3rd postoperative day seems to prevent the development of AI and could allow to identify patients who need glucocorticoid replacement therapy while awaiting confirmation of secondary AI by ACTH testing. In our study, ACTH was always within the reference values and did not allow us to discriminate those patients with secondary AI. It should be noted that most large sillar and/or suprasellar lesions (craniopharyngioma type) developed central AI. The SEEN protocol is safe and effective in patients undergoing TS.