ECEESPE2025 Poster Presentations Adrenal and Cardiovascular Endocrinology (169 abstracts)
Lowering the day 5 postoperative cortisol cutoff value to avoid over-diagnosis of secondary adrenal insufficiency following pituitary surgery
Daniella Bae 1 , Emmanuel Lawal 1 , Sirazum Choudhury 1,2,3 , Kavita Narula 1,2 , Katharine Lazarus 1,2 , Tricia Tan 1,2,3 , Debbie Papadopoulou 1,2 , Niamh Martin 1,2 & Karim Meeran 1,2
1Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom; 2Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom; 3Department of Clinical Biochemistry, Northwest London Pathology, London, United Kingdom
JOINT3448
Background: It is essential to identify patients who develop secondary adrenal insufficiency (SAI) following trans-sphenoidal pituitary surgery (TSS) to avoid life-threatening Addisonian crises. An early morning day 5 cortisol value may reliably assess hypothalamo-pituitary-adrenal (HPA) axis functioning following surgery.
Method: This was a retrospective cohort study of 54 patients undergoing TSS at Imperial Healthcare NHS Trust between 2019 and 2023. Receiver Operating Characteristic (ROC) curves were generated to evaluate the different predictive values of day 5 postoperative cortisol levels, using the Abbott Alinity cortisol immunoassay. Area Under the curve (AUC) was calculated from the ROC curve.
Results: The prevalence of SAI was 31%. The currently used cortisol cut-off value of >358 nmol/l to exclude SAI demonstrated 100% sensitivity and a specificity of 53.85%. Lowering this threshold to >308 nmol/l maintained 100% sensitivity but improved the specificity to 75.86%. A Day 5 cortisol value of <206 nmol/l predicts poor HPA function with a sensitivity of 70.59% and 100% specificity. Day 5 cortisol values (AUC 0.9645) provided better predictive values for SAI compared to values taken on Day 2/3 post-operatively (AUC 0.8095).
Conclusion: A day 5 serum cortisol value of >308 nmol/l reliably indicates an intact HPA axis. Values <206 nmol/l reliably detect SAI. Patients with Day 5 serum cortisol measurements between 206 and 308 nmol/l should be discharged on glucocorticoid therapy and undergo a dynamic test post-operatively to ascertain their true HPA function.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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