Article
High predictive value of early postoperative basal cortisol and postoperative IGF-1 for a hypothalamic-pituitary-adrenal axis dysfunction
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Authors
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Alexander von Werder
- II. Medizinische Klinik
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Bruno Neu
- II. Medizinische Klinik
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Jens Lehmberg
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
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Florian Ringel
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
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Bernhard Meyer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
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Jens Gempt
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
| Published: | June 2, 2015 |
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Outline
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Objective: Patients with pituitary tumors who undergo surgical treatment are frequently treated with perioperative glucocorticoid supplementation. The clinical assessment of a normal hypothalamic-pituitary-adrenal axis function after surgery is often difficult. The symptoms of an adrenal insufficiency are unspecific and differ from patient to patient. We aimed to evaluate the usefulness of an early postoperative basal cortisol and postoperative IGF-1 level to determine the function of the hypothalamic-pituitary-adrenal axis.
Method: A cohort of patients, who underwent surgery for pituitary tumors and received a complete endocrinological work-up pre- and postoperatively at our institution were included. Pre- and postoperative pituitary function, basal cortisol and IGF-1 levels, previous therapy, surgical approach, and tumor entity were recorded and statistically evaluated. ROC analysis was used for assessing the usefulness of postoperative basal cortisol and IGF-1 level.
Results: We included 43 patients with a mean age of 53 years (21 to 74 years). Tumor entities were: 35 endocrine inactive adenomas, 2 prolactinomas, 2 hGH producing adenomas, 1 hGH and TSH producing adenoma, 2 Rathke cysts, 1 intrasellar meningioma. 3 patients suffered from an impairment of the corticotrop axis already preoperatively, 5 patients (including the previous 3) suffered from a postoperative impairment. 18 of the 43 patients underwent a synacthen test postoperatively to definitely exclude any dysfunction. Regarding the postoperative basal cortisol levels at 1 week and 1 month postoperatively both were highly predictive for the identification of hypothalamic-pituitary-adrenal-axis dysfunction (according to ROC-analysis: basal cortisol level at 1 week AUC: 0.979, p<0.01; basal cortisol level at 1 month AUC 0.884, p < 0.01). For analysis of the IGF-1 level regarding its predictive value for hypothalamic-pituitary-adrenal-axis dysfunction the patients suffering from acromegaly were excluded for statistical evaluation. AUC for IGF-1 level at 1 month was 0.812, p < 0.05).
Conclusions: Basal cortisol level assessment one week postoperatively already predicts hypothalamic-pituitary-adrenal-axis dysfunction with a high sensitivity and specificity. Early postoperative determination of basal cortisol levels could therefore aid in avoiding a long-term glucocorticoid replacement therapy.
