Criterios para la indicación selectiva de glucocorticoides en pacientes con tumores hipofisiarios sometidos a cirugía transesfenoidal / Selective use of glucocorticoids during the perioperative period of transsphenoidal surgery for pituitary tumors
Rev. méd. Chile
;
142(9): 1113-1119, set. 2014. ilus, graf, tab
Article
in Spanish
| LILACS
| ID: lil-730281
ABSTRACT
Background:
There is consensus in promoting the selective use of glucocorticoids (GC) in the peri-operative period of transsphenoidal surgery (TE) for pituitary adenomas (PA).Aim:
To evaluate the safety of a selective glucocorticoid administration protocol and the usefulness of immediate postoperative cortisol levels as a predictor of final eucortisolism. Patients andMethods:
Clinical and biochemical data from 40 patients aged 27 to 78 years (65% males) were prospectively collected. Exclusion criteria were previous use of GC, apoplexy and Cushing disease. Patients with pre-operative short synthetic ACTH test (SST) > 18 µg/dl or basal cortisol > 15 µg/dl did not receive GC. A morning serum cortisol (SC) threshold of 10 µg/dl in postoperative days one to three was used to decide a discharge without GC. Hypotension, dizziness or nausea, requirement of increased dose of corticosteroids, hospitalizations and emergency service visits were investigated, as well as surgical and endocrinological complications. Corticotropic status was evaluated three months after surgery.Results:
Macroadenomas were present in 87% of patients. Median hospital stay was 4 days and follow up lasted 9 months. No differences were found in gender, age or tumor size between patients who received or not GC (35 and 65% respectively). Eighty five percent of patients were discharged without GC and all of them had normal corticotropic function three months after surgery. A SC ≥ 15 µg/dl had 100% specificity to predict eucortisolism.Conclusions:
Selective glucocorticoid administration is safe. A normal corticotropic function before surgery and in the immediate postoperative period are useful to identify patients who do not need GC.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Pituitary Neoplasms
/
Hydrocortisone
/
Adenoma
/
Perioperative Period
/
Glucocorticoids
Type of study:
Diagnostic study
/
Practice guideline
/
Prognostic study
Limits:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
Language:
Spanish
Journal:
Rev. méd. Chile
Journal subject:
Medicine
Year:
2014
Type:
Article
Affiliation country:
Chile
Institution/Affiliation country:
Pontifica Universidad Católica de Chile/CL
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