Consensus-driven in-hospital cortisol assessment after ACTH-secreting pituitary adenoma resection.

Abstract

PURPOSE:

Remission from Cushing disease (CD) after pituitary adenoma resection may be predicted by a postoperative reduction in serum cortisol level. A 2008 consensus statement recommends assessing morning cortisol levels during the first postoperative week, and replacing glucocorticoid (GC) if cortisol nadir of < 2 or < 5 µg/dL is achieved. We sought to evaluate adherence to consensus recommendations following adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma resection at our tertiary medical center, and assess time to cortisol nadir to better define the window for assessment and intervention.

METHODS:

We retrospectively analyzed data extracted from in-hospital electronic medical records for CD surgeries between January 1991 and September 2015. We compared cortisol levels and collection times, ACTH measurement, and postoperative and discharge GC treatment before and after consensus statement publication in July 2008.

RESULTS:

107 surgeries were performed in 92 patients with CD. After 2008, more surgeries had at least one cortisol value assessed (67.9% before vs. 91.3% after, p = 0.033), with median initial cortisol measurement at 14 h post-surgery. However, ACTH measurement remained unchanged (42.9% vs. 43.5%; p > 0.99). Cortisol collection during GC treatment tended to increase (32.7% vs. 57.1%; p = 0.068). Of surgeries performed without prior GC treatment, 31.7 and 55.0% had a cortisol nadir of < 2 and < 5 µg/dL, respectively, within 72 h postoperative.

CONCLUSIONS:

Our physicians were more diligent in measuring in-hospital postoperative cortisol levels consistent with 2008 consensus recommendations. Better management of cortisol measurements and their timing is an opportunity for improvement.

• Authors: Yana Stolyarov, James Mirocha, Adam N Mamelak, Anat Ben-Shlomo
• Journal: Pituitary (Pituitary) Vol. 21 Issue 1 Pg. 41-49 (Feb 2018) ISSN: 1573-7403 [Electronic] United States
• PMID: 29143885 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Glucocorticoids
• Hydrocortisone

Topics

• ACTH-Secreting Pituitary Adenoma (blood, complications, pathology, surgery)
• Adenoma (blood, complications, pathology, surgery)
• Adolescent
• Adrenal Cortex Function Tests (standards)
• Adrenal Insufficiency (blood, diagnosis, drug therapy, etiology)
• Adult
• Aged
• Biomarkers (blood)
• Circadian Rhythm
• Consensus
• Electronic Health Records
• Female
• Glucocorticoids (administration & dosage)
• Guideline Adherence
• Hospitalization
• Humans
• Hydrocortisone (blood)
• Hypophysectomy (adverse effects)
• Male
• Middle Aged
• Pituitary ACTH Hypersecretion (blood, diagnosis, etiology)
• Practice Guidelines as Topic
• Predictive Value of Tests
• Retrospective Studies
• Time Factors
• Treatment Outcome
• Young Adult