Rapid assessment of corticotropin reserve after pituitary surgery

N. B. Watts and G. T. Tindall
Department of Medicine, Emory University School of Medicine, Atlanta, GA.

Corticotropin deficiency may occur after pituitary surgery, and, if unrecognized and untreated, it can be fatal. In this study the insulin tolerance test was used to assess hypothalamic-pituitary-adrenal reserve five to seven days after pituitary surgery, and postoperative morning serum cortisol concentration was compared with the insulin tolerance test for predicting corticotropin deficiency. In 35 patients with pituitary tumors studied prospectively, 27 had normal insulin tolerance test results five to seven days after pituitary surgery; in these patients, the morning serum cortisol concentration two to three days after surgery was 250 nmol/L (9 micrograms/dL) or greater. Eight patients had subnormal insulin tolerance test results or clinical evidence of adrenal insufficiency; the morning serum cortisol concentration in these patients was 80 nmol/L (3 micrograms/dL) or less. Postoperative adrenal insufficiency was transient (one to three months) in five of these eight patients. We retrospectively identified 45 patients whose postoperative morning serum cortisol values were 200 nmol/L (7 micrograms/dL) or greater; none of these patients had clinical evidence of adrenal insufficiency. We conclude that a morning serum cortisol level obtained two to three days after surgery and 24 hours after the discontinuation of hydrocortisone accurately predicts postoperative corticotropin reserve.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Diagnosis of Adrenal Insufficiency: Evaluation of the Corticotropin-Releasing Hormone Test and Basal Serum Cortisol in Comparison to the Insulin Tolerance Test in Patients with Hypothalamic-Pituitary-Adrenal Disease
Schmidt et al.
J. Clin. Endocrinol. Metab. 2003;88:4193-4198.
ABSTRACT | FULL TEXT  

Ten Years on: Safety of Short Synacthen Tests in Assessing Adrenocorticotropin Deficiency in Clinical Practice
Gleeson et al.
J. Clin. Endocrinol. Metab. 2003;88:2106-2111.
ABSTRACT | FULL TEXT  

Glucocorticoid Replacement in Pituitary Surgery: Guidelines for Perioperative Assessment and Management
Inder and Hunt
J. Clin. Endocrinol. Metab. 2002;87:2745-2750.
ABSTRACT | FULL TEXT  

A Comparison between the 1-{micro}g Adrenocorticotropin (ACTH) Test, the Short ACTH (250 {micro}g) Test, and the Insulin Tolerance Test in the Assessment of Hypothalamo-Pituitary-Adrenal Axis Immediately after Pituitary Surgery
Dökmetas et al.
J. Clin. Endocrinol. Metab. 2000;85:3713-3719.
ABSTRACT | FULL TEXT  

Tests of adrenal insufficiency
Agwu et al.
Arch. Dis. Child. 1999;80:330-333.
ABSTRACT | FULL TEXT  

Evaluation of the Integrity of the Hypothalamic-Pituitary-Adrenal Axis by Insulin Hypoglycemia Test
Erturk et al.
J. Clin. Endocrinol. Metab. 1998;83:2350-2354.
ABSTRACT | FULL TEXT  

MORNING CORTISOL LEVELS AS A TEST OF CORTICOTROPIN RESERVE
JWatch General 1988;1988:2-2.
FULL TEXT