Department of Neurosurgery, S80, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Pituitary. 2010 Sep;13(3):249-55. doi: 10.1007/s11102-010-0227-6.
Accurate assessment of the hypothalamic-pituitary-adrenal (HPA) axis is critical for the appropriate management of patients with pituitary adenoma after transsphenoidal surgery. We examine the role of immediate postoperative cortisol levels to assess hypothalamic-pituitary-adrenal axis (HPA) axis function post-operatively. We performed preoperative cortrosyn stimulation test (CST) and measured immediate postoperative serum cortisol levels in 100 patients undergoing 104 transsphenoidal surgeries. These results were compared to those of the CST at 4-6 weeks postoperatively, which served as a measure of HPA axis function. The ability of immediate postoperative, day of surgery (DOS) cortisol levels to predict normal HPA axis function was determined using standard predictive analytic methods and confusion matrix calculations. We found that postoperative, DOS cortisol level > or =15 microg/dL is a sensitive and accurate predictors of normal postoperative HPA axis function, with a sensitivity of 98%, an accuracy of 97%, and a positive predictive value of 99%. Our data suggest that an immediate, postoperative, DOS cortisol level > or =15 microg/dL predicts distant, normal, post-operative HPA axis function following transsphenoidal surgery.
准确评估下丘脑-垂体-肾上腺（HPA）轴对于经蝶窦手术后垂体腺瘤患者的适当管理至关重要。我们研究了术后即刻皮质醇水平在评估术后 HPA 轴功能中的作用。我们对 100 例接受 104 例经蝶窦手术的患者进行了术前促皮质素释放激素刺激试验（CST）和即刻术后血清皮质醇水平检测。将这些结果与术后 4-6 周的 CST 结果进行比较，作为 HPA 轴功能的衡量标准。使用标准预测分析方法和混淆矩阵计算来确定术后即刻（手术当天，DOS）皮质醇水平预测正常 HPA 轴功能的能力。我们发现术后即刻，DOS 皮质醇水平>或=15μg/dL 是预测术后 HPA 轴功能正常的敏感和准确指标，其敏感性为 98%，准确性为 97%，阳性预测值为 99%。我们的数据表明，术后即刻，DOS 皮质醇水平>或=15μg/dL 可预测经蝶窦手术后远处正常的术后 HPA 轴功能。
