Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, South Australia, Australia.
Intern Med J. 2012 Oct;42(10):1120-4. doi: 10.1111/j.1445-5994.2011.02582.x.
There is limited consensus regarding optimal glucocorticoid administration for pituitary surgery to prevent a potential adrenal crisis.
To assess the investigation and management of the hypothalamic-pituitary-adrenal (HPA) axis in patients undergoing trans-sphenoidal hypophysectomy in Australasia.
A questionnaire was sent to one endocrinologist at each of 18 centres performing pituitary surgery in Australasia. Using hypothetical case vignettes, respondents were asked to describe their investigation and management of the HPA axis for a patient with a: non-functioning macroadenoma and intact HPA axis, non-functioning macroadenoma and HPA deficiency and growth hormone secreting microadenoma undergoing trans-sphenoidal hypophysectomy.
Responses were received from all 18 centres. Seventeen centres assess the HPA axis preoperatively by measuring early morning cortisol or a short synacthen test. Preoperative evaluation of the HPA status influenced glucocorticoid prescription by 10 centres, including 2/18 who would not prescribe perioperative glucocorticoids for a patient with a macroadenoma and an intact HPA axis. Tumour size influenced glucocorticoid prescribing patterns at 7/18 centres who prescribe a lower dose or no glucocorticoids for a patient with a microadenoma. Choice of investigations for definitive postoperative assessment of the HPA axis varied with eight centres requesting an insulin tolerance test, four centres a 250 µg short synacthen test and six centres requesting other tests.
There is wide variability in the investigation and management of perioperative glucocorticoid requirements for patients undergoing pituitary surgery in Australasia. This may reflect limited evidence to define optimal management and that further well-designed studies are needed.
对于预防潜在肾上腺危象的垂体手术，糖皮质激素的最佳给药方案尚未达成共识。
评估在澳大利亚和亚洲接受经蝶窦垂体切除术的患者下丘脑-垂体-肾上腺（HPA）轴的检查和管理。
向澳大利亚和亚洲的 18 个进行垂体手术的中心中的每位内分泌医生发送了一份问卷。使用假设病例，要求受访者描述他们对 HPA 轴的检查和管理，患者的情况为：无功能大腺瘤且 HPA 轴完好、无功能大腺瘤且 HPA 轴功能减退和生长激素分泌微腺瘤接受经蝶窦垂体切除术。
收到了来自所有 18 个中心的回复。17 个中心通过测量清晨皮质醇或短 Synacthen 试验来术前评估 HPA 轴。有 10 个中心的术前 HPA 状态评估影响了糖皮质激素的处方，其中包括 2/18 中心的患者即使有大腺瘤和完整的 HPA 轴，也不会开具围手术期糖皮质激素。有 7/18 个中心的肿瘤大小影响了糖皮质激素的处方模式，他们会为微腺瘤患者开具较低剂量或不使用糖皮质激素。有 8 个中心要求进行胰岛素耐量试验、4 个中心要求进行 250µg Synacthen 短试验，6 个中心要求进行其他检查，以明确术后 HPA 轴的检查。
在澳大利亚和亚洲接受垂体手术的患者中，围手术期糖皮质激素需求的检查和管理存在广泛的差异。这可能反映了定义最佳管理的有限证据，并且需要进一步进行精心设计的研究。
