Department of Neurosciences, Inova Health Systems Falls Church, VA, USA.
Front Endocrinol (Lausanne). 2013 Mar 18;4:30. doi: 10.3389/fendo.2013.00030. eCollection 2013.
Traditional neurosurgical practice calls for administration of peri-operative stress-dose steroids for sellar-suprasellar masses undergoing operative treatment. This practice is considered critical to prevent peri-operative complications associated with hypoadrenalism, such as hypotension and circulatory collapse. However, stress-dose steroids complicate the management of these patients. It has been our routine practice to use stress steroids during surgery only if the patient has clinical or biochemical evidence of hypocortisolism pre-operatively. We wanted to be certain that this practice was safe.
We present our retrospective analysis from a consecutive series of 114 operations in 109 patients with sellar and/or suprasellar tumors, the majority of whom were managed without empirical stress-dose steroid coverage. Only patients who were hypoadrenal pre-operatively or who had suffered apoplexy were given stress-dose coverage during surgery. We screened for biochemical evidence of hypoadrenalism as a result of surgery by measuring immediate post-operative AM serum cortisol levels.
There were no adverse events related to the selective use of cortisol replacement in this patient population.
Our experience demonstrates that selective use of corticosteroid replacement is safe; it simplifies the management of the patients, and has advantages over empiric "dogmatic" steroid coverage.
传统的神经外科手术实践要求对接受手术治疗的鞍上-鞍旁肿块患者给予围手术期应激剂量类固醇。这种做法被认为对于预防与肾上腺功能减退相关的围手术期并发症（如低血压和循环衰竭）至关重要。然而，应激剂量类固醇会使这些患者的管理复杂化。我们的常规做法是仅在患者术前有临床或生化证据表明存在皮质醇缺乏的情况下，在手术期间使用应激类固醇。我们想确定这种做法是否安全。
我们回顾性分析了 109 例鞍上和/或鞍旁肿瘤患者的连续 114 例手术，其中大多数患者未接受经验性应激剂量类固醇覆盖。仅对术前存在肾上腺功能减退或发生过卒中的患者，在手术期间给予应激剂量类固醇覆盖。我们通过测量术后即刻 AM 血清皮质醇水平，筛查因手术导致的肾上腺功能减退的生化证据。
在该患者人群中，选择性使用皮质醇替代治疗没有与手术相关的不良事件。
我们的经验表明，选择性使用皮质类固醇替代治疗是安全的；它简化了患者的管理，并且优于经验性的“教条式”类固醇覆盖。
