经蝶窦手术后患者糖皮质激素节省策略的效用。

UTILITY OF A GLUCOCORTICOID SPARING STRATEGY IN THE MANAGEMENT OF PATIENTS FOLLOWING TRANSSPHENOIDAL SURGERY.

出版信息

Endocr Pract. 2016 Sep;22(9):1033-9. doi: 10.4158/EP161256.OR. Epub 2016 Apr 28.

Abstract

OBJECTIVE

Following transsphenoidal surgery (TSS), it is important to assess for and manage adrenal insufficiency (AI). The goal of this study is to assess the efficacy and safety of a glucocorticoid (GC) sparing protocol to limit GC exposure in patients undergoing TSS.

METHODS

Adult patients undergoing TSS (excluding Cushing disease) with adequate adrenal function prior to surgery underwent TSS without perioperative GC coverage. Following TSS, daily morning fasting serum cortisol levels were tested. GCs were administered at stress doses for serum cortisol <5 mcg/dL, between 5 and 12 mcg/dL in the presence of clinically significant symptoms of AI, or >12 mcg/dL with severe headache, nausea or vomiting, fatigue, anorexia, or hyponatremia. The primary endpoint was the use of GCs in the immediate postoperative period.

RESULTS

Of 178 subjects, GCs were administered to 80 (45%) patients for the following indications: 31.3% for serum cortisol <5 mcg/dL; 36.3% for cortisol between 5 and 12 mcg/dL accompanied by symptoms or signs of AI; 8.8% for moderate to severe postoperative hyponatremia; and 7.5% for severe headache, nausea and vomiting, fatigue, or anorexia with cortisol >12 mcg/dL. Logistic regression analysis showed that longer length of hospital stay (odds ratio [OR] 1.22, confidence interval [CI] 1.02-1.45) and the presence of new postoperative anterior pituitary hormone deficiency (OR 3.3, CI 1.26-8.67) were associated with postoperative GC use. By 12 weeks, only 14% of subjects remained on GCs. There were no adverse events related to withholding GCs.

CONCLUSION

Our protocol for managing GC replacement is both safe and effective for limiting GC exposure in patients undergoing TSS.

ABBREVIATIONS

AI = adrenal insufficiency CI = confidence interval FSH = follicle-stimulating hormone GC = glucocorticoid GH = growth hormone IGF-1 = insulin-like growth factor-1 IV = intravenous LH = luteinizing hormone LOS = length of hospital stay OR = odds ratio TSS = transsphenoidal surgery.

摘要

目的

经蝶窦手术后（不包括库欣病），评估并治疗肾上腺功能不全（AI）非常重要。本研究旨在评估一种糖皮质激素（GC）节省方案的疗效和安全性，以限制接受经蝶窦手术（TSS）患者的 GC 暴露。

方法

术前肾上腺功能正常的成年患者接受 TSS（不包括库欣病），但不接受围手术期 GC 覆盖。TSS 后，每天清晨空腹检测血清皮质醇水平。当血清皮质醇 <5μg/dL 时，给予 GC 应激剂量；当皮质醇在 5 至 12μg/dL 之间且存在 AI 的临床显著症状时，或当皮质醇 >12μg/dL 且伴有严重头痛、恶心或呕吐、疲劳、厌食或低钠血症时，给予 GC。主要终点是术后即刻使用 GC。

结果

在 178 名患者中，80 名（45%）患者因以下原因使用了 GC：31.3%的患者因血清皮质醇 <5μg/dL；36.3%的患者因皮质醇在 5 至 12μg/dL 之间伴有 AI 的症状或体征；8.8%的患者因中度至重度术后低钠血症；7.5%的患者因皮质醇 >12μg/dL 且伴有严重头痛、恶心和呕吐、疲劳或厌食而使用 GC。Logistic 回归分析显示，较长的住院时间（比值比[OR]1.22，95%置信区间[CI]1.02-1.45）和新出现的术后垂体前叶激素缺乏（OR 3.3，95%CI 1.26-8.67）与术后 GC 使用相关。到 12 周时，只有 14%的患者仍在使用 GC。不使用 GC 无相关不良事件。