Department of Otorhinolaryngology, Karolinska University Hospital, Eugeniavägen 3, 171 76, Stockholm, Sweden.
Department of Clinical Sciences, Intervention and Technology, Division of Otorhinolaryngology, Karolinska Institute, Stockholm, Sweden.
Acta Neurochir (Wien). 2019 Aug;161(8):1715-1721. doi: 10.1007/s00701-019-03885-6. Epub 2019 May 7.
Hydrocortisone treatment in transsphenoidal pituitary surgery has been debated. Although several publications advocate restrictive treatment, centers around the world administer stress doses of hydrocortisone in patients with presumed intact cortisol production. Our aim with this analysis was to compare postoperative hypocortisolism in patients who received three different protocols of hydrocortisone therapy during and after surgery.
This was a retrospective observational study. Based on perioperative hydrocortisone dose given, patients were divided in three groups: high dose (HD), intermediate dose (ID), and low dose (LD). Postoperative evaluation of the pituitary function was performed using S-cortisol at day 4 and short Synacthen test (SST) at 6-8 weeks. Patients with ACTH-producing adenomas or preoperative hydrocortisone treatment were excluded.
There was no difference between the groups regarding failure rate of SST. The rate of failed SST (all groups) was 51/186 (27%), 24/74 (32%) in the HD group and 26/74 (35%) and 11/38 (29%) in the ID and LD groups respectively. There was no significant difference between the ID and LD groups regarding S-cortisol at postoperative day 4 regarding serum cortisol level below 200 nmol/L. There was a significant but weak correlation, r 0.330 (P < 0.01) between S-cortisol day 4 and SST at 4-6 weeks.
Peri and postoperative hydrocortisone treatment did not affect SST response 6-8 weeks postoperatively, whereas the rate of patients with S-cortisol below 200 nmol/L at postoperative day 4 did. LD hydrocortisone therapy seems to favor a better endogenous production in the early postoperative phase.
关于经蝶窦垂体手术中氢化可的松的治疗一直存在争议。尽管有几项出版物主张限制治疗，但世界各地的中心在假定皮质醇生成完整的患者中给予氢化可的松应激剂量。我们分析的目的是比较在手术期间和之后接受三种不同氢化可的松治疗方案的患者术后低皮质醇血症的情况。
这是一项回顾性观察性研究。根据围手术期给予的氢化可的松剂量，将患者分为三组：高剂量（HD）、中剂量（ID）和低剂量（LD）。术后使用 S-皮质醇在第 4 天和短 Synacthen 试验（SST）在 6-8 周进行垂体功能评估。排除 ACTH 分泌腺瘤或术前接受氢化可的松治疗的患者。
三组之间 SST 失败率无差异。SST 失败率（所有组）为 51/186（27%），HD 组为 24/74（32%），ID 和 LD 组分别为 26/74（35%）和 11/38（29%）。ID 和 LD 组之间在术后第 4 天的 S-皮质醇水平低于 200nmol/L 时没有显著差异。S-皮质醇第 4 天和 4-6 周时的 SST 之间存在显著但较弱的相关性，r 0.330（P<0.01）。
围手术期和术后氢化可的松治疗不影响术后 6-8 周时的 SST 反应，而术后第 4 天 S-皮质醇低于 200nmol/L 的患者比例则会。LD 氢化可的松治疗似乎在术后早期更有利于内源性产生。
