医学
围手术期
肾上腺功能不全
地塞米松
经蝶手术
尿崩症
随机对照试验
入射(几何)
外科
氢化可的松
前瞻性队列研究
皮质类固醇
麻醉
垂体瘤
内科学
垂体腺瘤
腺瘤
物理
光学
作者
Karin Sterl,Bithika Thompson,Charles W. Goss,Ralph G. Dacey,Keith M. Rich,Gregory J. Zipfel,Michael R. Chicoine,Albert H. Kim,Julie Silverstein
出处
期刊:Neurosurgery
[Oxford University Press]
日期:2018-10-15
卷期号:85 (2): E226-E232
被引量:20
标识
DOI:10.1093/neuros/nyy479
摘要
Perioperative steroid protocols for patients undergoing transsphenoidal surgery (TSS) for pituitary pathology vary by institution.To assess the safety of withholding glucocorticoids in patients undergoing TSS.Patients with an intact hypothalamic-pituitary-adrenal (HPA) axis undergoing TSS for a pituitary tumor at the same academic institution between 2012 and 2015 were randomized to either receive 100 mg of intravenous hydrocortisone followed by 0.5 mg of intravenous dexamethasone every 6 h for 4 doses (STER, n = 23) or to undergo surgery without steroids (NOSTER, n = 20). Postoperative cortisol levels were then used to determine the need for glucocorticoids after surgery. Data regarding postoperative cortisol levels, hospital stay length, and complications were collected.Mean postoperative 8 am cortisol levels were higher in the NOSTER group compared to the STER group (745 ± 359 nmol/L and 386 ± 193 nmol/L, respectively, P = .001) and more patients were discharged on glucocorticoids in the STER group (42% vs 12%, P = .07). There was no difference in the incidence of postoperative complications, including hyperglycemia, diabetes insipidus, or permanent adrenal insufficiency. Permanent adrenal insufficiency occurred in 8% of patients.Perioperative steroids can be safely withheld in patients with an intact HPA axis undergoing TSS. Although administration of perioperative glucocorticoids does not appear to increase the risk of complications, it may interfere with assessment of the HPA axis after surgery.
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