Postoperative adrenal insufficiency after Sellar and Parasellar surgery: Prevalence and result of perioperative glucocorticoid replacement.

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Thanakorn Thiensri



OBJECTIVE: To study prevalence of postoperative adrenal insufficiency and result of perioperative glucocorticoid replacement in patients with normal preoperative hypothalamic-pituitary-adrenal (HPA) axis functions undergoing sellar and parasellar surgery. METHODS: A retrospective cohort study was conducted to assess postoperative adrenal insufficiency in patients who underwent sellar and parasellar surgery in Phramongkutklao Hospital between 2010 to 2016. Losgistic regression was used for analysis the correlation between postoperative adrenal insufficiency and several factors, including perioperative glucocorticoid replacement. RESULTS:From 79 patients, 13 patients (16.5%) were operated transcranial surgery and 66 patients (83.5%) were operated transsphenoidal surgery. The pathological diagnosis was non-functioning pituitary adenoma in 60.8%, GH-secreting pituitary adenoma in 10.1%, prolactinoma in 2.5%, thyrotroph pituitary adenoma in 1.3%, craniopharyngioma in 5.1%, Rathke’s cleft cyst in 7.6%, meningioma in 10.1%, and schwannoma in 2.5%. Fifteen patients (19%) had postoperative adrenal insufficiency. Perioperative glucocorticoid replacement associated with lower rate of postoperative adrenal insufficiency, but this correlation was not statistically significant (OR = 0.63, 95%CI 0.58-9.57, p-value 0.338).  In multivariate analysis, only patients with postoperative central diabetes insipidus had significantly higher rate of postoperative adrenal insufficiency (adjusted OR = 8.512, 95%CI 2.211-32.769, p-value 0.002). Furthermore, perioperative glucocorticoid replacement did not associated with any postoperative complications. CONCLUSION: Routine perioperative glucocorticoid replacement is not necessary in patients undergoing sellar and parasellar surgery whose preoperative adrenal function is intact. In this study, we found significant correlation between postoperative central diabetes insipidus and postoperative adrenal insufficiency.

KEYWORDS: Postoperative adrenal insufficiency, Perioperative glucocorticoid replacement, Sellar and parasellar surgery

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นิพนธ์ต้นฉบับ (Original Article)