Rational use of glucocorticoid during pituitary surgery – A pilot study

Background & objectives: The conventionally used perioperative glucocorticoid replacement protocol in patients with pituitary tumours is far from optimal. In this study we evaluated the validity of a modified protocol for perioperative glucocorticoid replacement in non-functioning pituitary macroadenomas. Methods: A total of 24 consecutive patients with non functioning pituitary macroadenomas were included in this interventional study. Patients with a pre-operative 0800 h cortisol of ≥350 nmol/l ( ≥ 12.6 µg/dl) did not receive glucocorticoid replacement during perioperative (d0-d-2) period, while those with ≤100nmol/l ( ≤ 3.6 µg/dl) received gluocorticoid replacement. Those patients with 0800 h cortisol value between>100-349 nmol/l (> 3.6-12.6 µg/dl) required them to undergo an insulin induced hypoglycaemia (IIH). In response to IIH, patients with a peak cortisol of <550 nmol/l (< 19.8 µg/dl) received glucocorticoid replacement. Post-operatively, patients on day 3 with 0800 h cortisol of ≤100 nmol/l (≤3.6 µg/dl) received hydrocortisone 10 mg/m2 per day; those between>100-449nmol/l (>3.6-16µg/dl) received hydrocortisone replacement only if they had symptoms of adrenal insufficiency (AI) or during stress; while patients with ≥450 nmol/l (≥16.0 µg/dl) did not receive any glucocorticoid replacement. Retesting was done at 12 wk in 23 subjects based on the algorithm