Perioperative management of the hypothalamic-pituitary-adrenal axis in patients with pituitary adenomas: an Australasian survey
Article first published online: 10 OCT 2012
© 2011 The Authors; Internal Medicine Journal © 2011 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 42, Issue 10, pages 1120–1124, October 2012
How to Cite
Joseph, S. P., Ho, J. T., Doogue, M. P. and Burt, M. G. (2012), Perioperative management of the hypothalamic-pituitary-adrenal axis in patients with pituitary adenomas: an Australasian survey. Internal Medicine Journal, 42: 1120–1124. doi: 10.1111/j.1445-5994.2011.02582.x
Conflict of interest: None
- Issue published online: 10 OCT 2012
- Article first published online: 10 OCT 2012
- Accepted manuscript online: 1 SEP 2011 10:57AM EST
- Manuscript Accepted: 2 AUG 2011
- Manuscript Received: 12 APR 2011
- trans-sphenoidal hypophysectomy;
- insulin tolerance test;
- short synacthen test
There is limited consensus regarding optimal glucocorticoid administration for pituitary surgery to prevent a potential adrenal crisis.
To assess the investigation and management of the hypothalamic–pituitary–adrenal (HPA) axis in patients undergoing trans-sphenoidal hypophysectomy in Australasia.
A questionnaire was sent to one endocrinologist at each of 18 centres performing pituitary surgery in Australasia. Using hypothetical case vignettes, respondents were asked to describe their investigation and management of the HPA axis for a patient with a: non-functioning macroadenoma and intact HPA axis, non-functioning macroadenoma and HPA deficiency and growth hormone secreting microadenoma undergoing trans-sphenoidal hypophysectomy.
Responses were received from all 18 centres. Seventeen centres assess the HPA axis preoperatively by measuring early morning cortisol or a short synacthen test. Preoperative evaluation of the HPA status influenced glucocorticoid prescription by 10 centres, including 2/18 who would not prescribe perioperative glucocorticoids for a patient with a macroadenoma and an intact HPA axis. Tumour size influenced glucocorticoid prescribing patterns at 7/18 centres who prescribe a lower dose or no glucocorticoids for a patient with a microadenoma. Choice of investigations for definitive postoperative assessment of the HPA axis varied with eight centres requesting an insulin tolerance test, four centres a 250 µg short synacthen test and six centres requesting other tests.
There is wide variability in the investigation and management of perioperative glucocorticoid requirements for patients undergoing pituitary surgery in Australasia. This may reflect limited evidence to define optimal management and that further well-designed studies are needed.