The authors report the results of using recovery room (RR) cortisol to predict the need for long-term glucocorticoids in patients who underwent transsphenoidal surgery (TSS). They conducted a retrospective study of preoperative morning serum cortisol (MSC), RR cortisol and day one to day three post-TSS MSC from a central database. Historically glucocorticoids were administered to all patients undergoing TSS as disruption in the hypothalamic pituitary axis (HPA) can potentially lead to adrenocorticotropic hormone (ACTH) deficiency, hypotension and death. However, glucocorticoids are associated with risk of hyperglycaemia, delayed wound healing, hypertension and bone loss when administered in high doses. Insulin tolerance testing is typically used to identify patients at risk of developing HPA axis disruption.
The authors used RR cortisol as a predictor and compared it to other early post-TSS MSC measurements. They found that RR cortisol was an accurate predictor of subsequent hypocortisolemia.
This article discusses the limitations as well as the significance of their results. – GM