Selective use of peri-operative steroids in pituitary tumor surgery: escape from dogma
Objective: Traditional neurosurgical practice calls for administration of peri-operative stress-dose steroids for sellar-suprasellar masses undergoing operative treatment. This practice is considered critical to prevent peri-operative complications associated with hypoadrenalism, such as hypotensio...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2013-03-01
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| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | http://journal.frontiersin.org/Journal/10.3389/fendo.2013.00030/full |
| _version_ | 1818531363552231424 |
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| author | Jacqueline Marie Regan Joseph eWatson |
| author_facet | Jacqueline Marie Regan Joseph eWatson |
| author_sort | Jacqueline Marie Regan |
| collection | DOAJ |
| description | Objective: Traditional neurosurgical practice calls for administration of peri-operative stress-dose steroids for sellar-suprasellar masses undergoing operative treatment. This practice is considered critical to prevent peri-operative complications associated with hypoadrenalism, such as hypotension and circulatory collapse. However, stress-dose steroids complicate the management of these patients. It has been our routine practice to use stress steroids during surgery only if the patient has clinical or biochemical evidence of hypocortisolism pre-operatively. We wanted to be certain that this practice was safe.Methods: We present our retrospective analysis from a consecutive series of 114 operations in 109 patients with sellar and/or suprasellar tumors, the majority of whom were managed without empirical stress-dose steroid coverage. Only patients who were hypoadrenal pre-operatively or who had suffered apoplexy were given stress dose coverage during surgery. We screened for biochemical evidence of hypoadrenalism as a result of surgery by measuring immediate post-operative AM serum cortisol levels.Results: There were no adverse events related to the selective use of cortisol replacement in this patient population. Conclusions: Our experience demonstrates that selective use of corticosteroid replacement is safe; it simplifies the management of the patients, and has advantages over empiric dogmatic steroid coverage. |
| first_indexed | 2024-12-11T17:31:30Z |
| format | Article |
| id | doaj.art-715b498996a342e5b408e289a71bb8dd |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-12-11T17:31:30Z |
| publishDate | 2013-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-715b498996a342e5b408e289a71bb8dd2022-12-22T00:56:49ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922013-03-01410.3389/fendo.2013.0003033605Selective use of peri-operative steroids in pituitary tumor surgery: escape from dogmaJacqueline Marie Regan0Joseph eWatson1Inova Fairfax HospitalInova Fairfax HospitalObjective: Traditional neurosurgical practice calls for administration of peri-operative stress-dose steroids for sellar-suprasellar masses undergoing operative treatment. This practice is considered critical to prevent peri-operative complications associated with hypoadrenalism, such as hypotension and circulatory collapse. However, stress-dose steroids complicate the management of these patients. It has been our routine practice to use stress steroids during surgery only if the patient has clinical or biochemical evidence of hypocortisolism pre-operatively. We wanted to be certain that this practice was safe.Methods: We present our retrospective analysis from a consecutive series of 114 operations in 109 patients with sellar and/or suprasellar tumors, the majority of whom were managed without empirical stress-dose steroid coverage. Only patients who were hypoadrenal pre-operatively or who had suffered apoplexy were given stress dose coverage during surgery. We screened for biochemical evidence of hypoadrenalism as a result of surgery by measuring immediate post-operative AM serum cortisol levels.Results: There were no adverse events related to the selective use of cortisol replacement in this patient population. Conclusions: Our experience demonstrates that selective use of corticosteroid replacement is safe; it simplifies the management of the patients, and has advantages over empiric dogmatic steroid coverage.http://journal.frontiersin.org/Journal/10.3389/fendo.2013.00030/fullCraniopharyngiomacortisolpituitary adenomaRathke's cyststress-dose steroidspanhypopituitary |
| spellingShingle | Jacqueline Marie Regan Joseph eWatson Selective use of peri-operative steroids in pituitary tumor surgery: escape from dogma Frontiers in Endocrinology Craniopharyngioma cortisol pituitary adenoma Rathke's cyst stress-dose steroids panhypopituitary |
| title | Selective use of peri-operative steroids in pituitary tumor surgery: escape from dogma |
| title_full | Selective use of peri-operative steroids in pituitary tumor surgery: escape from dogma |
| title_fullStr | Selective use of peri-operative steroids in pituitary tumor surgery: escape from dogma |
| title_full_unstemmed | Selective use of peri-operative steroids in pituitary tumor surgery: escape from dogma |
| title_short | Selective use of peri-operative steroids in pituitary tumor surgery: escape from dogma |
| title_sort | selective use of peri operative steroids in pituitary tumor surgery escape from dogma |
| topic | Craniopharyngioma cortisol pituitary adenoma Rathke's cyst stress-dose steroids panhypopituitary |
| url | http://journal.frontiersin.org/Journal/10.3389/fendo.2013.00030/full |
| work_keys_str_mv | AT jacquelinemarieregan selectiveuseofperioperativesteroidsinpituitarytumorsurgeryescapefromdogma AT josephewatson selectiveuseofperioperativesteroidsinpituitarytumorsurgeryescapefromdogma |