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Selective perioperative steroid supplementation protocol in patients undergoing endoscopic transsphenoidal surgery for pituitary adenomas

  • Original Article - Pituitaries
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Abstract

Background

There is no consensus regarding the use of perioperative steroids for transsphenoidal pituitary surgery. We audited the effectiveness and safety of our selective perioperative steroid supplementation protocol in patients with pituitary adenomas.

Methods

Two hundred ninety-seven patients underwent 306 endoscopic transsphenoidal surgeries for removal of their pituitary tumors. Steroids were given to those with an impaired hypothalamic-pituitary-adrenal (HPA) axis, age ≥ 60 years, clinical apoplexy, hyponatremia, or if the pituitary gland was not preserved at surgery. We excluded 111 patients in whom the integrity of the HPA axis could not be determined. We compared the incidence of early postoperative adrenal insufficiency and complications in 135 patients with intact HPA axes who underwent surgery without steroids (group A) with 60 patients who had compromised preoperative HPA axes and received perioperative steroids (group B). In addition, we audited the total number of protocol violations during this period.

Results

Five patients (3.7%) in group A developed postoperative hypocortisolemia. There was no significant difference in the incidence of cerebrospinal fluid leak, diabetes insipidus, or hyponatremia between both groups. There were protocol deviations in 47 (15.4%) patients. Twenty one of these patients did not receive perioperative steroids in violation of the protocol, of whom 4 (19%) developed postoperative hypocortisolemia.

Conclusions

Our steroid sparing protocol was both safe and effective. The 15% incidence of protocol deviations is a reminder that the rigorous usage of checklists is mandatory for successful clinical practice.

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Abbreviations

ACTH:

Adrenocorticotropic hormone

AUC:

Area under the curve

CSF:

Cerebrospinal fluid

DI:

Diabetes insipidus

FSH:

Follicle-stimulating hormone

GH:

Growth hormone

HPA:

Hypothalamic-pituitary-adrenal

ICU:

Intensive care unit

IGF-1:

Insulin-like growth factor-1

LH:

Luteinizing hormone

ROC:

Receiver operating characteristic

T4:

Thyroxine

TSH:

Thyroid-stimulating hormone

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Authors and Affiliations

  1. Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India

    Shireen R. Chacko, Ananth P. Abraham & Ari G. Chacko

  2. Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India

    Hesarghatta Shyamasunder Asha, Nitin Kapoor & Simon Rajaratnam

Authors
  1. Shireen R. Chacko
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  2. Ananth P. Abraham
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  3. Hesarghatta Shyamasunder Asha
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  4. Nitin Kapoor
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  5. Simon Rajaratnam
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  6. Ari G. Chacko
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Corresponding author

Correspondence to Ari G. Chacko.

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The authors declare that they have no conflict of interest.

Ethical approval and informed consent

The perioperative steroid protocol approved by the Ethics Committee of our Institutional Review Board (IRB No 7558, dated 09/08/2011). For this retrospective study no formal consent was required.

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Chacko, S.R., Abraham, A.P., Asha, H.S. et al. Selective perioperative steroid supplementation protocol in patients undergoing endoscopic transsphenoidal surgery for pituitary adenomas. Acta Neurochir 162, 2381–2388 (2020). https://doi.org/10.1007/s00701-020-04530-3

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