Evaluation of the XXXX immediately after pituitary adenomectomy: is perioperative steroid therapy necessary?

@entity1 @entity21422 @entity1887 @entity2339 @entity977 @entity701
@entity1 undergoing pituitary adenomectomy are usually given glucocorticoid therapy, although there are no data to document the need for such therapy. We prospectively studied @entity2339 ( @entity2339 ) function in 88 consecutive @entity977 @entity1 before and after selective adenomectomy, excluding those with @entity21422 . Preoperatively, 5 @entity1 had @entity1887 ( @entity1887 ); they were treated with glucocorticoids and excluded from the analysis. The remaining 83 @entity1 had normal @entity2339 function preoperatively and were not given glucocorticoids before, during, or immediately after surgery, but were closely monitored, and their serum @entity701 levels were measured in the immediate postoperative period. Two @entity1 were clinically suspected to have @entity1887 postoperatively and were treated accordingly. The remaining 81 @entity1 had no clinical manifestations of @entity1887 and received no glucocorticoid therapy. Their serum @entity701 levels in the immediate postoperative period were appropriately elevated. The mean serum @entity701 level was 40.5 +/- 11.1 (+/- SD) micrograms/dL (1117 +/- 306 nmol/L) 6 h after surgery; serum @entity701 levels decreased gradually thereafter. Morning serum @entity701 levels were within the normal range on the fourth, fifth, and sixth days after surgery: day 4, 15.1 +/- 7.0 micrograms/dL (417 +/- 193 nmol/L); day 5, 16.4 +/- 5.6 micrograms/dL (453 +/- 155 nmol/L); and day 6, 16.3 +/- 5.7 micrograms/dL (450 +/- 157 nmol/L). When tested 3 months after surgery, all 81 @entity1 had normal @entity2339 function. We conclude that @entity2339 function is rarely compromised after selective pituitary adenomectomy. Close observation and serum @entity701 measurements in the immediate postoperative period can reliably predict the integrity of the @entity2339 after surgery. Routine glucocorticoid therapy is not needed in @entity1 undergoing selective adenomectomy whose preoperative adrenal function is normal.
