Prediction of adrenal insufficiency after pituitary surgery: a retrospective study using beckman access cortisol assay
Authors' conclusion
Clinicians might rely on the first- and second- postoperative days 8.00 a.m. cortisol to identify patients to discharge with glucocorticoid replacement therapy waiting for the confirmation of SAI through the ACTH test.
Study context
- Population
- Patients undergoing pituitary surgery, Humanitas Research Hospital, Italy, March 2017–August 2022; Secondary adrenal insufficiency (SAI) diagnosed by 1 µg ACTH test six weeks after surgery (cortisol peak <14.8 µg/dL [408 nmol/L] at 30 or 60 min)7 developed SAI
- Participants
- 64 patients
- Comparison
- First vs second postoperative day 8.00 a.m. cortisol for predicting SAI
- Outcome
- Reliability of 8.00 a.m. cortisol of the first and second postoperative days in predicting SAI
Methodological detailssingle-centre
- Single-centre
Performance
As reported in the abstract
Prediction of SAI
| Test or model | AUC | Optimal threshold | Accuracy |
|---|---|---|---|
| First-day cortisol | 0.94 | 15.6 µg/dL (430.3 nmol/L) | 89% |
| Second-day cortisol | 0.95 | 11.5 µg/dL (317.2 nmol/L) | 81% |
AUC
First-day cortisol0.94
Second-day cortisol0.95
Optimal threshold
First-day cortisol15.6 µg/dL (430.3 nmol/L)
Second-day cortisol11.5 µg/dL (317.2 nmol/L)
Accuracy
First-day cortisol89%
Second-day cortisol81%
Further findings
Preoperative predictors of SAI · before surgery
- Larger tumors in patients who developed SAI
- P = 0.004
- Lower fT4 in patients who developed SAI
- P = 0.038
Original publication
Prediction of adrenal insufficiency after pituitary surgery: a retrospective study using beckman access cortisol assay. Pituitary. Published 3 January 2024. doi:10.
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