OBJECTIVE The aim was to study the prevalence of secondary adrenal insufficiency before and after surgery for non-functioning pituitary adenomas, as well as determine risk factors for developing secondary adrenal insufficiency. A secondary aim was to determine adequate p-cortisol response to a 1-μg Short Synacthen Test after surgery. DESIGN Longitudinal cohort study. METHODS One hundred seventeen patients (52/65 females/males, age 59 years) undergoing primary surgery for clinically non-functioning pituitary adenomas were included. P-cortisol was measured in morning blood samples. Three months after surgery, a Short Synacthen Test was performed. RESULTS All tumours were macroadenomas (mean size 26.9 mm, range 13-61 mm). The surgical indications were visual impairment (93), tumour growth (16), pituitary apoplexy (6) and headache (2). Before surgery, 17% of the patients had secondary adrenal insufficiency (SAI), decreasing to 15% 3 months postoperatively. Risk of SAI was increased in patients operated for pituitary apoplexy (p < 0.001), while age, sex, tumour size and complication rate were not different from the remaining cohort. Three months after surgery, all patients with baseline p-cortisol ≥ 172 nmol/l (6.2 μg/dl) and peak p-cortisol during Short Synacthen Test ≥ 320 nmol/l (11.6 μg/dl) tapered cortisone unproblematically. In patients with intact hypothalamic-pituitary-adrenal axis, p-cortisol peaked < 500 nmol/l (18.1 μg/dl) during Short Synacthen Test in 48% of patient. CONCLUSION Pituitary surgery is safe and transsphenoidal surgery rarely causes new SAI. Relying solely on morning p-cortisol for diagnosing secondary adrenal insufficiency gives false positives and the Short Synacthen Test remains useful. A peak p-cortisol ≥ 320 during (11.6 μg/dl) Short Synacthen Test indicates a sufficient response, while < 309 nmol/l (11.2 μg/dl) indicates secondary adrenal insufficiency.

中文翻译：

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无功能垂体腺瘤手术后对低剂量短 Synacthen 试验的足够皮质醇反应的临界值。

目的旨在研究无功能垂体腺瘤手术前后继发性肾上腺皮质功能不全的患病率，并确定发生继发性肾上腺皮质功能不全的危险因素。次要目的是确定手术后对 1-μg 短 Synacthen 测试的足够 p-皮质醇反应。设计 纵向队列研究。方法 117 名接受临床无功能垂体腺瘤初次手术的患者（52/65 女性/男性，年龄 59 岁）。在早晨的血液样本中测量 P-皮质醇。手术后三个月，进行了一次短 Synacthen 测试。结果 所有肿瘤均为大腺瘤（平均大小 26.9 mm，范围 13-61 mm）。手术适应症为视力障碍 (93)、肿瘤生长 (16)、垂体卒中 (6) 和头痛 (2)。手术前，17% 的患者有继发性肾上腺皮质功能减退症 (SAI)，术后 3 个月降至 15%。垂体卒中患者的 SAI 风险增加（p < 0.001），而年龄、性别、肿瘤大小和并发症发生率与其余队列没有差异。手术后三个月，所有基线对皮质醇 ≥ 172 nmol/l (6.2 μg/dl) 和在短 Synacthen 测试期间峰值对皮质醇 ≥ 320 nmol/l (11.6 μg/dl) 的患者毫无问题地逐渐减少可的松。在下丘脑-垂体-肾上腺轴完整的患者中，48% 的患者在 Short Synacthen 试验期间对皮质醇峰值 < 500 nmol/l (18.1 μg/dl)。结论 垂体手术是安全的，经蝶手术很少引起新的 SAI。仅依靠早晨对皮质醇来诊断继发性肾上腺皮质功能不全会产生误报，而短 Synacthen 测试仍然有用。在 (11.6 μg/dl) Short Synacthen 测试期间峰值 p-皮质醇 ≥ 320 表示反应充分，而 < 309 nmol/l (11.2 μg/dl) 表示继发性肾上腺功能不全。