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- Title
Prospective evaluation of a week one overnight metyrapone test with subsequent dynamic assessments of hypothalamic-pituitary-adrenal axis function after pituitary surgery.
- Authors
English, Katherine; Inder, Warrick J.; Weedon, Zara; Dimeski, Goce; Sorbello, Jane; Russell, Anthony W.; Duncan, Emma L; Cuneo, Ross
- Abstract
Objective To determine whether an overnight metyrapone test ( OMT) within the first week postpituitary surgery can definitively assess the hypothalamic-pituitary-adrenal ( HPA) axis, compared with subsequent dynamic tests and glucocorticoid requirement at 6 months. Design Prospective study measuring morning cortisol levels on days 3 and 4 post-operatively, OMT day 5-7 and week 6, week 6 250 μg short Synacthen test ( SST) and week 7 insulin tolerance test ( ITT). Patients and Measurements Forty participants who underwent pituitary surgery at a single centre (Cushing's disease excluded) were followed for at least 6 months. 46% had pre-operative adrenal insufficiency. Primary outcome: week 1 OMT compared to glucocorticoid requirement at 6 months. Secondary outcomes: the performance of ITT as a 'definitive' test and all tests compared to glucocorticoid requirement at 6 months. Results Week 1 OMT showed concordance with ITT at week 7 of 78% and glucocorticoid requirement at 6 months of 81% respectively which was not significantly different from post-operative morning cortisol levels; 37% of participants with an abnormal OMT on day 6 had a normal OMT at week 6. All HPA axis tests showed similar concordance with glucocorticoid requirement at 6 months of 80%-85%. Conclusions Overnight metyrapone test within the first week after pituitary surgery was no better than an early morning cortisol level at predicting glucocorticoid requirement at 6 months. OMT at week 6 demonstrated recovery of HPA axis in a substantial proportion of participants who failed earlier assessments; thus, definitive testing should be delayed until 6 weeks post-operatively.
- Subjects
METOPIRONE; PITUITARY surgery; HYPOTHALAMIC-pituitary-adrenal axis; NEUROENDOCRINOLOGY; GLUCOCORTICOIDS
- Publication
Clinical Endocrinology, 2017, Vol 87, Issue 1, p35
- ISSN
0300-0664
- Publication type
Article
- DOI
10.1111/cen.13334