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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Published on: January 17, 2018

Rapid decrease in adrenal responsiveness to ACTH stimulation after successful pituitary surgery in patients with

R A Alwani¹, W W de Herder, F H de Jong

¹Department of Internal Medicine, Endocrine section, Erasmus Medical Centre, Rotterdam, The Netherlands. r.alwani@erasmusmc.nl

Clinical Endocrinology

|June 1, 2011

Summary

Transsphenoidal surgery for Cushing's disease rapidly decreases adrenal sensitivity to ACTH stimulation. This indicates successful treatment and aids in predicting remission post-surgery.

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Area of Science:

Endocrinology
Neurosurgery
Oncology

Background:

Cushing's disease (CD) results from excess cortisol production, often due to pituitary adenomas.
Transsphenoidal surgery (TS) is a primary treatment for CD, aiming to remove the adenoma.
Assessing postoperative adrenal function is crucial for monitoring treatment efficacy.

Purpose of the Study:

To evaluate the impact of TS on adrenal gland responsiveness to ACTH stimulation in CD patients.
To determine if reduced adrenal sensitivity post-surgery correlates with successful remission.
To assess the utility of a low-dose ACTH stimulation test in predicting surgical outcomes.

Main Methods:

Cortisol levels were measured 6 days post-TS following a 1 μg synthetic ACTH (1-24) stimulation in 45 CD patients.
Patients were monitored for a mean follow-up of 56.5 months.
Adrenal response was assessed by peak cortisol concentrations post-ACTH stimulation.

Main Results:

In patients achieving sustained remission (24/28), peak cortisol levels were below 774 nM after ACTH stimulation (86%).
Patients with persistent CD (14/15) showed high peak cortisol levels (>774 nM) post-ACTH stimulation.
Two patients with late relapse also exhibited suppressed cortisol responses.

Conclusions:

Post-TS remission in CD is associated with a rapid decrease in adrenal responsiveness to exogenous ACTH.
This adrenal hypo-responsiveness may be due to ACTH-receptor down-regulation following adenoma removal.
The low-dose ACTH stimulation test demonstrated high sensitivity (93%) and specificity (87%) for predicting immediate remission.