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下垂体手术后上腺功能缺陷的预测:使用贝克曼访问皮质醇试验进行的一项回顾性研究

Maria Francesca Birtolo^1,2, Emma Giannini¹, Simone Antonini^1,2

¹Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.

|January 3, 2024

概括

手术后的早晨皮质醇水平可以可靠地预测下垂体手术后的二次上腺功能不足 (SAI). 早期识别可以及时进行葡萄糖皮质激素替代疗法,改善患者的治疗结果.

科学领域:

内分泌学在内分泌学.
神经外科神经外科
临床化学临床化学

背景情况:

在下垂体手术后诊断二次上腺功能缺陷 (SAI) 是具有挑战性的,因为标准测试在手术后期不适合.
关于早期手术后早晨皮质醇水平对SAI诊断的有用性存在有争议的数据,有测试特定的变化.
这项研究解决了需要可靠的SAI在下垂体手术后的早期指标的需求.

研究的目的:

评估在第一和第二次术后几天上午8点的皮质醇测量的预测准确度,以确定SAI.
建立最佳的皮质醇值,以预测早期术后阶段的SAI.
根据临床决策,决定是否启动葡萄糖皮质醇替代疗法.

主要方法:

在2017年3月至2022年8月期间接受了下垂体手术的64名患者的回顾性分析.
在手术后6周,SAI诊断通过1μg的ACTH刺激测试得到证实.
使用Beckman Access皮质醇测定法测量皮质醇水平;SAI定义为皮质醇峰值<14.8μg/dL (408nmol/L) 在30或60分钟内.

主要成果:

64名患者中有7名患上了SAI.
接收器操作特征 (ROC) 曲线分析显示,第一天 (AUC 0.94) 和第二天 (AUC 0.95) 术后8:00上午皮质醇水平的强有力的预测值.
最佳值:第一天皮质醇>15.6μg/dL (430.3nmol/L;准确率89%) 和第二天皮质醇>11.5μg/dL (317.2nmol/L;准确率81%).
与SAI相关的术前因素包括较大的瘤和较低的自由甲状腺素 (fT4) 水平.

结论:

术后第一天和第二天早上8点的皮质醇水平是SAI的可靠预测指标.
这些早期皮质醇测量可以指导临床医生在等待最终ACTH测试结果时识别可能需要葡萄糖皮质醇替代疗法的患者.
这种方法有助于及时管理和出院规划SAI风险的患者.

关键词:

皮质醇是一种皮质醇.新的测定方法.新的切断线.下垂体外科手术是什么?二次上腺功能不充分症

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