基底皮质醇与 metyrapone 相关的证据在预测下垂体手术后上腺功能不足时得到证实
Pieter E Huisman1, Sarah E Siegelaar1,2,3, Jantien Hoogmoed4,2,5,6
1Department of Endocrinology and Metabolism, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.
Pituitary
|January 19, 2024
概括
在下垂体手术后将术后皮质醇值降至357nmol/L,可以安全地减少对皮质替代的需要,改善患者的治疗结果并减少医疗负担.
科学领域:
- 内分泌学 在内分泌学.
- 神经外科 神经外科
- 临床诊断 临床诊断 临床诊断
背景情况:
- 下垂体手术经常导致上腺功能不充分,需要替代葡萄糖皮质类药物.
- 目前的管理依赖于高的手术后第三天 (POD3) 血皮质醇值 (450 nmol/L) 来指导皮质素的启动.
- 这种方法可能会导致不必要的葡萄糖皮质激素使用和相关的患者负担.
研究的目的:
- 批判性地评估下垂体手术后手术后上腺功能不足的诊断和治疗算法.
- 为了确定POD3的较低血皮质醇切断值是否可以安全地指导皮质替代疗法.
主要方法:
- 在阿姆斯特丹UMC (2018年1月至2022年2月) 进行下垂体手术的95名患者的回顾性分析.
- 患有POD3皮质醇<450nmol/L的患者接受了皮质,并在3个月后接受了 metyrapone 测试.
- 排除标准包括库辛病和手术前使用皮.
主要成果:
- 357nmol/L的POD3皮质醇切断值显示了100%的灵敏度和100%的负预测值,用于识别上腺功能不充分.
- 使用这个较低的值 (357nmol/L) 可以减少28%的需要替换皮质相比目前的450nmol/L切断.
- 这种优化值可确保准确识别需要葡萄糖皮质醇治疗的患者.
结论:
- 在下垂体手术后降低早晨血皮质醇切断值是安全有效的.
- 低于450nmol/L的门值可以可靠地指导需要补充皮的需求.
- 这种精细化优化了患者管理,减少了不必要的治疗.
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