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Withholding perioperative steroids & transsphenoidal resection for pituitary disease

Julie M Silverstein, MD
Julie M. Silverstein, MD
Karin Sterl, MD
Karin Sterl, MD

First author Karin Sterl, MD and senior author Julie M. Silverstein, MD had the findings of their recent study published in the October 15 issue of Neurosurgery. Collaborators included Bithika Thompson, MD, Charles W. Goss, PhD, Ralph G. Dacey, MD, Keith M. Rich, MD, Gregory J. Zipfel, MD, Michael R. Chicoine, MD, and Albert H. Kim, MD, PhD.

The purpose of the study was to evaluate the safety of withholding steroids in patients undergoing transsphenoidal surgery of pituitary tumors by prospectively comparing patients who did and did not receive perioperative glucocorticoids. Patients who undergo transsphenoidal resection of pituitary tumors are at risk for adrenal insufficiency.

The authors wrote, “The major finding of our study is that a steroid-sparing protocol is safe in patients with an intact HPA (hypothalamic-pituitary-adrenal) axis and does not affect surgical complications or the incidence of adrenal insufficiency, diabetes insipidus, or delayed hyponatremia. Furthermore, this study supports the notion that the administration of glucocorticoids, especially dexamethasone, may interfere with postoperative testing and lead to unnecessary treatment at discharge. Future randomized, controlled studies to establish the safety of lower postoperative cortisol cutoffs have the potential to minimize inappropriate use of glucocorticoids.”