RATIONALE FOR THE INTRA-OPERATIVE MANAGEMENT OF GLUCOCORTICOIDS
Pimentel F, Cukiert A, Andrioli M, Goldman J, Nery M, Salgado LR, Knoepfelmacher M, Liberman B.
Serviços de Neurocirurgia e Endocrinologia do Hospital Brigadeiro, São Paulo SP.
Glucocorticoid administration during and after transesphenoidal surgery has been proposed for patients with pre-operative cortisol deficiency or Cushing’s disease. On the other hand, the definition of the dosage has been empirically obtained and no stress data during transesphenoidal surgery is available. We examined dayly urinary cortisol secretion in 20 patients with sellar tumors (10 with Cushing’s disease; 5 with acromegaly, 3 with non-secreting tumors) operated through the transesphenoidal route. Patients were divided in 2 groups: Group I (n=12) patients received 300-500 mg of solucortef within the 2 first post-operative days and Group II patients did not receive solucortef. Mean urinary cortisol (m g / 24 hours) levels for Group I and II were, respectively: in the immediate post-operative day 9828 and 793; in the first post-operative day 4013 and 259; in the second post-operative day 1240 and 141; in the third post-operative day 191 and 79 and in the fourth post-operative day 58 and 74. These data suggest that the steroid doses currently used during transesphenoidal surgery are excessive and should be reduced.