正常皮质醇垂体腺瘤围术期不常规激素替代治疗探讨

目的：评估术前清晨血清皮质醇正常的垂体腺瘤患者围术期不常规使用糖皮质激素进行替代治疗的安全性。方法回顾分析66例术前皮质醇正常的垂体腺瘤且围术期无常规使用糖皮质激素的患者，观察及对比术前及术后1、3、7 d清晨8：00血清皮质醇、促肾上腺皮质激素（ACTH）水平变化，并统计围术期相关并发症。结果术后1 d的皮质醇和ACTH水平均显著高于术前，差异有统计学意义（P＜0．01）；术后3、7 d恢复至术前水平，差异无统计学意义（P＞0．05）。仅3例患者术后皮质醇水平低于正常值，其中，1例合并低钠血症，但均未出现精神差等与皮质醇低下相关的临床表现。结论术前正常皮质醇垂体腺瘤患者，术后皮质醇能满足围术期自身的需要，在密切监测患者皮质醇水平及皮质醇低下相关临床表现的前提下，围术期不常规使用糖皮质激素进行替代治疗是安全的。

Discussion on no routine glucocorticoids replacement of pituitary adenoma with normal cortisol in perioperative period

Objective To evaluate the security of no routine glucocorticoids replacement of pituitary adenoma with normal cortisol in perioperative period .Methods We retrospectively analyzed 66 cases of pituitary tumor resection operation with normal serum cortisol that did not receive perioperative routine glucocorticoids .Changes of cortisol and ACT H levels in the morning 8 :00 preoperative and postoperative day 1 ,3 ,and 7 were observed and compared .Statistics on the perioperative complications was also collected .Results The levels of cortisol and ACTH on postoperative day 1 were higher than preoperative and the differences were statistically significant(P<0 .01) .The levels of cortisol and ACT H on postoperative day 3 and 7 recovered to preoperative level , but without statistical significances(P>0 .05) .Three patients failed to achieve normal postoperative cortisol level and only 1 pa‐tients complicated with hyponatremia ,but none of them appeared clinical presentation associated with low cortisol such as poor mental .Conclusion The postoperative cortisol of pituitary adenoma with normal preoperative cortisol can meet the needs of periop‐erative itself .On the premise that the level of cortisol and clinical manifestations associated with low cortisol are closely monitored , it is safe that pituitary adenoma with normal cortisol doesn′t use glucocorticoids routinely .