Transphenoidal Cushing

Cushing’s disease:

 

Check labs:

  • AM cortisol and ACTH levels 6am and 6pm post-op day 1 and 2 (off steroids).

Treatment:

  • Avoid starting steroids until biochemical evidence of hypocortisolemia or clinical evidence of adrenal insufficiency.
  • Pt is deemed to be in early remission if morning cortisol level ≤5mcg/dl on postoperative day 1 or 2, necessitating glucocorticoid replacement.
  • Check BP q 2 hours. If BP<90/60 or nausea/vomiting/dizziness, immediately draw cortisol and ACTH levels and start Dexamethasone 0.5mg BID or HC 25mg daily (if on wards)
  • Assuming BP stable, start Dexamethasone 0.5 mg BID or HC 10mg AM and 5mg PM second post-op day 2
  • Send home on Dexamethasone 0.5 mg BID o HC 10mg AM and 5mg PM and have endocrinologist potentially adjust at 2 week post-op visit. Stress importance of this medication.
  • Subsequent assessments of corticotroph function are performed at a minimum of 3, 6, and 12 months after surgery. If successful surgery, unable to be weaned off of glucocorticoid replacement for at least 6-12 months after surgery.

 

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