The safety of withholding hydrocortisone during preoperative periods in pituitary adenomas patients with an intact HPA axis: A meta-analysis of randomized controlled trials.
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Abstract
Objectives: For patients with pituitary adenomas with an intact hypothalamus-pituitary-adrenal axis before surgery, whether routine steroid therapy is needed is still controversial. We conducted a meta-analysis to assess the safety of withholding hydrocortisone compared with hydrocortisone in pituitary adenoma patients during preoperative periods.
Material and methods: We searched PubMed, Embase, Web of Science, and Cochrane Library databases up to November 2022 using inclusion and exclusion criteria. We employed either a fixed-effect or random-effect model for the analysis and assessed heterogeneity using the I2 statistic.
Results: Three studies involving 512 patients out of 400 studies were conducted. The pooled data revealed a higher incidence of postoperative transient diabetes insipidus in the no-hydrocortisone group than in the hydrocortisone group (RR, 1.88; 95% CI, 1.13 to 3.12; p = 0.02). The cortisol level in the no-hydrocortisone group was lower than in the hydrocortisone group after tumor removal (mean difference, -36.82; 95% CI, -44.27 to -29.38; p < 0.00001) but higher on the second day after surgery (mean difference, 4.04; 95% CI, 2.38 to 5.71; p < 0.00001). No significant differences were observed in early adrenal insufficiency (RR, 1.04; 95% CI, 0.37 to 2.96; p = 0.93), adrenal insufficiency in the third month after surgery (RR, 1.56; 95% CI, 0.70 to 3.48; p = 0.28), cortisol level on the first day after surgery (mean difference, 0.24; 95% CI, -11.25 to 11.73; p = 0.97), postoperative permanent diabetes insipidus (RR, 1.61; 95% CI, 0.43 to 6.07; p = 0.48), postoperative delayed hyponatremia (RR, 1.06; 95% CI, 0.41 to 2.74; p = 0.91), or postoperative blood glucose level (mean difference, -0.41; 95% CI, -1.19 to 0.37; p = 0.31) between the no-hydrocortisone and hydrocortisone groups.
Conclusion: Withholding preoperative steroid therapy is safe for pituitary adenomas patients with an intact hypothalamus-pituitary-adrenal axis.
目的：对于术前下丘脑-垂体-肾上腺轴完整的垂体腺瘤患者，是否需要常规类固醇治疗仍有争议。我们进行了一项荟萃分析，以评估垂体腺瘤患者术前停用氢化可的松与氢化可的松的安全性。材料和方法：我们使用纳入和排除标准搜索了截至2022年11月的PubMed、Embase、Web of Science和Cochrane Library数据库。我们采用固定效应或随机效应模型进行分析，并使用I2统计量评估异质性。结果：进行了三项研究，涉及400项研究中的512名患者。汇总数据显示，非氢化可的松组术后短暂性尿崩症的发生率高于氢化可的松对照组（RR，1.88；95%CI，1.13至3.12；p=0.02）。肿瘤切除后，非氢化可的松组的皮质醇水平低于氢化可的松小组（平均差异为-36.82；95%CI为-44.27至-29.38；p<0.0001）术后第二天（平均差异，4.04；95%可信区间，2.38-5.71；p<0.00001）。早期肾上腺功能不全（RR，1.04；95%置信区间，0.37-2.96；p=0.93）、术后第三个月肾上腺功能不全无显著差异（RR，1.56；95%置信度，0.70-3.48；p=0.28），术后第一天的皮质醇水平（平均差异，0.24；95%可信区间，-11.25-11.73；p=0.097）、术后永久性尿崩症（RR，1.61；95%置信区间，0.43-6.07；p=0.48）、术后迟发性低钠血症（RR，1.06；95%CI，0.41-2.74；p=0.91），或术后血糖水平（平均差异-0.41；95%可信区间-1.19至0.37；p=0.31）。结论：对于下丘脑-垂体-肾上腺轴完整的垂体腺瘤患者，术前不使用类固醇治疗是安全的。
Sávio Batista , Jose Alberto Almeida , Stefan Koester , Luisa Glioche Gasparri , Laís Silva Santana , Bruno Henrique Dallo Gallo , Lucca B. Palavani , Raphael Bertani , José Alberto Landeiro
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