| Objective:1. To realize the blood cortisol curves after the replacement therapy by monitoring the blood cortisol in different times. 2. To evaluate the therapeutic doses for secondary adrenal insufficiency by monitoring the blood cortisol and 24-hour urinary free cortisol.Methods:cross-sectional survey. The patients of secondary adrenal insufficiency were investigated inendocrinology department of Huashan Hospital between September,2010 and July,2011. Clinical data and therapeutic dose was collected. Cortisol day curves were monitored.24-hour urinary free cortisol was monitored by 30 patients. The data was analyzed by SPSS 17.0 software.Resluts:36 patients were included studies. There were 22 males and 14 females. The age is range from 15-78 years,and the median age is 51.12 cases accepted replacement therapy once a day with the mean dose of 19.3+ 7.3mg cortisone acetate (range 6.25-25mg).23 cases accepted replacement therapy twice a day(0730h and 1400h of 5cases,0730h and 1500h of 7 cases,0730h and 1600h of 11 cases) with the mean dose of 35.8±4.7mg cortisone acetate(range 18.75-37.5mg). 1 cases accepted replacement therapy three times a day (0730h,1200h,1600h) with the dose of 12.5mg,6.25mg,6.25mg.Among the once-daily replacement therapy, the cortisol target rate of 0800h,1600h and 2400h were 58.3%,75.0%and 83.3%with 12 cases. The cortisol target rate of these three points was 8.70%,65.2%,65.2%with 23 cases among the twice-daily replacement therapy. Compared once-daily with twice-daily replacement therapy, it indicated that the cortisol target rate at 0800h of once-daily therapy was higher than of twice-daily therapy, and it indicated no statistical significance of the other two points.From the cortisol curves, we found that the conventional replacement regimens(cortisone acetate 25 mg+12.5 mg)of many patients were higher. Cortisol concentration before taking the medicine was very low. All patinets could not restore. the normal cortisol biorhythm. The 0800h cortisol could not reach the normal range after replacement therapy among most patients. It is not appropriate to estimate the repalcement doses by 0800h cortisol clinically. We should combine with medication. We also found that the l000h cortisol of most patients was higher than 1200h cortisol, which indicated the cortisol concentration of medication after two hours was higher than medication after four hours. We advise medication immediately after getting up, and let the cortisol rise up as early as possibleMeanwhile we found that the 1200h cortisol was usually higher than 1400h cortisol, and the 1400h cortisol of most patients was higher than 1600h cortisol, including medication at 1400h or 1500h. We recommend medication at 1600h except the patients who are obviously weak in the afternoon and have very low cortisol level at 1400h.The cortisol peak concentration of 10 cases were over 20ug/dl, and the patients had the possibility of over-treatment. Analyzing their urine free cortisol,3 cases were less than the normal range,5 cases were within the normal range,2 cases were more than the normal range.The cortisol peak concentration of 12 cases were under 20ug/dl. Analyzing their urine free cortisol,2 cases were less than the normal range,8 cases were within the normal range,2 cases were more than the normal range.The individual variation of 24-hour urinary free cortisol was very wide which could not reflect on the appropriate dose of replacement therapy. It returns flase positive and flase negative reslutsConclusions:Current replacement therapy can not restore the normal cortisol biorhythm We condiser the daily cortisol curves as the better evaluating method. The 0800h cortisol could not reach the normal range after replacement therapy among most patients. The cortisol of medication after two hours in the morning was highest in one day. It is not appropriate to estimate the repalcement doses by 0800h cortisol clinically Monitoring the cortisol of medication after two hours in the morning,1400h,1600h, 1800h is recommended. We advise medication immediately after getting up. Many patients who administered the conventional replacement regimens(cortisone acetate 25 mg+12.5 mg) have over-repalcement theapy. We should adjust the doses and frequency according to the daily cortisol curves. Objective:To analyz the incidence, general information, influencing factors, average concentartion, duration time of hyponatremia following pituitary adenoma surgery.Methods:The clinical data were reviewed in patients who were operated in Huashan Hospital between January 1993 and December 2004 for pituitary adenoma and postoperative serum sodium<135mmol/l in hospital. The data were analyzed by SPSS 17.0 software.Results:There were 85 cases of hyponatremia in the 2096 patinets for pituitary adenoma except 140 cases who used antidiuretic hormone after surgery. The incidence of hyponatremia was 4.3%, There were 47 males and 38 females. The average age was 53.7±14.8 years. The tumor maximum diameter was range from 4mm-50mm. There were 15 cases of microadenomas plus 58 cases of macroadenomas and 12 cases of huge adenomas. The most frequent pathological type was nonfunctioning adenoma(36.5%), followed by prolactinomas (25.9%), plurihormonal pituitary adenoma(20.0%), growth hormone(GH)-secreting adenoma(5.9%), luteinizing hormone(LH)-secreting adenoma(4.7%), follicle-stimulating hormone(FSH)-secreting adenoma(3.5%), thyroid-stimulating hormone(TSH)-secreting adenoma(2.4%) and thyroid-stimulating hormone(TSH)-secreting adenoma(1.2%). There were 60 cases of transsphenoidal surgery and 25 cases of craniotomy. Gross tumor resection was accomplished in 54 patients, subtotal resection in 29 patients, and partial resection in 2 patients.The mean postoperative sodium blood concentration of starting to reduce was 130.8±3.7mmol/l with 85 cases. The average lowest concentration was 129.3■4.7mmol/l. Hyponatremia was first observed on the first to eleventh postoperative day. Serum sodium levels reached a nadir on Day on the first to thirteenth postoperative day. The duration of postoperative hyponatremia was on day 1-18. There was no statistical significance on the sodium blood concentration of starting to reduce, the lowest concentration, the time of starting to reduce, the lowest time and duration of hyponatremia with different gender and resection sizes. The time of starting to reduce, the lowest time and duration of hyponatremia by transsphenoidal surgery was earlier than by craniotomy. The duration of hyponatremia with macroadenomas was earlier than with the others. There was statistical significance on duration of hyponatremia with different pathological type.The incidence of hyponatremia by transsphenoidal surgery was lower than by craniotomy. The incidence of hyponatremia with Gross tumor resection was lower than with subtotal resection and partial resection. There was no statistical significance on the incidence of hyponatremia with different age, different gender, different sizes of tumor, different pathological type. Sizes of tuomrs and the kind of surgery were the influencing factors of hyponatremia by logistic regressions.Conclusions:Hyponatremia was a common complication of pituitary tumor surgery. The incidence of hyponatremia was 4.3%in our research. The incidence of hyponatremia by transsphenoidal surgery was lower than by craniotomy. The incidence of hyponatremia with Gross tumor resection was lower than with subtotal resection and partial resection. The average lowest concentration was 129.3■4.7mmol/l, and it did not correlate with the sex, sizes of tumor, pathological type, resection sizes and the kind of suergery. The duration of postoperative hyponatremia was 7.1+3.6 which correlate with the kind of the surgery, sizes of tumor and pathological type. Sizes of tuomrs and the kind of surgery were the influencing factors of hyponatremia... |
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