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Patients with Cushing\u2019s disease were excluded. Optimal test performances were assessed using ROC analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 156 patients were included. Sensitivity and specificity of the CRH test were 78% and 90%, respectively, and 86% and 92% for basal cortisol, respectively, using an optimal cutoff of 220\u2009nmol\/L. Eight patients had false-negative test results with the CRH test (normal test but adrenal insufficient at follow-up), and six patients with basal cortisol, the majority of which had multiple pituitary hormone deficiencies and fluid imbalances. No clinical adverse events occurred in patients with false-negative test results. The diagnostic performance of a single basal cortisol measurement was superior to the CRH test.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The early postoperative basal cortisol is a safe and simple measurement to guide (dis)continuation of hydrocortisone replacement. However, disturbing factors, e.g., sodium balance disorders, contraceptives, untreated hypopituitarism, and illness impact the interpretation and in those cases this measure is unreliable. We propose an algorithm in which hydrocortisone replacement at discharge is based on basal cortisol &lt;220\u2009nmol\/L on postoperative day 2 or 3 in a stable condition.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s12020-019-02094-6","type":"journal-article","created":{"date-parts":[[2019,9,25]],"date-time":"2019-09-25T17:03:40Z","timestamp":1569431020000},"page":"161-171","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Early postoperative HPA-axis testing after pituitary tumor surgery: reliability and safety of basal cortisol and CRH test"],"prefix":"10.1007","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3660-6093","authenticated-orcid":false,"given":"Friso","family":"de Vries","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2523-8707","authenticated-orcid":false,"given":"Daniel J.","family":"Lobatto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leontine E. 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This study was approved by the Medical Ethical Committee of the Leiden University Medical Center. A waiver of medical ethical review was approved by our institutional medical ethical review board (G19.011).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}