{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:38:00Z","timestamp":1761824280860,"version":"3.40.5"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T00:00:00Z","timestamp":1610323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether early (4\u20108h) post\u2010operative ACTH after trans\u2010sphenoidal surgery (TSS) predicts long\u2010term hypothalamic\u2013pituitary\u2013adrenal (HPA) axis function and to investigate early morning day 1 ACTH\/cortisol variability using rapid sampling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective observational study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants undergoing TSS were included; those treated with glucocorticoids pre\u2010operatively received 100\u00a0mg intravenous hydrocortisone on anaesthetic induction. ACTH and cortisol were measured post\u2010operatively at\u00a0+\u00a04h and\u00a0+\u00a08h after induction and on day 1 every 10\u00a0minutes between 0700h and 0900h. Primary outcome: glucocorticoid requirement at 6\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nineteen participants (10F, 9M): 6\/19 (32%) were treated with replacement glucocorticoids pre\u2010operatively; 4 had ceased by 6\u00a0weeks post\u2010operatively. One patient developed new hypopituitarism post\u2010operatively meaning 3\/19 (16%) required glucocorticoids at 6\u00a0months. Post\u2010operative\u00a0+\u00a04h ACTH\u00a0&lt;\u00a014.3\u00a0pmol\/L (65\u00a0ng\/L) predicted secondary adrenal insufficiency (SAI) (sensitivity 100%, specificity 75%), whilst no participant with a post\u2010operative\u00a0+\u00a04h ACTH\u00a0\u2265\u00a014.3\u00a0pmol\/L (65\u00a0ng\/L) required glucocorticoids at 6\u00a0months. Day 1 ACTH and cortisol showed a significant circadian fall between 0700h\u20100900h; ACTH 4.2\u00a0pmol\/L (IQR 2.9\u20105.9) to 3.7\u00a0pmol\/L (IQR 2.9\u20105.1) <jats:italic>P<\/jats:italic>\u00a0=\u00a0.006 and cortisol 549\u00a0nmol\/L (IQR 337\u2010618) to 439\u00a0nmol\/L (IQR 315\u2010606) <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001, with clinically insignificant ultradian secretory pulses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>No participant with a post\u2010operative\u00a0+\u00a04h ACTH\u00a0\u2265\u00a014.3\u00a0pmol\/L (65\u00a0ng\/L) required glucocorticoids at 6\u00a0months; however, given only 3\/19 participants had the primary outcome of interest, this must be confirmed in a larger cohort. The timing of a day 1 morning cortisol between 0700h and 0900h influences the accuracy of a single cut\u2010off to diagnose SAI after pituitary surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14404","type":"journal-article","created":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T18:41:05Z","timestamp":1609180865000},"page":"636-644","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The relationship between early post\u2010operative ACTH \/ cortisol following pituitary surgery and long\u2010term glucocorticoid requirement \u2013 Do ultradian rhythms matter?"],"prefix":"10.1111","volume":"94","author":[{"given":"Katherine A.","family":"English","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology Princess Alexandra Hospital Brisbane Qld 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