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Safety of withholding perioperative steroids for patients with pituitary resection with an intact hypothalamus-pituitary-adrenal axis: A meta-analysis of randomized clinical trials.
Batista, Sávio; Almeida, Jose Alberto; Koester, Stefan; Gasparri, Luisa Glioche; Santana, Laís Silva; Gallo, Bruno Henrique Dallo; Palavani, Lucca B; Bertani, Raphael; Landeiro, José Alberto.
Afiliación
  • Batista S; Federal University of Rio de Janeiro, Faculty of Medicine, Brazil.
  • Almeida JA; Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil.
  • Koester S; Vanderbilt University, School of Medicine, Nashville, TN, USA.
  • Gasparri LG; Estácio de Sá University, Rio de Janeiro, RJ, Brazil.
  • Santana LS; São Paulo University, Faculty of Medicine, São Paulo, SP, Brazil.
  • Gallo BHD; Pontifical Catholic University of Paraná, Faculty of Medicine, Curitiba, PR, Brazil.
  • Palavani LB; Max Planck University Center, Indaiatuba, SP, Brazil. Electronic address: lucca.palavani730@al.unieduk.com.br.
  • Bertani R; Department of Neurosurgery, University of São Paulo, São Paulo, Brazil.
  • Landeiro JA; Department of Neurosurgery, Federal Fluminense University, Rio de Janeiro, Brazil.
Clin Neurol Neurosurg ; 234: 107974, 2023 11.
Article en En | MEDLINE | ID: mdl-37797363
INTRODUCTION: Several observational studies have evaluated the effects of pre-operative steroids (STER) for transsphenoidal pituitary removal in patients with an intact hypothalamus-pituitary-adrenal axis. However, a consensus built upon randomized studies has not been previously performed. PURPOSE: To comprehensively evaluate the clinical effects of patients receiving STER when compared to those not receiving steroids (NOSTER) in transsphenoidal pituitary resection, a meta-analysis of randomized clinical trials (RCT) was conducted. METHODS: A systematic review of the literature of RCTs comparing STER and NOSTER was performed in accordance with the PRISMA guidelines. Databases, including PUBMED, Cochrane Library, Web of Science, and Embase were queried. The primary outcomes were adrenal insufficiency (AI) and diabetes insipidus (DI) post-operatively. RESULTS: A total of 4 final studies were included, in which 530 total patients were analyzed. The meta-analysis suggested that there was no significant difference between STER and NOSTER groups post-operatively related to transient AI (RR= 0.83, 95% CI [0.51-1.35], p = 0.45; I² = 52%), permanent AI (RR= 0.97, 95% CI [0.41-2.31], p = 0.95; I² = 0%), and permanent DI (RR= 0.62, 95% CI [0.16-2.33], p = 0.48; I² = 0%). Nevertheless, STER group had significantly lower rates of transient DI (RR= 0.60, 95% CI [0.38-0.95], p = 0.03; I² = 5%), and post-op hyponatremia (RR = 0.49, 95% CI [0.28-0.87], p = 0.02; I² = 0%). CONCLUSION: This study demonstrates evidence from RCTs that patients receiving pre-operative STER are both safe and effective pre-operatively for resection of pituitary adenomas with an intact hypothalamus-pituitary-adrenal axis.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Hipofisarias / Insuficiencia Suprarrenal / Diabetes Insípida Tipo de estudio: Clinical_trials / Guideline / Observational_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Clin Neurol Neurosurg Año: 2023 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Países Bajos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Hipofisarias / Insuficiencia Suprarrenal / Diabetes Insípida Tipo de estudio: Clinical_trials / Guideline / Observational_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Clin Neurol Neurosurg Año: 2023 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Países Bajos