Effect of hydrocortisone on hypocorticolism caused by pituitary adenoma

Abstract

Objectives: Pituitary adenoma is a tumor that can cause hormonal secretion problems, including hypocortisolism. Hypocortisolism may result in negative impacts such as an increase in proinflammatory cytokine and immune system activation. Hypocortisolism therapy is performed by giving high-dose hydrocortisone. This case report presented a hypocortisolism therapy using hydrocortisone in a patient with pituitary adenoma.

Case presentation: A 17-year-old boy was admitted to a hospital due to right-eye vision loss, headache, and swallowing difficulty. During the treatment at the hospital, the patient had light depression. The brain Magnetic Resonance Imaging (MRI) scanning with contrast showed there was a supratentorial axial lesion enlarged from the intrasellar to the suprasellar. The anamnesis and physical examination, as well as laboratory and supporting examinations, showed that the patient was diagnosed to suffer from pituitary macroadenoma. The laboratory examination showed that the size of hypocortisolism was at <0.5 μg/dL (reference value ranges from 4.30-22.40 μg/dL). The patient was treated with hydrocortisone IV therapy at 100 mg/dose administered in the morning and evening for 4 days. Then, the dose tapering off of 100 mg/dose was administered in the morning for 4 days. After that, the patient received hydrocortisone of 20 mg/dose peroral administration in the morning and evening until the patient was discharged from the hospital. Tapering off was performed to prevent the side effects of high-dose hydrocortisone. Besides, the patient was alsounder the Endoscopic Endonasal Transsphenoidal Hypophysectomy (EETH). The cortisol level in the pretreatment was at <0.5 and 5.3 μg/dL during the treatment. There were no side effects of the treatment when the patients were hospitalized.

Conclusions: The hydrocortisone IV therapy with 100 mg/do was administered in the morning and evening for 4 days, and then the dose tapering off of 100 mg/dose was done in the morning for 4 days. Then, the hydrocortisone therapy of 20 mg/dose peroral administration to the patient with pituitary macroadenoma in the morning and evening to improve the cortisol level. The cortisol level in the pretreatment was at 0.5 and 5.3 μg/dL in the post-treatment.

Keywords: hydrocortisone; hypocorticolism; pituitary adenoma.