Pituitary Tumors

Pituitary Tumors

A Comprehensive and Interdisciplinary Approach
2021, Pages 421-427
Pituitary Tumors

Chapter 29 - Perioperative endocrinological management in patients with pituitary adenomas

https://doi.org/10.1016/B978-0-12-819949-7.00047-0Get rights and content

Abstract

Pituitary surgery is the first-line treatment for the majority of pituitary adenomas; close monitoring and safe management of the endocrine status of the patients is a vital element of their peri- and early postoperative care. Consensus on the optimal strategy of assessment and management of central adrenal insufficiency is not currently available and various approaches are adopted ranging from perioperative stress dose glucocorticoids with gradual tapering, to steroid-sparing protocols with careful observation. Water balance disorders, mainly diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion, are also relatively common in the early postoperative period. Monitoring of fluid balance together with measurement of serum electrolytes and plasma/urine osmolality (or urinary specific gravity) are required for prompt recognition and treatment of these disorders. Finally, reliable assessment of cortisol status in the early postoperative period in patients with Cushing's disease is of major importance for determining further management plans.

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