Abstract
Neurosurgical patients can exhibit severe endocrine conditions due to hypothalamic-pituitary-adrenal axis dysfunction. Anatomic and perfusion issues render pituitary function especially vulnerable to trauma, neoplasms, and edema. Superimposed stress or illness increases the systemic cortisol requirement, and cortisol replacement should be considered for stressed patients at risk for insufficient cortisol response. Short-term steroid treatment has few negative effects and may be life-saving. Patients with intracranial injury should have serum electrolytes concentrations, urine electrolytes concentrations, plasma glucose concentrations, body weight, and water balance monitored frequently to detect postoperative endocrine problems early to obviate fulminant consequences such as refractory hypotension, hyponatremia, hyperkalemia, and/or hypoglycemia.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
Suggested Reading
Aditya S, Rattan A. Vaptans: a new option in the management of hyponatremia. Int J Appl Basic Med Res. 2012;2(2):77–83.
Bloomfield R, Noble DW. Etomidate, pharmacological adrenalectomy and the critically ill: a matter of vital importance. Crit Care. 2006;10(4):16. https://doi.org/10.1186/cc5020.
Capatina C, Paluzzi A, et al. Diabetes insipidus after traumatic brain injury. J Clin Med. 2015;4(7):1448–62.
Cardoso AP, Dragosavac D, et al. Syndromes related to sodium and arginine vasopressin alterations in post-operative neurosurgery. Arq Neuropsiquiatr. 2007;65(3B):745–51.
Clapper A, Nashelsky M, et al. Evaluation of serum cortisol in the postmortem diagnosis of acute adrenal insufficiency. Am J Forensic Med Pathol. 2008;29(2):181–4.
Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med. 2003;348(8):727–34.
Cotton BA, Guillamondegui OD, et al. Increased risk of adrenal insufficiency following etomidate exposure in critically injured patients. Arch Surg. 2008;143(1):62–7; discussion 67.
Dumont AS, Nemergut EC 2nd, et al. Postoperative care following pituitary surgery. J Intensive Care Med. 2005;20(3):127–40.
Gibson SC, Hartman DA, et al. The endocrine response to critical illness: update and implications for emergency medicine. Emerg Med Clin N Am. 2005;23(3):909–29, xi.
Jackson WL Jr. Should we use etomidate as an induction agent for endotracheal intubation in patients with septic shock?: a critical appraisal. Chest. 2005;127(3):1031–8.
Leonard J, Garrett RE, et al. Cerebral salt wasting after traumatic brain injury: a review of the literature. Scand J Trauma Resusc Emerg Med. 2015;23:98. https://doi.org/10.1186/s13049-015-0180-5.
Mohammad Z, Afessa B, et al. The incidence of relative adrenal insufficiency in patients with septic shock after the administration of etomidate. Crit Care. 2006;10(4):R105. https://doi.org/10.1186/cc5020.
Nemergut EC, Dumont AS, et al. Perioperative management of patients undergoing transsphenoidal pituitary surgery. Anesth Analg. 2005;101(4):1170–81.
Nielsen S, Chou C-L, et al. Vasopressin increases water permeability of kidney collecting duct by inducing translocation of aquaporin-CD water channels to plasma membrane. Proc Natl Acad Sci U S A. 1995;92(2):1013–7.
Powner DJ, Boccalandro C. Adrenal insufficiency following traumatic brain injury in adults. Curr Opin Crit Care. 2008;14(2):163–6.
Schneider HJ, Kreitchmann-Andermahr I, et al. Hypopituitary dysfunction following traumatic brain injury and aneurismal subarachnoid hemorrhage: a systematic review. JAMA. 2007;298(12):1429–38.
Tanriverdi F, Schneider HJ, et al. Pituitary dysfunction after traumatic brain injury: a clinical and pathological approach. Endocr Rev. 2015;36(3):305–42.
Ullian ME. The role of corticosteroids in the regulation of vascular tone. Cardiovasc Res. 1999;41(1):55–64.
Venkataraman S, Munoz R, et al. The hypothalamic-pituitary-adrenal axis in critical illness. Rev Endocr Metab Disord. 2007;8(4):365–73.
Verbalis JG. Management of disorders of water metabolism in patients with pituitary tumors. Pituitary. 2002;5(2):119–32.
Zaloga GP, Marik P. Hypothalamic-pituitary-adrenal insufficiency. Crit Care Clin. 2001;17(1):25–41.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Harrskog, O., Shangraw, R.E. (2020). Endocrinologic Emergencies After Neurosurgery. In: Brambrink, A., Kirsch, J. (eds) Essentials of Neurosurgical Anesthesia & Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-17410-1_79
Download citation
DOI: https://doi.org/10.1007/978-3-030-17410-1_79
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-17408-8
Online ISBN: 978-3-030-17410-1
eBook Packages: MedicineMedicine (R0)