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The Perioperative and Postoperative Care for Pituitary Patients

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Transsphenoidal Surgery

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Abstract

Sellar masses are among the most common types of brain pathology. Many such masses, including the majority of non-prolactin producing secretory pituitary adenomas and non-secreting adenomas with mass effect, require surgical intervention, and the surgical approach taken is usually by a transsphenoidal route. In this chapter, we will review the perioperative endocrine management of patients undergoing surgery for sellar and parasellar masses. We will review the key components of preoperative assessment and the most common postoperative complications including disorders of water balance and adrenal insufficiency. Finally, we will highlight the special postoperative management needs of patients with cortisol excess secondary to Cushing’s disease.

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References

  1. Dolecek TA, Propp JM, Stroup NE, Kruchko C. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005-2009. Neuro Oncol. 2012;14(Suppl 5):v1–49.

    Article  Google Scholar 

  2. Woodmansee WW, Carmichael J, Kelly D, Katznelson L, AACE Neuroendocrine and Pituitary Scientific Committee. American Association of Clinical Endocrinologists and American College of endocrinology disease state clinical review: postoperative management following pituitary surgery. Endocr Pract. 2015;21:832–8.

    Article  Google Scholar 

  3. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA, Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:273–88.

    Article  CAS  Google Scholar 

  4. Laws Jr ER. Management of a prolactin macroadenoma with visual loss: indications for surgery. J Clin Neurosci. 1997;4:64–5.

    Article  Google Scholar 

  5. Nieman LK, Biller BM, Findling JW, Murad MH, Newell-Price J, Savage MO, Tabarin A, Endocrine Society. Treatment of cushing's syndrome: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100:2807–31.

    Article  CAS  Google Scholar 

  6. Mathioudakis N, Pendleton C, Quinones-Hinojosa A, Wand GS, Salvatori R. ACTH-secreting pituitary adenomas: size does not correlate with hormonal activity. Pituitary. 2012;15:526–32.

    Article  CAS  Google Scholar 

  7. Inder WJ, Hunt PJ. Glucocorticoid replacement in pituitary surgery: guidelines for perioperative assessment and management. J Clin Endocrinol Metab. 2002;87:2745–50.

    Article  CAS  Google Scholar 

  8. Ladenson PW, Levin AA, Ridgway EC, Daniels GH. Complications of surgery in hypothyroid patients. Am J Med. 1984;77:261–6.

    Article  CAS  Google Scholar 

  9. Kohl BA, Schwartz S. Surgery in the patient with endocrine dysfunction. Anesthesiol Clin. 2009;27:687–703.

    Article  Google Scholar 

  10. Jane Jr JA, Laws ER. Craniopharyngioma. Pituitary. 2006;9:323–6.

    Article  Google Scholar 

  11. Kelly DF, Laws Jr ER, Fossett D. Delayed hyponatremia after transsphenoidal surgery for pituitary adenoma. J Neurosurg. 1995;83:363–7.

    Article  CAS  Google Scholar 

  12. Loh JA, Verbalis JG. Disorders of water and salt metabolism associated with pituitary disease. Endocrinol Metab Clin North Am. 2008;37:213–34, x.

    Article  CAS  Google Scholar 

  13. Nemergut EC, Zuo Z, Jane Jr JA, Laws Jr ER. Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg. 2005;103:448–54.

    Article  Google Scholar 

  14. Singer I, Oster JR, Fishman LM. The management of diabetes insipidus in adults. Arch Intern Med. 1997;157:1293–301.

    Article  CAS  Google Scholar 

  15. Hannon MJ, Finucane FM, Sherlock M, Agha A, Thompson CJ. Clinical review: disorders of water homeostasis in neurosurgical patients. J Clin Endocrinol Metab. 2012;97:1423–33.

    Article  CAS  Google Scholar 

  16. Knepper MA. Molecular physiology of urinary concentrating mechanism: regulation of aquaporin water channels by vasopressin. Am J Physiol. 1997;272:F3–12.

    CAS  PubMed  Google Scholar 

  17. Sladek CD. Regulation of vasopressin release by neurotransmitters, neuropeptides and osmotic stimuli. Prog Brain Res. 1983;60:71–90.

    Article  CAS  Google Scholar 

  18. Verbalis JG. Diabetes insipidus. Rev Endocr Metab Disord. 2003;4:177–85.

    Article  Google Scholar 

  19. Ciric I, Ragin A, Baumgartner C, Pierce D. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery. 1997;40:225–36; discussion 236–7.

    Google Scholar 

  20. Sharkey P, Perry J, Ehni G. Diabetes insipidus following section of the hypophyseal stalk. J Neurosurg. 1961;18:445–60.

    Article  Google Scholar 

  21. Lipsett M, Maclean J, West C. An analysis of the polyuria induced by hypophysectomy in man. J Clin Endocrinol Metab. 1956;16:183–95.

    Article  CAS  Google Scholar 

  22. Robinson AG. Disorders of antidiuretic hormone secretion. Clin Endocrinol Metab. 1985;14:55–88.

    Article  CAS  Google Scholar 

  23. Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, Thompson CJ. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126:S1–42.

    Article  Google Scholar 

  24. Hwang JJ, Hwang DY. Treatment of endocrine disorders in the neuroscience intensive care unit. Curr Treat Options Neurol. 2014;16:271. doi:10.1007/s11940-013-0271-4.

    Article  PubMed  Google Scholar 

  25. Seckl JR, Dunger DB, Lightman SL. Neurohypophyseal peptide function during early postoperative diabetes insipidus. Brain. 1987;110(Pt 3):737–46.

    Article  Google Scholar 

  26. Oiso Y, Robertson GL, Norgaard JP, Juul KV. Clinical review: treatment of neurohypophyseal diabetes insipidus. J Clin Endocrinol Metab. 2013;98:3958–67.

    Article  CAS  Google Scholar 

  27. Zueger T, Kirchner P, Herren C, Fischli S, Zwahlen M, Christ E, Stettler C. Glucocorticoid replacement and mortality in patients with nonfunctioning pituitary adenoma. J Clin Endocrinol Metab. 2012;97:E1938–42.

    Article  CAS  Google Scholar 

  28. Salem M, Tainsh Jr RE, Bromberg J, Loriaux DL, Chernow B. Perioperative glucocorticoid coverage. A reassessment 42 years after emergence of a problem. Ann Surg. 1994;219:416–25.

    Article  CAS  Google Scholar 

  29. Fatemi N, Dusick JR, Mattozo C, McArthur DL, Cohan P, Boscardin J, Wang C, Swerdloff RS, Kelly DF. Pituitary hormonal loss and recovery after transsphenoidal adenoma removal. Neurosurgery. 2008;63:709–718; discussion 718–9.

    Google Scholar 

  30. Little A, Oppenlander M, Knecht L, Duick D, White W. Early postoperative serum cortisol measurements guide management in a steroid-sparing protocol and predict need for long-term steroid replacement after resection of nonfunctioning pituitary adenomas. J Biosci Med. 2013;3:18–22.

    Google Scholar 

  31. Manuylova E, Calvi LM, Vates GE, Hastings C, Shafiq I. Morning serum cortisol level after transsphenoidal surgery for pituitary adenoma predicts hypothalamic-pituitary-adrenal function despite intraoperative dexamethasone use. Endocr Pract. 2015;21:897–902.

    Article  Google Scholar 

  32. Marko NF, Hamrahian AH, Weil RJ. Immediate postoperative cortisol levels accurately predict postoperative hypothalamic-pituitary-adrenal axis function after transsphenoidal surgery for pituitary tumors. Pituitary. 2010;13:249–55.

    Article  CAS  Google Scholar 

  33. Rutkowski MJ, Breshears JD, Kunwar S, Aghi MK, Blevins LS. Approach to the postoperative patient with Cushing's disease. Pituitary. 2015;18:232–7.

    Article  CAS  Google Scholar 

  34. Dumont AS, Nemergut 2nd EC, Jane Jr JA, Laws Jr ER. Postoperative care following pituitary surgery. J Intensive Care Med. 2005;20:127–40.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, and Pituitary Center, Johns Hopkins University School of Medicine, 1830 East Monument Street #333, Baltimore, 21287, MD, USA

    Saira Khan MD & Roberto Salvatori MD

Authors
  1. Saira Khan MD
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  2. Roberto Salvatori MD
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Corresponding author

Correspondence to Roberto Salvatori MD .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Harvard Medical School Brigham and Women’s Hospital, Boston, MA, USA

    Edward R. Laws, Jr

  2. Department of Neurosurgery, Indianapolis Methodist Hospital, Indianapolis, IN, USA

    Aaron A. Cohen-Gadol

  3. Department of Neurosurgery, Weill Cornell Medical College New York Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

  4. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA

    Jason P. Sheehan

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Khan, S., Salvatori, R. (2017). The Perioperative and Postoperative Care for Pituitary Patients. In: Laws, Jr, E.R., Cohen-Gadol, A.A., Schwartz, T.H., Sheehan, J.P. (eds) Transsphenoidal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-56691-7_5

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  • DOI: https://doi.org/10.1007/978-3-319-56691-7_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56689-4

  • Online ISBN: 978-3-319-56691-7

  • eBook Packages: MedicineMedicine (R0)

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