Endocrine Management in the Neurosurgical Patient

  • Shaun E. Gruenbaum
  • Christian S. Guay
  • Saul S. Siller
  • Federico Bilotta


The endocrine system closely interacts with the nervous system to regulate numerous physiological functions in the human body. Disorders of the endocrine system are common in the neurosurgical patient, and the perioperative care of these patients requires an in-depth understanding of how endocrine dysfunction affects neurophysiology and postoperative outcomes. A diligent preoperative workup and optimization is essential to minimize the risk of perioperative complications. Complications associated with endocrine dysfunction can be severe and even life-threatening, and must be promptly recognized and treated. In this chapter, we review the considerations for the perioperative management of the neurosurgical patient with coexisting endocrine dysfunction. Specifically, we address relevant anatomy and physiology principles, perioperative considerations for the patient undergoing pituitary adenoma resection, and management of intracranial and extracranial endocrinopathies and highlight important perioperative endocrine-associated complications.


Endocrine disorders Neuroanesthesia Neurocritical care Diabetes mellitus Pituitary gland Adrenal gland Pancreas Hypothalamus Pineal gland Thyroid gland 


  1. 1.
    DeFronzo RA, Ferrannini E, Groop L, et al. Type 2 diabetes mellitus. Nat Rev Dis Primers. 2015;1:15019.CrossRefGoogle Scholar
  2. 2.
    Katsarou A, Gudbjornsdottir S, Rawshani A, et al. Type 1 diabetes mellitus. Nat Rev Dis Primers. 2017;3:17016.CrossRefGoogle Scholar
  3. 3.
    Wilson CB. Surgical management of pituitary tumors. J Clin Endocrinol Metab. 1997;82(8):2381–5.CrossRefGoogle Scholar
  4. 4.
    Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocr Rev. 2006;27(5):485–534.CrossRefGoogle Scholar
  5. 5.
    Nemergut EC, Dumont AS, Barry UT, Laws ER. Perioperative management of patients undergoing transsphenoidal pituitary surgery. Anesth Analg. 2005;101(4):1170–81.CrossRefGoogle Scholar
  6. 6.
    Li CR, Zhang S, Hung CC, et al. Depression in chronic ketamine users: sex differences and neural bases. Psychiatry Res. 2017;269:1–8.CrossRefGoogle Scholar
  7. 7.
    Ali Z, Bithal PK, Prabhakar H, Rath GP, Dash HH. An assessment of the predictors of difficult intubation in patients with acromegaly. J Clin Neurosci. 2009;16(8):1043–5.CrossRefGoogle Scholar
  8. 8.
    Fatti LM, Scacchi M, Pincelli AI, Lavezzi E, Cavagnini F. Prevalence and pathogenesis of sleep apnea and lung disease in acromegaly. Pituitary. 2001;4(4):259–62.CrossRefGoogle Scholar
  9. 9.
    Castellano G, Affuso F, Conza PD, Fazio S. The GH/IGF-1 axis and heart failure. Curr Cardiol Rev. 2009;5(3):203–15.CrossRefGoogle Scholar
  10. 10.
    Rajasoorya C, Holdaway IM, Wrightson P, Scott DJ, Ibbertson HK. Determinants of clinical outcome and survival in acromegaly. Clin Endocrinol. 1994;41(1):95–102.CrossRefGoogle Scholar
  11. 11.
    Kahaly G, Olshausen KV, Mohr-Kahaly S, et al. Arrhythmia profile in acromegaly. Eur Heart J. 1992;13(1):51–6.CrossRefGoogle Scholar
  12. 12.
    Campkin TV. Radial artery cannulation. Potential hazard in patients with acromegaly. Anaesthesia. 1980;35(10):1008–9.CrossRefGoogle Scholar
  13. 13.
    Sato A, Suzuki H, Murakami M, et al. Glucocorticoid increases angiotensin II type 1 receptor and its gene expression. Hypertension. 1994;23(1):25–30.CrossRefGoogle Scholar
  14. 14.
    Romijn JA. Pituitary diseases and sleep disorders. Curr Opin Endocrinol Diabetes Obes. 2016;23(4):345–51.CrossRefGoogle Scholar
  15. 15.
    Ferguson JK, Donald RA, Weston TS, Espiner EA. Skin thickness in patients with acromegaly and Cushing’s syndrome and response to treatment. Clin Endocrinol. 1983;18(4):347–53.CrossRefGoogle Scholar
  16. 16.
    Banoub M, Tetzlaff JE, Schubert A. Pharmacologic and physiologic influences affecting sensory evoked potentials: implications for perioperative monitoring. Anesthesiology. 2003;99(3):716–37.CrossRefGoogle Scholar
  17. 17.
    Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116(15):1725–35.CrossRefGoogle Scholar
  18. 18.
    Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001;344(7):501–9.CrossRefGoogle Scholar
  19. 19.
    Kohl BA, Schwartz S. How to manage perioperative endocrine insufficiency. Anesthesiol Clin. 2010;28(1):139–55.CrossRefGoogle Scholar
  20. 20.
    Spell NO 3rd. Stopping and restarting medications in the perioperative period. Med Clin North Am. 2001;85(5):1117–28.CrossRefGoogle Scholar
  21. 21.
    Zwillich CW, Pierson DJ, Hofeldt FD, Lufkin EG, Weil JV. Ventilatory control in myxedema and hypothyroidism. N Engl J Med. 1975;292(13):662–5.CrossRefGoogle Scholar
  22. 22.
    Palace MR. Perioperative Management of Thyroid Dysfunction. Health Serv Insights. 2017;10:1178632916689677.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Axelrod L. Perioperative management of patients treated with glucocorticoids. Endocrinol Metab Clin N Am. 2003;32(2):367–83.CrossRefGoogle Scholar
  24. 24.
    Henzen C, Suter A, Lerch E, et al. Suppression and recovery of adrenal response after short-term, high-dose glucocorticoid treatment. Lancet. 2000;355(9203):542–5.CrossRefGoogle Scholar
  25. 25.
    Jabbour SA. Steroids and the surgical patient. Med Clin North Am. 2001;85(5):1311–7.CrossRefGoogle Scholar
  26. 26.
    Wagner RL, White PF, Kan PB, Rosenthal MH, Feldman D. Inhibition of adrenal steroidogenesis by the anesthetic etomidate. N Engl J Med. 1984;310(22):1415–21.CrossRefGoogle Scholar
  27. 27.
    Pinhas-Hamiel O, Zeitler P. Acute and chronic complications of type 2 diabetes mellitus in children and adolescents. Lancet. 2007;369(9575):1823–31.CrossRefGoogle Scholar
  28. 28.
    Mercado DL, Petty BG. Perioperative medication management. Med Clin North Am. 2003;87(1):41–57.CrossRefGoogle Scholar
  29. 29.
    Kohl BA, Schwartz S. Surgery in the patient with endocrine dysfunction. Med Clin North Am. 2009;93(5):1031–47.CrossRefGoogle Scholar
  30. 30.
    Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014;118(1):85–113.CrossRefGoogle Scholar
  31. 31.
    Hensen J, Henig A, Fahlbusch R, et al. Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas. Clin Endocrinol. 1999;50(4):431–9.CrossRefGoogle Scholar
  32. 32.
    Olson BR, Gumowski J, Rubino D, Oldfield EH. Pathophysiology of hyponatremia after transsphenoidal pituitary surgery. J Neurosurg. 1997;87(4):499–507.CrossRefGoogle Scholar
  33. 33.
    Harrigan MR. Cerebral salt wasting syndrome. Crit Care Clin. 2001;17(1):125–38.CrossRefGoogle Scholar
  34. 34.
    Reeder RF, Harbaugh RE. Administration of intravenous urea and normal saline for the treatment of hyponatremia in neurosurgical patients. J Neurosurg. 1989;70(2):201–6.CrossRefGoogle Scholar
  35. 35.
    Vance ML. Perioperative management of patients undergoing pituitary surgery. Endocrinol Metab Clin N Am. 2003;32(2):355–65.CrossRefGoogle Scholar
  36. 36.
    Grzywotz A, Kleist B, Moller LC, et al. Pituitary apoplexy - a single center retrospective study from the neurosurgical perspective and review of the literature. Clin Neurol Neurosurg. 2017;163:39–45.CrossRefGoogle Scholar
  37. 37.
    Zada G, Woodmansee WW, Iuliano S, Laws ER. Perioperative management of patients undergoing transsphenoidal pituitary surgery. Asian J Neurosurg. 2010;5(1):1–6.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Atkins JH, Smith DS. A review of perioperative glucose control in the neurosurgical population. J Diabetes Sci Technol. 2009;3(6):1352–64.CrossRefGoogle Scholar
  39. 39.
    Gruenbaum SE, Toscani L, Fomberstein KM, et al. Severe intraoperative hyperglycemia is independently associated with postoperative composite infection after craniotomy: an observational study. Anesth Analg. 2017;125(2):556–61.CrossRefGoogle Scholar
  40. 40.
    Duggan EW, Carlson K, Umpierrez GE. Perioperative hyperglycemia management: an update. Anesthesiology. 2017;126(3):547–60.CrossRefGoogle Scholar
  41. 41.
    Varon J, Marik PE. Perioperative hypertension management. Vasc Health Risk Manag. 2008;4(3):615–27.CrossRefGoogle Scholar
  42. 42.
    Ambrosi M, Orsini A, Verrotti A, Striano P. Medical management for neurosurgical related seizures. Expert Opin Pharmacother. 2017;18(14):1491–8.CrossRefGoogle Scholar
  43. 43.
    Temkin NR. Prophylactic anticonvulsants after neurosurgery. Epilepsy Curr. 2002;2(4):105–7.CrossRefGoogle Scholar
  44. 44.
    Ringel MD. Management of hypothyroidism and hyperthyroidism in the intensive care unit. Crit Care Clin. 2001;17(1):59–74.CrossRefGoogle Scholar
  45. 45.
    Dutta P, Bhansali A, Masoodi SR, et al. Predictors of outcome in myxoedema coma: a study from a tertiary care centre. Crit Care. 2008;12(1):R1.CrossRefGoogle Scholar
  46. 46.
    Connery LE, Coursin DB. Assessment and therapy of selected endocrine disorders. Anesthesiol Clin North Am. 2004;22(1):93–123.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Shaun E. Gruenbaum
    • 1
  • Christian S. Guay
    • 2
  • Saul S. Siller
    • 3
  • Federico Bilotta
    • 4
  1. 1.Mayo ClinicJacksonvilleUSA
  2. 2.Montreal Neurological Institute and Hospital at McGill UniversityMontrealCanada
  3. 3.Stony Brook University School of MedicineStony BrookUSA
  4. 4.Sapienza University of RomeRomeItaly

Personalised recommendations