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Endocrine Management after Pituitary Surgery

  • William E. Cobb

Abstract

The detection and treatment of pituitary-hormone deficiencies constitutes a major part of patient management following surgery for pituitary and hypothalamic tumors. In the immediate postoperative period, the appearance of adrenocorticotropic hormone (ACTH) and/or thyroid-stimulating hormone (TSH) deficiency may be of little importance due to the routine use of corticosteroids and to the long plasma half-life of thyroxine, whereas acute deficiency of the posterior pituitary octapeptide, vasopressin, may result in a life-threatening disturbance of water balance. The management of ACTH, TSH, gonadotropin, and growth-hormone (GH) deficiencies assumes a greater significance in the long-term follow-up of patients beyond the immediate postoperative period. This chapter will review some basic concepts and recent developments in the perioperative use of corticosteroids and in the postoperative detection and treatment of pituitary-hormone deficiencies.

Keywords

Diabetes Insipidus Human Growth Hormone Urine Osmolality Nephrogenic Diabetes Insipidus Pituitary Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    K.D. Post, B.J. Biller, L.S. Adelman, M.E. Molitch, S.M. Wolpert, and S. Reichlin, Results of selective transsphenoidal adenomectomy in women with galactorrhea—amenorrhea, J. Am. Med. Assoc. 242:158, 1979.CrossRefGoogle Scholar
  2. 2.
    C.B. Wilson, and L.C. Dempsey, Transsphenoidal removal of 250 pituitary adenomas, J. Neurosurg. 48:13, 1978.PubMedCrossRefGoogle Scholar
  3. 3.
    T.S. Danowski, J.V. Bonessi, G. Sabeh, R.D. Sutton, M.W. Webster, Jr., and M.E. Sarver, Probabilities of pituitary-adrenal responsiveness after steroid therapy, Ann. Intern. Med. 61:11, 1964.PubMedGoogle Scholar
  4. 4.
    T. Livanou, D. Ferriman, and V.H.Y. James, Recovery of hypothalamo-pituitary-adrenal function after corticosteroid therapy, Lancet 2:856, 1967.PubMedCrossRefGoogle Scholar
  5. 5.
    J. Lindholm, H. Kehlet, M. Blichert-Toft, B. Dinesen, and J. Riishede, Reliability of the 30 minute ACTH test in assessing hypothalamic-pituitary-adrenal function, J. Clin. Endocrinol. Metab. 47:272, 1978.PubMedCrossRefGoogle Scholar
  6. 6.
    L. Axelrod, Glucocorticoid therapy, Medicine 55:39, 1976.PubMedCrossRefGoogle Scholar
  7. Oral corticosteroids, Med. Lett. 17:99, 1975.Google Scholar
  8. 8.
    H. Kehlet, C. Binder, and M. Blichert-Toft, Glucocorticoid maintenance therapy following adrenalectomy: Assessment of dosage and preparation, Clin. Endocrinol. 5:37, 1976.Google Scholar
  9. 9.
    C. Fisher, W.R. Ingram, and S.W. Ranson, Diabetes Insipidus and the Neuro-Hormonal Control of Water Balance: A Contribution to the Structure and Function of the Hypothalamio-hypophysial System, Edwards Bros., Ann Arbor, Michigan, 1938.Google Scholar
  10. 10.
    E.A. Zimmerman and A.G. Robinson, Hypothalamic neurons secreting vasopressin and neurophysin, Kidney Int. 10:12, 1976.PubMedCrossRefGoogle Scholar
  11. 11.
    R.V. Randall, E.C. Clark, H.W. Dodge, Jr., and J.G. Love, Polyuria after operation for tumors in the region of the hypophysis and hypothalamus, J. Clin. Endocrinol. 120:1614, 1960.CrossRefGoogle Scholar
  12. 12.
    W.A. Shucart and I. Jackson, Management of diabetes insipidus in neurosurgical patients, J. Neurosurg. 44:65, 1976.PubMedCrossRefGoogle Scholar
  13. 13.
    S. Deutsch, M. Goldberg, and R.D. Dripps, Post-operative hyponatremia with the inappropriate release of antidiuretic hormone, Anesthesiology 27:250, 1966.PubMedGoogle Scholar
  14. 14.
    R.C. DeBods, The antidiuretic action of morphine and its mechanism, J. Pharmacol. Exp. Ther. 82:74, 1944.Google Scholar
  15. 15.
    H. Schneider and E.K. Blackmore, The effect of nalorphine on the antidiuretic action of morphine in rats and man, Br. J. Pharmacol. 10:45, 1955.Google Scholar
  16. 16.
    R.C. DeBoda and K.F. Prescott, The antidiuretic action of barbiturates (phénobarbital, amytal, pentobarbital) and the mechanism involved in this action, J. Pharmacol. Exp. Ther. 85:222, 1945.Google Scholar
  17. 17.
    L. Share, Extracellular fluid volume and vasopressin secretion, in: Frontiers in Neuroen-docrinology (W.F. Ganong and L. Martini, eds.), pp. 183–210, Oxford University Press, New York, 1969.Google Scholar
  18. 18.
    A.M. Moses, J. Miller, and D.H.P. Streeten, Pathophysiologic and pharmacologic alterations in the release and action of ADH, Metabolism 25:697, 1976.PubMedCrossRefGoogle Scholar
  19. 19.
    R.H. Aubry, H.R. Nankin, A.M. Moses, and D.H.P. Streeten, Measurement of the osmotic threshold for vasopressin release in human subjects, and its modification by Cortisol, J. Clin. Endocrinol. Metab. 25:1481, 1965.PubMedCrossRefGoogle Scholar
  20. 20.
    D.H.P. Streeten, G.S. Ross, and M. Souma, Osmotic threshold for ADH release: Effects of Cortisol introduced into supraoptic nuclei, Presented at the 5th Meeting of the Endocrine Society, Chicago, Illinois, June 20–22, 1973.Google Scholar
  21. 21.
    C.R.W. Edwards, M.J. Kitan, T. Chard, and G.M. Besser, Vasopressin analogue dDAVP in diabetes insipidus: Clinical and laboratory studies, Br. Med. J. 3:375, 1973.PubMedCrossRefGoogle Scholar
  22. 22.
    A.G. Robinson, dDAVP in the treatment of central diabetes insipidus, N. Engl. J. Med. 294:507, 1976.PubMedCrossRefGoogle Scholar
  23. 23.
    W.E. Cobb, S. Spare, and S. Reichlin, Neurogenic diabetes insipidus: Management with DDAVP (l-desamino-8-D-arginine vasopressin), Ann. Intern. Med. 11:183, 1978.Google Scholar
  24. 24.
    D.J. Becker and T.P. Foley, l-Desamino-8-D arginine vasopressin in the treatment of central diabetes insipidus in childhood, J. Pediatr. 92:1011, 1978.PubMedCrossRefGoogle Scholar
  25. 25.
    J. Wright, Endocrine effects of alcohol, Clin. Endocrinol. Metab. 7:351, 1978.Google Scholar
  26. 26.
    M. Miller, T. Dalakos, A.M. Moses, H. Fellerman, and D.H.P. Streeten, Recognition of partial defects in antidiuretic hormone secretion, Ann. Intern. Med. 73:721, 1970.PubMedGoogle Scholar
  27. 27.
    W.H. Sawyer, M. Acosta, L. Balaspiri, J. Judd, and M. Manning, Structural changes in the arginine vasopressin molecule that enhance antidiuretic activity and specifity, Endocrinology 94:1106, 1974.PubMedCrossRefGoogle Scholar
  28. 28.
    W.H. Sawyer, M. Acosta, and M. Manning, Structural changes in the arginine vasopressin molecule that prolong its antidiuretic action, Endocrinology 95:140, 1974.PubMedCrossRefGoogle Scholar
  29. 29.
    J.B. Martin, S. Reichlin, and G.M. Brown, Clinical Neuroendocrinology, pp. 83–84, F.A. Davis, Philadelphia, 1977.Google Scholar
  30. 30.
    F. Arduino, F.P.J. Ferray, and J. Rodrigues, Antidiuretic action of chlorpropamide in idiopathic diabetes insipidus, J. Clin. Endocrinol. Metab. 26:1325, 1966.PubMedCrossRefGoogle Scholar
  31. 31.
    A.E. Meinders, J.L. Touber, and L.A. deUries, Chlorpropamide treatment in diabetes insipidus, Lancet 2:544, 1967.PubMedCrossRefGoogle Scholar
  32. 32.
    A.M. Moses, J. Howantiz, M. vanGemert, and M. Miller, Clofibrate induced antidiuretics, J. Clin. Invest. 52:535, 1973.PubMedCrossRefGoogle Scholar
  33. 33.
    M. Miller and A.M. Moses, Drug-induced states of impaired water excretion, Kidney Int. 10:96, 1976.PubMedCrossRefGoogle Scholar
  34. 34.
    A.M. Moses, P. Numan, and M. Miller, Mechanism of chlorpropamide-induced antidiuresis in man: Evidence for release of ADH and enhancement of peripheral action, Metabolism 22:59, 1973.PubMedCrossRefGoogle Scholar
  35. 35.
    T. Kimura, K. Matsui, T. Sato, and K. Yoshinaga, Mechanism of carbamazepine (Tegretol)-in-duced antidiuresis: Evidence for release of antidiuretic hormone and impaired excretion of water load, J. Clin. Endocrinol. Metab. 38:356, 1974.PubMedCrossRefGoogle Scholar
  36. 36.
    G.L. Robertson and E. Mahr, The mechanism of chlorpropamide antidiuresis in diabetes insipidus: Studies with a new radioimmunoassay for plasma vasopressin, Endocrinology 88:125, 1971.Google Scholar
  37. 37.
    A.E. Meinders, V. Cejka, and G.L. Robertson, The antidiuretic action of carbamazepine in man, Clin. Soc. Mol. Med. 47:289, 1974.Google Scholar
  38. 38.
    S. Mendoze, Effect of chlorpropamide on the permeability of urinary bladder of the toad and the response to vasopressin, adenosine 3’,5’-monophosphate and theophylline, Endocrinology 86:1028, 1970.CrossRefGoogle Scholar
  39. 39.
    M. Miller and A.M. Moses, Potentiation of vasopressin action by chlorpropamide in vivo, Endocrinology 86:1024, 1970.PubMedCrossRefGoogle Scholar
  40. 40.
    J.P. Rado and J. Marosi, Prolongation of duration of action of l-deamino-8-D-arginine vasopressin (dDAVP) by ineffective doses of Clofibrate in diabetes insipidus, Horm. Metab. 7:527, 1975.CrossRefGoogle Scholar
  41. 41.
    B. Webster and J. Bain, Antidiuretic effect and complications of chlorpropamide therapy in diabetes insipidus, J. Clin. Endocrinol. Metab. 30:215, 1970.PubMedCrossRefGoogle Scholar
  42. 42.
    J.H. Mahoney and A.D. Goodman, Hypernatremia due to hypodipsia and elevated threshold for vasopressin release: Effects of treatment with hydrochlorothiazide, chlorpropamide and tolbutamide, N. Engl. J. Med. 279:1191, 1968.PubMedCrossRefGoogle Scholar
  43. 43.
    H.N. Bode, D.M. Harey, and J.D. Crawford, Restoration of normal drinking behavior by chlorpropamide in patients with hypodipsia and diabetes insipidus, Am. J. Med. 51:304, 1971.PubMedCrossRefGoogle Scholar
  44. 44.
    M. Miller and A.M. Moses, Clinical states due to alteration of ADH release and action, in: Neurohypophysis: International Conference, Key Biscayne, Florida, 1976, pp. 153–166, S. Karger, Basel, 1977.Google Scholar
  45. 45.
    F. Plum and R.V. Vitert, Nonendocrine diseases and disorders of the hypothalamus, in: The Hypothalamus (S. Reichlin, R.J. Baldessarini, and J.B. Martin, eds.), pp. 415–473, Raven Press, New York, 1978.Google Scholar
  46. 46.
    J.T. Harrington and J.J. Cohen, Clinical disorders of urine concentration and dilution, Arch. Intern. Med. 131:810, 1973.PubMedCrossRefGoogle Scholar
  47. 47.
    K.M. McDonald, P.D. Miller, R.J. Anderson, R. Berl, and R.W. Schrier, Hormonal control of renal water excretion, Kidney Int. 10:38, 1976.PubMedCrossRefGoogle Scholar
  48. 48.
    C. Macaron and O. Famuyiwa, Hyponatremia of hypothyroidism: Appropriate suppression of antidiuretic hormone levels, Arch. Intern. Med. 138:820, 1978.PubMedCrossRefGoogle Scholar
  49. 49.
    A.I. Arieff and R. Guisado, Effects on the central nervous system of hypernatremic and hy-ponatremic states, Kidney Int. 10:104, 1976.PubMedCrossRefGoogle Scholar
  50. 50.
    O. Hantman, B. Rossier, R. Zohlman, and R.W. Schrier, Rapid correction of hyponatremia in the syndrome of inappropriate secretion of antidiuretic hormone, Ann. Intern. Med. 78:870, 1973.PubMedGoogle Scholar
  51. 51.
    M.G. White and C.D. Fetner, Treatment of the syndrome of inappropriate secretion of antidiuretic hormone with lithium carbonate, N. Engl. J. Med. 292:390, 1975.PubMedCrossRefGoogle Scholar
  52. 52.
    A. DeTroyer and J.C. Demanet, Correction of antidiuresis by demeclocycline, Ann. Intern. Med. 85:336, 1975.Google Scholar
  53. 53.
    K. Graze, M. Molitch, and K. Post, Chronic demeclocycline therapy in the syndrome of inappropriate ADH secretion due to brain tumor, J. Neurosurg. 47:933, 1977.PubMedCrossRefGoogle Scholar
  54. 54.
    J.N. Forrest, M. Cox, C. Hong, G. Morrison, M. Bia, and I. Singer, Superiority of demeclocycline over lithium in the treatment of chronic syndrome of inappropriate secretion of antidiuretic hormone, N. Engl. J. Med 298:173, 1978.PubMedCrossRefGoogle Scholar
  55. 55.
    M. Eichelbaum, G. Bodem, R. Gugler, C. Schneider-Deters, and H.J. Dengler, Influence of thyroid status on plasma half-life of antipyrine in man, N. Engl. J. Med. 290:1040, 1974.PubMedCrossRefGoogle Scholar
  56. 56.
    C.W. Zwillich, D.J. Pierson, F.D. Hofeldt, E.G. Lufkin, and J.V. Weil, Ventilatory control in myxedema and hypothyroidism, N. Engl. J. Med. 292:662, 1975PubMedCrossRefGoogle Scholar
  57. 57.
    W.F. Crowley, Jr., E.C. Ridgway, E.W. Bough, G.S. Francis, G.H. Daniels, I.A. Kourides, G.S. Meyers, and F. Maloof, Noninvasive evaluation of cardiac function in hypothyroidism, N. Engl. J. Med. 296:1, 1977.PubMedCrossRefGoogle Scholar
  58. 58.
    E.W. Bough, W.F. Crowley, E.C. Ridgway, H. Walker, F. Maloof, G.S. Myers, and G.H. Daniels, Myocardial function in hypothyroidism, Arch. Intern. Med. 138:1476, 1978.PubMedCrossRefGoogle Scholar
  59. 59.
    W.E. Cobb and I.M.D. Jackson, Management of hypothyroidism, Am. J. Hosp. Pharm. 35:51, 1978.PubMedGoogle Scholar
  60. 60.
    K.W. Wenzel and H.E. Kirschsieper, Aspects of the absorption of oral l-thyroxine in normal man, Metabolism 26:1, 1977.PubMedCrossRefGoogle Scholar
  61. 61.
    C.E. Menendez and R.S. Rivlin, Thyrotoxic crisis and myxedema coma, Med. Clin. N. Am. 57:1463, 1973.PubMedGoogle Scholar
  62. 62.
    S.C. Werner, Myxedema coma, in: The Thyroid (S.C. Werner and S.H. Ingbar, eds.), pp. 971–973, Harper and Row, Hagerstown, Maryland, 1978.Google Scholar
  63. 63.
    D. Evered, E.T. Young, B.J. Ormston, R. Menzies, P.A. Smith, and R. Hall, Treatment of hypothyroidism: A reappraisal of thyroxine therapy, Br. Med. J. 3:131, 1973.PubMedCrossRefGoogle Scholar
  64. 64.
    J.M. Stock, M.I. Surks, and J.H. Oppenheimer, Replacement dosage of L-thyroxine in hypothyroidism, N. Engl. J. Med. 290:529, 1974.PubMedCrossRefGoogle Scholar
  65. 65.
    M.I. Surks, A.R. Schadlow, and J.H. Opperheimer, A new radioimmunoassay for plasma l-triiodothyronine: Measurement in thyroid disease and in patients maintained on hormonal replacement, J. Clin. Invest. 51:3104, 1972.PubMedCrossRefGoogle Scholar
  66. 66.
    I.M.D. Jackson and W.E. Cobb, Why does anyone still use desiccated thyroid USP?, Am. J. Med. 64:284, 1978.PubMedCrossRefGoogle Scholar
  67. 67.
    J.B. Martin, S. Reichlin, and C.M. Brown, Clinical Neuroendocrinology, pp. 370–372, F.A. Davis, Philadelphia, 1977.Google Scholar
  68. 68.
    E. Rosembeg, Medical treatment of male infertility, AndroJogia 8:(Suppl. 1):95, 1976.Google Scholar
  69. 69.
    R.H. Glass, Infertility, in: Reproductive Endocrinology (S.S.C. Yen and R.B. Jaffe, eds.), pp. 413–417, W.D. Saunders, Philadelphia, 1978.Google Scholar
  70. 70.
    R.J. Sherins, D. Brightwell, and P.M. Sternthal, Longitudinal analysis of semen of fertile and infertile men, in: New Concepts of the Testis in Normal and Infertile Men: Morphology, Physiology and Pathology (P. Troen and H.R. Nankin, eds.), pp. 473–488, Raven Press, New York, 1977.Google Scholar
  71. 71.
    C.H. Mortimer, A.S. McNeilly, R.A. Fisher, M.A.F. Murray, and G.M. Besser, Gonadotrophin-releasing hormone therapy in hypogonadal males with hypothalamic or pituitary dysfunction, Br. Med. J. 4:617, 1974.PubMedCrossRefGoogle Scholar
  72. 72.
    D. Rabin, Diagnosis and preliminary therapeutic use of LH-RH in isolated gonadotropin deficiency, Presented at Workshop on LH-RH Testing, Memphis, Tennessee, December 8–10, 1977.Google Scholar
  73. 73.
    P.A. Kelly, A. deLean, C. Auclair, L. Cusan, G.S. Kledzik, and F. Labrie, Regulation of polypeptide hormone receptors, Presented at Recent Advances in Neuroendocrinology sponsored by the American College of Physicians, Montreal, Quebec, March 6–8, 1978.Google Scholar
  74. 74.
    W.V. Moore, The role of aggravated HGH in the therapy of HGH-deficient children, J. Clin. Endocrinol. Metab. 46:20, 1978.PubMedCrossRefGoogle Scholar
  75. 75.
    H. Guyda, H. Friesen, J.D. Bailey, G. LeBoeuf, and J.C. Beck, Medical Research Council of Canada therapeutic trial of human growth hormone: First five years of therapy, Can. Med. Assoc. J. 112:1301, 1975.PubMedGoogle Scholar
  76. 76.
    S.D. Frasier, T. Aceto, Jr., A.B. Hayles, and V.C. Mikity, Collaborative study of the effects of human growth hormone in growth hormone deficiency. IV. Treatment with low doses of human growth hormone based on body weight, J. Clin. Endocrinol. Metab. 44:22, 1977.PubMedCrossRefGoogle Scholar
  77. 77.
    M.A. Preece, J.M. Tanner, R.H. Whitehouse, and N. Cameron, Dose dependence of growth response to human growth hormone in growth hormone deficiency, J. Clin. Endocrinol. Metab. 42:477, 1966.CrossRefGoogle Scholar
  78. 78.
    W.H. Daughaday, Hormonal regulation of growth by somatomedin and other tissue growth factors, Clin. Endocrinol. Metab. 6:117, 1977.PubMedCrossRefGoogle Scholar
  79. 79.
    S.A. Kaplan, Hypopituitarism, in: Endocrine and Genetic Diseases of Childhood and Adolescence (L.I. Gardner, ed.), pp. 121–125, W.D. Saunders, Philadelphia, 1975.Google Scholar
  80. 80.
    B.M. Lippe, A.J. VanHerle, S.H. LaFranchi, R.P. Uller, N. Lavin, and S.A. Kaplan, Reversible hypothyroidism in growth hormone—deficient children treated with human growth hormone, J. Clin. Endocrinol. Metab. 40:612, 1975.PubMedCrossRefGoogle Scholar
  81. 81.
    S. Raiti, E. Trias, L. Levitsky, and M.S. Grossman, Oxandrolone and human growth hormone, Am. J. Dis. Child. 126:597, 1973.PubMedGoogle Scholar
  82. 82.
    M.H. MacGillivray, M. Kolotkin, and R.W. Munschauer, Enhanced linear growth responses in hypopituitary dwarfs treated with growth hormone plus androgen versus growth hormone alone, Pediatr. Res. 8:103, 1974.PubMedCrossRefGoogle Scholar
  83. 83.
    A. Aynsley-Green, M. Zachman, and A. Prader, Interrelation of the therapeutic effects of growth hormone and testosterone on growth in hypopituitarism, J. Pediatr. 89:992, 1976.PubMedCrossRefGoogle Scholar
  84. 84.
    J.M. Tanner, R.H. Whitehouse, P.C.R. Hughes, and B.S. Carter, Relative importance of growth hormone and sex steroids for the growth at puberty of trunk length, limb length, and muscle width in growth hormone deficient children, J. Pediatr. 89:1000, 1976.PubMedCrossRefGoogle Scholar
  85. 85.
    A. Pertzelan, I. Blum, M. Grunebaum, and A. Laron, The combined effect of growth hormone and methandrostenolone on the linear growth of patients with multiple pituitary hormone deficiencies, Clin. Endocrinol. 6:271, 1977.CrossRefGoogle Scholar
  86. 86.
    M.S. Raben, Treatment of pituitary dwarf with human growth hormone, J. Clin. Endocrinol. Metab. 18:901, 1958.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1980

Authors and Affiliations

  • William E. Cobb
    • 1
    • 2
  1. 1.Department of Medicine, Division of EndocrinologyTufts-New England Medical Center HospitalBostonUSA
  2. 2.Quincy City HospitalQuincyUSA

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