Treatment of Hypopituitarism in Patients Undergoing Pituitary Surgery
Clinical Scenario
Patients with pituitary pathology who are scheduled for pituitary surgery carry a significant risk of existing or newly developing hypopituitarism. Pituitary adenomas, as well as the surgical and radiation treatments used to address them, can cause hypopituitarism — making perioperative hormonal evaluation and targeted management essential before and after the procedure.
Perioperative Management Approach
The protocol addresses specific pituitary hormone axes in the perioperative window. Management is staged around the timing of surgery, with distinct strategies for identified hormonal deficits — including coverage during the surgical stress period. The full sequencing, agent selection, monitoring thresholds, and post-operative reassessment steps are available in the complete protocol.
References
DOI: 10.1210/jc.2016-2118
- Pituitary adenomas, as well as the associated surgical and radiation treatments, can cause hypopituitarism.
- We recommend using stress doses of steroids in AI before surgery and tapered doses after surgery before repeating testing.
- With preoperative CH, we recommend using L-T4 therapy before nonemergency surgery and throughout the perioperative period.
- We suggest that initial therapy for DI utilizes short-acting sc aqueous ADH, allowing for safer use in the vast majority of cases in whom DI resolves spontaneously.
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