Perioperative management of patients undergoing pituitary surgery

The management of a patient who requires pituitary surgery should be a constant collaboration between the neurosurgeon and the endocrinologist. Because the pituitary gland is an anatomic and functional entity, both medical specialties are necessary to treat these patients for the best possible outcome. The notion that pituitary surgery is always curative is not accurate because of the risk for tumor recurrence. A patient with a pituitary lesion who undergoes surgery is clinically identical to a patient with diabetes mellitus--these patients require lifelong monitoring and management as indicated by the clinical, endocrine and anatomic findings. Because there is always a risk for tumor recurrence, appropriate surgical or radiation treatment and hormone replacement may be required at any time after the initial operation. In the patient who undergoes postoperative pituitary radiation, the risk for developing a new pituitary hormone deficiency ranges from 33% to 50%, and is probably higher over time. Thus, these patients must receive regular evaluations regarding the need for additional treatment and hormone replacements. A regular program of life long assessment of pituitary function and anatomy, appropriate hormone replacement and close collaboration with a pituitary surgeon is the ideal care of these patients. Only with such a program can a patient with a pituitary adenoma achieve the best possible outcome.