Perioperative Endocrine Management Of Pituitary Tumors

Perioperative Endocrine Management Of Pituitary Tumors

Mahshid Babaei M.D.

Endocrinologist

98.4.13

• Pre- op assessment
• Adrenal insufficiency
• Post-op assessment
• Patients with pituitary disease present unique challenges to the anesthesiologist secondary to the prominent role of the pituitary gland in the endocrine system.
• Successful surgical management of patients harboring pituitary tumors requires a multidisciplinary approach and is critically dependent on the quality of perioperative care.

Preoperative management

• a complete medical history & physical exam
• formal neuro-ophthalmologic assessment with formal  visual  field  testing  if  the MRI  shows  evidence  that  the  tumor is abutting or compressing the optic chiasm
• evaluation for potential medical comorbidities:

• a complete blood count
• A metabolic panel to evaluate possible

    hyponatremia(adrenal –thyroid- post.pit),

    hypercalcemia (MEN-1)

    hyperglycemia, and other metabolic abnormalities

• Cardiovascular and respiratory disease 

• Hormone hypersecretion
• Hormone defficiency
• Baseline endocrine studies should include:
  •  HPA axis evaluation
  •  Free thyroxine  (FT4), TSH
  • Prolactin (neat and diluted)
  • LH,FSH(alfa subunit), testosterone (men)
  • Insulin like growth factor-1 (IGF-1)