Hypopituitarism and Central Diabetes Insipidus

Pituitary tumors are a unique class of intracranial neoplasms with the potential to disrupt hormone function and water metabolism. Preoperative and postoperative endocrine assessment is mandatory to recognize and promptly treat new deficiencies and identify those that have resolved. Close collaboration among neurosurgical, endocrine, and anesthetic teams is equally vital during the perioperative period. Appropriate patient education at the time of discharge regarding the symptoms of diabetes insipidus, hyponatremia, and adrenal insufficiency is increasingly important.

•
Pituitary tumors have the capacity to result in hormone deficiencies and disorders of water metabolism secondary to their unique location.
•
The evaluation of pituitary function before surgery is essential both to identify and treat life-threatening pituitary deficiencies and to rule out the presence of a hormone-secreting tumor.
•
Patients who have recently received surgery in the pituitary region must be closely monitored for both diabetes insipidus and hyponatremia, so that these disorders may be promptly addressed.
•
All patients who have undergone pituitary surgery require a thorough assessment of pituitary function at least 4 to 6 weeks after surgery to identify new deficits and recognize those that may have resolved.

Key Points

Introduction

Pituitary tumors represent a unique class of intracranial neoplasms uniquely located to cause mass effect on vital nearby structures including, but not limited to, the pituitary gland and the hypothalamus, which may result in hormone deficiencies as well as disorders of water metabolism. Patients with pituitary lesions may present with hormone deficiencies before surgery, during surgery, or during the weeks following surgery. Disorders of water metabolism most commonly do not present until the postoperative period and usually are transient. The neurosurgeon’s challenge is to safely remove the lesion, decompress nearby vital structures, and preserve or restore pituitary function. Close collaboration between neurosurgical, endocrine, and anesthetic teams is vital during the perioperative time period. This article reviews the perioperative evaluation and management of hormone deficiencies and disorders of water metabolism in patients with lesions of the pituitary region.

Only gold members can continue reading. Log In or Register to continue