AI Article Synopsis
- - Patients with pituitary masses who have surgery face risks like diabetes insipidus (DI) and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) due to potential damage to the hypothalamic-pituitary axis.
- - The "triple-phase response" occurs post-surgery, showing an initial acute DI, a rebound of SIADH, followed by chronic DI, which complicates recovery.
- - The University of Utah has developed a specialized management protocol that includes monitoring and treatment for these conditions, with a focus on minimizing complications through standardized care.
Article Abstract
Patients with pituitary masses who undergo transsphenoidal resection are at risk for a number of medical complications postoperatively. Among these are disturbances in fluid and sodium homeostasis, including diabetes insipidus (DI) and syndrome of inappropriate secretion of antidiuretic hormone (SIADH). It is believed that these pathologic states are a result of damage to the hypothalamic-pituitary axis from surgery, as are the downstream consequences, such as the triple phase response. The triple-phase response describes the pattern of initial acute DI, subsequent rebound SIADH, and eventual chronic DI, the pathophysiology of which is described. Given the medical complexity of managing postoperative pituitary patients, it is essential to develop dedicated postoperative management protocols. Here, we describe the University of Utah's postoperative pituitary management protocol that includes immediate postoperative monitoring, treatment of DI, surveillance for the triple-phase response after discharge with outpatient serum sodium checks, and involvement of the endocrinology service for assistance with management of hypopituitarism. A complete understanding of the relevant anatomy, physiology, and development of standardized protocols for postoperative management can aid with minimizing medical complications after pituitary surgery.
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| http://dx.doi.org/10.4103/0028-3886.287679 | DOI Listing |
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