Postoperative Considerations Following Pituitary Surgery: A Guide for Clinicians

Abstract

Transsphenoidal surgery represents the primary treatment for pituitary adenomas (other than prolactin-secreting) and other sellar/suprasellar masses including craniopharyngiomas. Endocrine evaluation for anterior hypopituitarism and water metabolism disorders is indicated in all patients. Transient fluid restriction postoperatively in patients without vasopressin deficiency reduces the risk of hyponatremia and hospital readmission. In Cushing disease, the postoperative serum cortisol levels in the first postoperative days guide further management. In acromegaly, remission is established primarily by insulin-like growth factor-1 measurement 3 months postoperatively. Patients with functioning adenomas require proactive management of comorbidities related to hormone excess and lifelong monitoring for recurrence. Surgical outcomes are superior at high-volume institutions with neurosurgical and endocrinological expertise.

Keywords: postoperative management; recurrence; remission; syndrome of inappropriate antidiuresis; transsphenoidal surgery; vasopressin deficiency.