title: Current best practice in the management of patients after pituitary surgery.
abstract: Sellar and parasellar masses are a common finding, and most of them are treated surgicallyviatranssphenoidal approach. This type of surgery has revolutionized the approach to several hypothalamic-pituitary diseases and is usually effective, and well-tolerated by the patient. However, given the complex anatomy and high density of glandular, neurological and vascular structures in a confined space, transsphenoidal surgery harbors a substantial risk of complications. Hypopituitarism is one of the most frequent sequelae, with central adrenal insufficiency being the deficit that requires a timely diagnosis and treatment. The perioperative management of AI is influenced by the preoperative status of the hypothalamic-pituitary-adrenal axis. Disorders of water metabolism are another common complication, and they can span from diabetes insipidus, to the syndrome of inappropriate antidiuretic hormone secretion, up to the rare cerebral salt-wasting syndrome. These abnormalities are often transient, but require careful monitoring and management in order to avoid abrupt variations of blood sodium levels. Cerebrospinal fluid leaks, damage to neurological structures such as the optic chiasm, and vascular complications can worsen the postoperative course after transsphenoidal surgery as well. Finally, long-term follow up after surgery varies depending on the underlying pathology, and is most challenging in patients with acromegaly and Cushing disease, in whom failure of primary pituitary surgery is a major concern. When these pituitary functioning adenomas persist or relapse after neurosurgery other treatment options are considered, including repeated surgery, radiotherapy, and medical therapy.
authors.affiliation: Unit of Endocrinology, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Prete
authors.affiliation: Unit of Endocrinology, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy.
authors.forename: Salvatore Maria
authors.initials: SM
authors.lastname: Corsello
authors.affiliation: Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, 1830 East Monument Street #333, Baltimore, MD 21287, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvatori
keywords: Cushing disease; diabetes insipidus; hypopituitarism; hypothalamic hormones; hypothalamic neoplasms; hypothalamo-hypophyseal system; pituitary hormones; pituitary neoplasms