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Preoperative Endocrine Function and Fluid Electrolyte Balance

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Pituitary Apoplexy

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Abstract

Endocrine dysfunction is present in the majority of patients with pituitary apoplexy; about 70 % will have a deficiency of at least one pituitary hormone, and many patients will have pituitary hormone excess. Although endocrine dysfunction may be long-standing, most patients are not known to have pituitary disease prior to presentation. A key medical intervention to decrease mortality is the replacement of glucocorticoids in those with adrenal insufficiency; however, acute investigations are often unable to exclude this and clinicians should have a low threshold for presumptive treatment. Other pituitary hormones are unlikely to require acute preoperative replacement. Hyponatraemia is commonly associated with pituitary apoplexy and may contribute to neurological deterioration if severe; causes include adrenal insufficiency and excess antidiuretic hormone secretion. Preoperative diabetes insipidus is rare. Evaluation of preoperative endocrine function as well as fluid and electrolyte balance is necessary in all patients with pituitary apoplexy before an early surgical intervention to prevent a catastrophic outcome.

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Abbreviations

ACTH:

Adrenocorticotropic hormone

ADH:

Antidiuretic hormone

FBC:

Full blood count

FSH:

Follicular stimulating hormone

GH:

Growth hormone

IGF1:

Insulin-like growth factor 1

IM:

Intramuscular

IV:

Intravenous

LH:

Luteinising hormone

SIADH:

Syndrome of inappropriate antidiuretic hormone secretion

T4:

Thyroxine

TSH:

Thyrotrophin

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Authors and Affiliations

  1. Department of Endocrinology, Royal Devon and Exeter Hospital and University of Exeter Medical School, Barrack Road, Exeter, EX2 5DW, UK

    Angus G. Jones MBBS, MRCP & Bijay Vaidya MBBS, PhD, FRCP

Authors
  1. Angus G. Jones MBBS, MRCP
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  2. Bijay Vaidya MBBS, PhD, FRCP
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Corresponding author

Correspondence to Bijay Vaidya MBBS, PhD, FRCP .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Adnan Menderes University, School of Medicine, Aydin, Turkey

    Mehmet Turgut

  2. Department of Neurosurgery, All India Institute of Medical Sciences Neurosciences Center (AIIMS), New Delhi, India

    Ashok Kumar Mahapatra

  3. The Victor Horsley Nerosurgical Department, The National Hospital for Neurology and Neurosurgery, London, United Kingdom

    Michael Powell

  4. Department of Neurosurgery, Madurai Medical College, Madurai, Tamil Nadu, India

    Natarajan Muthukumar

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Jones, A.G., Vaidya, B. (2014). Preoperative Endocrine Function and Fluid Electrolyte Balance. In: Turgut, M., Mahapatra, A., Powell, M., Muthukumar, N. (eds) Pituitary Apoplexy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38508-7_12

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  • DOI: https://doi.org/10.1007/978-3-642-38508-7_12

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