Perioperative management of patients undergoing pituitary surgery

The management of a patient who requires pituitary surgery should be a constant collaboration between the neurosurgeon and the endocrinologist. Because the pituitary gland is an anatomic and functional entity, both medical specialties are necessary to treat these patients for the best possible outcome. The notion that pituitary surgery is always curative is not accurate because of incomplete tumor resection and the risk for tumor recurrence. A patient with a pituitary lesion who undergoes surgery is clinically identical to a patient with diabetes mellitus-these patients require lifelong monitoring and management as indicated by the clinical, endocrine and anatomic findings. Because there is always a risk for tumor recurrence, appropriate surgical or radiation treatment and hormone replacement may be required at any time after the initial operation.