Malenković Vesna, Gvozdenović Ljiljana, Milaković Branko, Sabljak Vera, Ladjević Nebojsa, Zivaljević Vladan
Clinical Hospital Centre Bezanijska Kosa, Belgrade, Serbia.
Acta Chir Iugosl. 2011;58(2):91-6. doi: 10.2298/aci1102091m.
This paper presents the most common disorders of pituitary function: acromegaly, hypopituitarism, diabetes insipidus and syndrome similar to diabetes insipidus, in terms of their importance in preoperative preparation of patients. Pituitary function manages almost the entire endocrine system using the negative feedback mechanism that is impaired by these diseases. The cause of acromegaly is a pituitary adenoma, which produces growth hormone in adults. Primary therapy of acromegaly is surgical, with or without associated radiotherapy. If a patient with acromegaly as comorbidity prepares for non-elective neurosurgical operation, then it requires consultation with brain surgeons for possible delays of that operation and primary surgical treatment of pituitary gland. If operative treatment of pituitary gland is carried out, the preoperative preparation (for other surgical interventions) should consider the need for perioperative glucocorticoid supplementation. Panhypopituitarism consequences are different in children and adults and the first step in diagnosis is to assess the function of target organs. Change of electrolytes and water occurs in the case of pituitary lesions in the form of central or nephrogenic diabetes insipidus as a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Preoperative preparation of patients with pituitary dysfunction should be multidisciplinary, whether it is a neurosurgical or some other surgical intervention. The aim is to evaluate the result of insufficient production of pituitary hormones (hypopituitarism), excessive production of adenohypophysis hormones (acromegaly, Cushing's disease and hyperprolactinemia) and the influence of pituitary tumours in surrounding structures (compression syndrome) and to determine the level of perioperative risk. Pharmacological suppressive therapy of the hyperfunctional pituitary disorders can have significant interactions with drugs used in the perioperative period.
本文从垂体功能障碍在患者术前准备中的重要性角度，介绍了最常见的垂体功能紊乱疾病：肢端肥大症、垂体功能减退、尿崩症以及类似尿崩症的综合征。垂体功能通过负反馈机制管理几乎整个内分泌系统，而这些疾病会损害该机制。肢端肥大症的病因是垂体腺瘤，其在成年人中分泌生长激素。肢端肥大症的主要治疗方法是手术，可联合或不联合放疗。如果患有肢端肥大症合并症的患者准备进行非择期神经外科手术，则需要咨询脑外科医生，以考虑该手术可能的延迟以及垂体的初次手术治疗。如果进行垂体手术治疗，术前准备（针对其他外科手术干预）应考虑围手术期补充糖皮质激素的必要性。儿童和成人全垂体功能减退的后果不同，诊断的第一步是评估靶器官的功能。垂体病变时，会以中枢性或肾性尿崩症的形式出现电解质和水的变化，表现为抗利尿激素分泌不当综合征（SIADH）。垂体功能障碍患者的术前准备应是多学科的，无论其是神经外科手术还是其他外科手术干预。目的是评估垂体激素分泌不足（垂体功能减退）、腺垂体激素分泌过多（肢端肥大症、库欣病和高催乳素血症）以及垂体肿瘤对周围结构的影响（压迫综合征）的结果，并确定围手术期风险水平。垂体功能亢进疾病的药物抑制治疗可能与围手术期使用的药物产生显著相互作用。
