Department of Medicine, Division of Endocrinology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Becker B-131, Los Angeles, CA 90048, USA.
Department of Neurosurgery, Cedars-Sinai Medical Center, 127 S San Vicente Boulevard, A6600, Los Angeles, CA 90048, USA.
Neurosurg Clin N Am. 2019 Oct;30(4):491-498. doi: 10.1016/j.nec.2019.05.009. Epub 2019 Jul 13.
Although removal of pituitary tumors yields excellent surgical outcomes, perturbations in the hypothalamic-pituitary axis are not uncommon. Careful assessment of postoperative hormone status with supplementation or further medical therapy is critical to successful outcomes. Although many centers routinely use perioperative steroids, they can be associated with worse outcomes in the absence of intact preoperative adrenal function or damage to the pituitary gland or stalk during surgery. Postoperative assessment of prolactin, cortisol, and growth hormone can be prognostic of surgical cure. Hormonal axes should be reevaluated routinely several weeks after surgery, because longitudinal monitoring is important for surgical and medical outcomes.
虽然垂体肿瘤的切除可以获得极好的手术效果,但下丘脑-垂体轴的紊乱并不罕见。术后仔细评估激素状态,并进行补充或进一步的药物治疗,对于获得成功的结果至关重要。虽然许多中心常规使用围手术期类固醇,但如果术前肾上腺功能不完整,或在手术过程中垂体或柄受损,它们可能会导致更糟糕的结果。术后泌乳素、皮质醇和生长激素的评估可以预测手术的治愈情况。术后数周应常规重新评估激素轴,因为纵向监测对于手术和药物治疗的结果都很重要。