Perioperative managment of patients with pituitary tumors

Abstract

Pituitary tumors (PT) represent 10 - 15% of all intracranial tumors. Although they are usually benign, up to 30 - 45% invade
the cavernous or sphenoid sinus. Less frequently, they can behave aggressively, recurring several times and/or becoming
resistant to conventional treatments, or more rarely, metastasizing. A 10% of PT are found incidentally on magnetic resonance imaging. The majority, however, generate visual disability secondary to chiasmal compression or endocrinological dysfunction. Common associated clinical conditions are acromegaly
(excess growth hormone) and Cushing's disease (excess adrenocorticotropic hormone). Acromegaly is associated with a
doubling of the mortality rate and patients with uncontrolled Cushing's disease have a five-fold increased risk of mortality.
Treatment often reverses these adverse outcomes. The perioperative management of PT is essential to identify and treat associated complications, the most common being
diabetes insipidus (DI); a multidisciplinary approach is required.