Post Surgery Care in Pituitary Adenoma|Dr.Roopesh Kumar

We saw many types of pituitary tumors, Nonfunctioning tumors are more common. 80% to 85% of it is non functioning tumors. It gradually becomes big and it affects the eye nerve. They would go to the eye doctor, do a scan, then they would come to a neurologist. The second type is hormone excess, it can be prolactin, cortisol or even growth hormone.

So if we look at the solution, apart from prolactinoma the solution for everything else is surgery which is done using an endoscope through the nose.

What issues will such patients face after surgery?
When the tumor becomes too big to be removed through the nose, the skull is opened and we would have to remove through that.

The proportion of such procedures is very low. The part where the tumor was removed in order to fill the gap, we take some fat from either the thighs or stomach. If the gap is filled there will be no discharge from the nose.

The most common side effect for the people for whom pituitary tumor adenoma is done, the commonest complication is CSF rhinorrhea. The hole where the tumor was will become empty, the fluid that flows in the brain will leak through that hole. Because we do not want that leakage to happen, we plug that hole with fat. Despite that, for some people, if there is the CSF leakage, we will have to once again plug fat in that hole.

The second issue is for some people after the tumor is removed, the pituitary hormones will reduce. At the time, commonly there are chances for two types of hormones to reduce. One is, thyroid hormones can be reduced. The second is, cortisol can be reduced. For such people. Those hormones have to be medically replaced. Eltroxin and thyroxine are the thyroid medicines given as replacement.

For cortisol the tablet is called Hisone, Hydrocortisone that is a tablet. Some people might have to take these tablets lifelong. After their surgery is completed after a month the hormone levels in the body are checked. If some people have deficiency we give them such hormones.

The third type of complication in pituitary adenoma is diabetes insipidus. I am not talking about diabetes where the sugar levels are high. There are two types of diabetes; one is diabetes mellitus, that is the type where the sugar level is high. The second type of diabetes is called diabetes insipidus. What is that? Normally the amount of urine that we pass there is a hormone to control that. That is also in the pituitary gland's control. When that hormone reduces urination will become excess. That is only called diabetes insipidus.

Most of the time Normally the quantity of urine passed by a person is 1.5 to 2 liters and for adults it can go up to 2.5 liters. If we look at it roughly based on the body weight, it is around 3 to 5 ml per kg. That is the normal urine output. That is normal.

For some people after the pituitary tumor is removed, when the hormone reduces when they pass urine excessively they will pass more urine. What happens in such cases is that in the body sodium levels will become high. Normally, if we test the sodium levels in a person's blood 135 mg to 145 mg is the normal value. If they pass excess urine, when the urine gets diluted the sodium level in the body increases. Then, the upper limit of sodium which has to be 145 will become 150, 155 or 160 which is hyper.

When the sodium levels become high, it is an issue. Therefore, when the person passes excess urine we have to treat them. There is hormone replacement for that. There are some tablets for that. We will have to give that too. These are the problems that can be caused by the removal of the pituitary gland and the solutions for it.

Rarely, even if the tumor is noncancerous if there are fragments of tumor that remain, the tumor can grow back, that is Recurrent pituitary adenoma. When the tumor grows recurrently like that we can do a surgery again and clear it.

There is a gland next to the pituitary gland called cavernous sinus. If it goes deep into it we will not disturb it. When there is such a residue, to ensure it does not grow again in that area we can give focal radiation for that part alone. There is stereotactic radiosurgery, gamma knife radiosurgery. If we give such radiation, there is a chance for us to prevent the tumor from growing.

Chapters
00:04 Functioning and non functioning tumors
00:42 What issues will such patients face after surgery?
01:55 CSF rhinorrhea
02:23 Reduction of pituitary hormones
03:04 Diabetes insipidus
04:31 Treatment for high sodium levels in the body
05:03 Recurrent pituitary adenoma



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