In summary, we see a patient 6 wk after pituitary surgery and perform a clinical evaluation. At that time, we measure free-T4 and testosterone level (in men) and perform a low-dose ACTH stimulation test for cortisol levels. We replace any of these deficient hormones and recheck levels as appropriate for the individual hormone. If a patient decides that GH therapy is an option, a GH stimulation test is performed on a separate visit once the other hormones are adequately replaced.
If a patient has had pituitary surgery but no other treatment directed at the tumor, the postoperative evaluation listed in the previous paragraph only needs to be done once, unless the tumor regrows and new symptoms develop. However, patients who undergo radiation therapy require repeated monitoring for pituitary hormone deficiencies that can develop years after radiation (see Chapter 12). In published studies, partial or complete hypopituitarism occurred in up to 85% of patients within 10 yr of conventional radiation therapy (40,41). In patients who have received radiation therapy, the evaluation summarized in the preceding paragraph is repeated yearly.
Most patients with clinically nonfunctioning pituitary tumors have large tumors and symptoms related to mass and/or pituitary hormone deficiencies. In most cases, initial treatment is surgical, with adjuvant radiotherapy or medical therapy prescribed on an individual basis. Careful hormonal follow-up of patients is needed to accurately diagnose and treat hormone deficiencies attributable to the tumor or its treatment.
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