Hormone Replacement After Pituitary Surgery

Strategies to determine deficiencies in both anterior and posterior pituitary function are outlined in the previous subheadings. Protocols for the performance of basal and dynamic testing are detailed in Appendix 1 and are summarized in Table 1.

Until recently, conventional replacement therapy for the hypopituitary adult has focused on the use of glucocorticoid, thyroxine, and sex steroid replacement. dDAVP is used to treat DI related to hypothalamic/posterior pituitary dysfunction. It is now established that GH is essential for health in the adult, and GH replacement is dealt with in the next subheading. Although traditionally thyroid and vasopressin deficiencies were treated with oral thyroxine and intranasal desmopressin, various preparations of glucocorticoid and sex steroid are available for use in hypopituitarism. These formulations are summarized in Appendix 2.

We advocate the use of hydrocortisone as replacement glucocorticoid, because this preparation lends itself to monitoring serum levels, and in general administration three times daily leads to optimal subjective feelings of good

Table 1

Determination of Pituitary Hormone Status and Summary of Replacement Hormones

Table 1

Determination of Pituitary Hormone Status and Summary of Replacement Hormones

Hormone

Test

Replacement

Forms

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