Preoperative Investigations and Workup

Ideally, all pituitary tumors should be managed in specialist centers [4]. In an emergency there are three important tests without which no pituitary surgery should take place. These are:

• Thyroid function. Operations on the myxedematous patient severely threaten cardiac function, and also make interpretation of investigation difficult.

• Prolactin levels. In macroadenomas with severe visual loss, even short-term dopamine agonist treatment can quickly restore vision, and although tumor shrinkage can lag behind, a better result than with surgery is usually obtained with patience.

• Adequate imaging. This should include details of the sphenoid septation if trans-sphenoidal surgery is to be attempted.

Cortisol cover is recommended for all large tumors for safety, as loss of ACTH output is dangerous and may occur postoperatively. Successful surgery for Cushing's tumors demands replacement.

Hydrocortisone 100 mg given with the induction of anesthesia is sufficient.

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