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Vol. 34. Issue 6.
Pages 292-307 (November - December 2023)
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Vol. 34. Issue 6.
Pages 292-307 (November - December 2023)
Special article
Executive summary of the expert consensus document from the Spanish Society of Neurosurgery and the Spanish Society of Endocrinology and Nutrition: clinical recommendations on the perioperative management of pituitary tumors
Resumen ejecutivo del documento de consenso de expertos de la Sociedad Española de Neurocirugía y de la Sociedad Española de Endocrinología y Nutrición sobre: recomendaciones clínicas en el manejo perioperatorio de los tumores hipofisarios
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Marta Araujo-Castroa, Víctor Rodríguez- Berrocalb, Elena Diosc, Ramon Serramitod, Betina Biagettie, Ignacio Bernabeuf,
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a Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
b Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
c Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBIS), Hospital Virgen del Rocío, Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Sevilla, Sevilla, Spain
d Servicio de Neurocirugía, Complejo Hospitalario Universitario de Santiago de Compostela, Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, Spain
e Servicio de Endocrinología y Nutrición, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
f Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Tables (13)
Table 1. General indications for pituitary surgery in PT and other sellar lesions.
Table 2. Preoperative medical treatment of hypersecretion and hormone deficiencies: indications and treatment guidelines.
Table 3. Preoperative treatment of hormone deficiencies.
Table 4. Intraoperative complications.
Table 5. Contents of the report following pituitary tumour surgery.
Table 6. Day of intervention and first 24h in the Post-Anaesthesia Recovery/High Dependency Unit.
Table 7. Immediate perioperative timetable.
Table 8. Early postoperative complications, incidence and management.66,71,72
Table 9. Differential diagnosis of hyponatraemia after pituitary tumour surgery (adapted from Garrahy et al.37) and SIADH diagnostic criteria.
Table 10. Definition of diabetes insipidus (DI) after pituitary surgery (adapted from de Vries et al).77
Table 11. Discharge recommendations after pituitary surgery.34,75,77–79
Table 12. Postoperative assessment of the adenohypophysis.
Table 13. Monitoring criteria in functioning pituitary tumours.
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Abstract

Pituitary tumors (PT) account for 15% of intracranial tumors affect 10.7–14.4% of the population although the incidence of clinically relevant PT is 5.1 cases/100,000 inhabitants. Surgical treatment is indicated in PTs with hormone hypersecretion (except for prolactin-producing PTs) and those with local compressive or global neurological symptoms. Multidisciplinary care, is essential for patients with PTs, preferably delivered in a center of excellence and based on a well-defined care protocol. In order to facilitate and standardize the clinical procedures for this type of tumor, this document gathers the positioning of the Neuroendocrinology Knowledge Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Society of Neurosurgery (SENEC) on the management of patients with PTs and their preoperative, surgical and postoperative follow-up.

Keywords:
Pituitary tumor
PITNET
Transsphenoidal surgery
Acromegaly
Cushing’s disease
Non-functioning pituitary tumor
Diabetes insipidus
Hyponatremia
Vasopressin deficiency
SIADH
Resumen

Los tumores hipofisarios (TH) suponen el 15% de los tumores intracraneales y afectan del 10,7al 14,4% de la población, si bien la incidencia de TH clínicamente relevantes es de 5,1 casos / 100.000 habitantes. El tratamiento quirúrgico está indicado en los TH que cursan con hipersecreción hormonal (a excepción de los TH productores de prolactina), así como en aquellos con clínica compresiva local o neurológica global. Los pacientes con TH requieren una atención multidisciplinar, idealmente en un centro de excelencia y basada en un protocolo asistencial bien definido. Con el objetivo de facilitar y estandarizar la práctica clínica ante este tipo de tumores, el presente documento recoge el posicionamiento del Área de Conocimiento de Neuroendocrinología de la Sociedad Española de Endocrinología y Nutrición (SEEN) y la Sociedad Española de Neurocirugía (SENEC) sobre el manejo y el seguimiento prequirúrgico, quirúrgico y posquirúrgico del paciente con un TH.

Palabras clave:
Tumor hipofisario
PITNET
Cirugía transesfenoidal
Acromegalia
Enfermedad de cushing
Adenoma hipofisario no funcionante
Diabetes insípida
Hiponatremia
Déficit de vasopresina
SIADH

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