Pituitary Innovation and Teaching

When to see an endocrinologist

Speaker: Dr. Jeannette Goguen, endocrinologist

Video transcript

So when would you typically see an endocrinologists if you have a pituitary tumour? Well you should see me before surgery, at the time of surgery, and even after the surgery as well.

You need to see a pituitary doctor, endocrinologist, before surgery for several reasons. One, to assess if you have the over-function of the pituitary we were discussing. If you have a prolocatinoma, that is treated over 90 per cent of the cases just with medication so that could save you having to go through surgery. If you have Cushing's or acromegaly, you will almost certainly need surgery. There are some medications that can help before surgery as well. If you have deficiencies of pituitary hormones, some of those will need to be replaced in order to have safe surgery. Some of them may recover after surgery which is the potential good news. As well some of the medical problems, like Cushing's or arcomegaly, can have associated additional problems like diabetes, hypertension, or heart disease and I can help you diagnose if any of those are present and help manage those as well before surgery. During surgery you'll be with the neurosurgeon, but after that the endocrinologist will follow you in hospital to look for any acute loss of the most important pituitary hormone. Those are ACTH, which is monitored by cortisol levels. If the cortisol falls too low, I've already indicated that's the most important hormone, we will replace that in the hospital. That's monitored closely well in hospital.

The second thing you will learn after surgery is sometimes ADH, or water conserving hormone, can be disrupted by surgery that can be temporary or permanent. It can lead to large volume of urine output, you'l find yourself very thirsty drinking water. And if you can't keep up that can cause your blood sodium level to fluctuate and that can be quite serious so we also monitor very closely for that. We can replace ADH as DDAVP if we need to.

Finally, you're discharged after few days and you'll go home. You'll see an endocrinologist typically between 3 to 6 weeks after discharge. And my job then is to see if you're on the DDAVP, do you still need it. If you're taking any steroid replacement, cortisol replacement for ACTH deficiency, do you still need it. Or have new hormonal deficiencies manifested themselves and need to be treated at that point. As well, if you've had overproduction of any of the prolactin hormone, the ACTH causing Cushing's, the growth hormone causing acromegaly, we'll check after surgery to see if you're cured or not. If you're not cured, you may need a second surgery or you may need medications to treat that.

So after discharge home from the hospital, after your pituitary surgery. you'll be asked to do some blood test within a week or two of discharge. You'll see the endocrinologist shortly after that as well as the ENT, the ear nose throat doctor, to get the tubes out of your nose. You'll have an MRI booked in a month or two after surgery and you'll see the neurosurgeon. You should also make an appointment to see your eye specialist as well. If all is well, and there's no hormonal manipulations, you'll typically see the endocrinologist 4 to 6 months after that and then every 6 to 12 months on ongoing basis to monitor for excess hormonal deficiencies and to monitor your MRI.

 

Page last updated: June 3, 2016