Work

MON-006 Optimizing Perioperative Care for Patients Undergoing Resection of Pituitary Adenoma: A Standardized Approach

Year: 2025

Type: article

Abstract: Disclosure: A. Kothapalli: None. N. Patel: None. M. Hodge: None. I. Javeed: None. H. Elias: None. D.C. Garcia-Banigan: None. J. Upadhyay: None. S. Sperling: None. Introduction: In many hormonal and nonfunctional pituitary adenomas (excluding prolactinomas), surgical resection is the mainstay of treatment. We believe it is crucial for endocrinologists to be actively involved throughout the process. However, we have identified a lack of comprehensive standardized protocols guiding care from preoperative to postoperative stages. To address this, we aim to create a more standardized, guideline-based approach at our institution. We created consensus-based guidelines through a process like the Pituitary Society Delphi Survey, in which endocrinologists participated in two rounds of rating extent of agreement with statements on perioperative management using a Likert scale. Methods: We conducted a retrospective analysis of de-identified pituitary hormone data from those undergoing pituitary adenoma resection, obtained from TriNetx, a nationwide database of primarily laboratory data associated with various diagnosis (analysis run 12/12/2024, n = 6046, 48 HCOs around the US) and identified a lack of standardization in preoperative pituitary hormone testing. TSH was checked in 47%, free T4 in 47%, ACTH in 34%, cortisol in 40%, FSH in 40%, LH in 36%, estradiol in 8%, testosterone in 20%, IGF-1 in 34%. Prolactin was the only hormone checked in over half of the cases (51%). To address these discrepancies, we surveyed a group of Lahey Hospital and Medical Center endocrinologists. An electronic survey with multiple-choice questions was created, focusing on key management areas that had achieved consensus in the DELPHI survey. We conducted two in-person meetings (n=11, n=13) to review the survey results and proposed guidelines. Endocrinologists provided feedback on the aspects they agreed or disagreed with. Following Delphi survey methodology, discussion continued until consensus was reached. Independent analysts (AK, NP) reviewed all comments and incorporated suggestions in-scope and not duplicated. Results: We achieved consensus on a comprehensive set of guidelines for perioperative endocrine evaluation and management of patients undergoing surgical resection of pituitary adenoma. However, certain areas such as postoperative remission of Cushing's and frequency of postoperative monitoring for diabetes insipidus (DI)did not reach a clear consensus. These issues also lacked consensus in the Pituitary Society Delphi Survey. Continued research is needed to determine the optimal evidence-based guidance for these areas. Conclusions: TriNetx data showed that pituitary hormones are checked less than 50% of the time across institutions worldwide. Therefore, hormonal evaluation should be encouraged for all pituitary surgeries, pre- and post-operatively. We have now introduced these guidelines in our hospital and plan to conduct a series of education sessions to inform neurocritical care specialists, neurosurgeons, and other involved groups. Presentation: Monday, July 14, 2025

Source: Journal of the Endocrine Society

DOI: 10.1210/jendso/bvaf149.1339