Protein Steroid Management Of Patients With A Normal Hypothalamic Pituitary Axis Essay

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Pituitary Surgery Perioperative Steroid Management in Patients with a Normal Hypothalamic Pituitary Axis INTRODUCTION Surgery on the pituitary gland and around the sellar region is of special interest to the neurosurgeon. The approach to the gland has evolved over the past 50 years and so has the role of steroids in the perioperative management of these patients. Being one of the organs that play a key role in the hormonal balance of an individual, the neurosurgeon should be particularly careful that all steps must be taken to optimise the hormonal status and also ensure there is no disruption in that balance postoperatively. For more than half a decade the meticulous administration of steroid perioperatively has become common place. Today, however, the old philosophies are being challenged and new philosophies pioneered creating a paradigm shift in the way we manage patient requiring an operation around the sellar region, in particular pituitary surgery. CASE A 47 year old hypertensive male presented to the outpatient department at our institution with a history of headaches and worsening vision over a one year period. In particular he noticed that he had difficulty in seeing peripherally. His headaches were pounding in character and frontal in location. He had no other significant symptoms. On examination his vital signs were within normal limits. His Glasgow Coma Score (GCS) was 15 with no motor deficits. His visual acuity was 20/200 in both eyes and he

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