Table 1.

Multidisciplinary Team and Standard Postoperative Protocols

Multidisciplinary team	Pituitary neurosurgeon Neuroendocrinologist Endocrinology fellow Specialty nurse
In-hospital DIa surveillance	Strict I/O monitoring and urine specific gravity checks every 2 hours Daily BMP, more frequent if DI or electrolyte abnormalities develop
Pituitary-adrenal axis assessment	Standard glucocorticoid administration and assessments for uncomplicated pituitary adenomas ◦ Day of surgery: dexamethasone 4 mg intraoperatively ◦ Postop day 1: dexamethasone 1 mg in the morning ◦ Postop day 2: measure morning cortisol ◦ If cortisol <10 µg/dL, patient discharged on glucocorticoid replacement therapyb
Discharge planning	Patient education ◦ Education on fluid intake and monitoring of intake and output ◦ Education on signs and symptoms of adrenal insufficiencyc, hyponatremia and DI
Early postoperative follow-up	Telephone follow-up within 1st week Outpatient office follow-up postop day 7 Postop day 7 laboratory testing - electrolytes and morning cortisol, thyroid function (if indicated) Assessment for clinical signs of SIADH, DI, or adrenal insufficiency

Abbreviations: BMP = basic metabolic profile; DI = diabetes insipidus; I/O = fluid intake and output; SIADH = syndrome of inappropriate antidiuretic hormone.

^aDI diagnostic criteria: Urine volume >250 cc/hour for 2 to 3 hours and urine specific gravity <1.005 (or urine osmolality < 200 mOsm/kg H₂O). Indications for desmopressin therapy: Patient unable to maintain adequate oral fluid intake, urine output >> fluid intake or hypernatremia.

^bPatients with preoperative hypopituitarism discharged on replacement therapy routinely. Glucocorticoids are tapered postoperatively based on am cortisol assessment and results of Cortrosyn^® stimulation test as needed (8).

^cIncluding education on stress dose steroid use for patients discharged on glucocorticoids.