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After pituitary and adrenal surgery, adrenal insufficiency often occurs as replacement steroid hormones are tapered and adrenal hormone production slowly improves toward normal. If hormone production does not return to normal then replacement hormones will be needed on a permanent basis. Symptoms of adrenal insufficiency are dizziness, weakness, nausea, and loss of appetite (see the link on the Publications page for more about adrenal insufficiency).
As the cortisol declines, the body will start to go into a withdrawal process due to craving the cortisol it has been used to. This is a good thing! One may ask “How can this be a good thing?” Well…..if the cortisol is declining or absent then it is an indication that your surgery was a success!
After pituitary surgery some physicians prefer to give the patient cortisol replacement and gradually withdraw them after surgery. While other physicians prefer to let the patient drop to a very low level or what we know as “crash” usually within 24-48 hours after surgery. Obviously, various physicians believe that both methods of preference have advantages and disadvantages. However, this does not indicate that one method is the correct method and the other incorrect. It indicates a matter of preference. In some cases the method of withdrawal that the physician prefers could depend upon the individual circumstance. Such factors as the physical condition of the patient, how long the patient has had Cushing’s, or how high the cortisol level was prior to surgery, etc. could effect the decision that your physician makes. Your physician can make the best decision for your withdrawal based on your individual needs.
Whether your physician prefers to let you crash immediately after surgery or do it gradually, at some point you will need to start working toward decreasing your glucocorticoid hormone replacement. This is in an effort to see if the remaining pituitary gland will wake up and start working again.
As you start to decrease your glucocorticoid hormone replacement you will most likely start to notice some withdrawal symptoms if your surgery was a success. You will most likely experience some symptoms similar to those you experienced with Cushing’s and sometimes it’s hard to distinguish between the two. Muscle aches and pains are very common with withdrawal. Fatigue is a common symptom, also. It is very important to learn the difference between withdrawal symptoms and an adrenal crisis.
When returning home after your surgery a nice quiet atmosphere with loving support of family and friends will be most helpful in achieving a speeding recovery.
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