International guidance on pituitary surgery during COVID-19

This newly published paper discusses the risks associated with pituitary surgery during the pandemic and suggests the best way for medics to respond. It also gives advice on living with and managing pituitary conditions. Below is a brief summary of the paper. You can read the full version here >

 

Pituitary society guidance: pituitary disease management and patient care recommendations during the COVID‑19 pandemic—an international perspective


Summary:

With the arrival of Covid-19, ‘lockdowns’ are the new ‘norm’ as governments try to prevent healthcare services from being overwhelmed. This has implications for the delivery of existing services for other diseases and conditions, and is significant for the pituitary community as clinical care requires a multi-disciplinary approach to deliver timely, complex, disease investigation and management, including pituitary surgery. The pandemic has brought about major disruption to such services, limiting access to care and opportunities for testing, and dramatically reducing the ability to safely undertake transsphenoidal surgery.

This document is a response from the Professional Education Committee of the Pituitary Society, aiming to provide guidance for continued safe management and care.

The paper addresses the following areas:

Pituitary surgery challenges during the COVID‑19 pandemic

  • Phase of the pandemic- after the immediate post peak period, active cases remain and the possibility of a second wave remains high. There will remain a significant possibility of patients and surgeons contracting COVID-19 until a vaccine is developed.
  • Patients requiring pituitary surgery may be especially vulnerable to COVID-19 (Cushing’s and acromegaly particularly), and are at higher risk of complications following surgery.
  • Surgeons remain in direct contact with the patient throughout their operation and is therefore at risk of contracting COVID-19 if the patient has an active infection
  • Hospitals will divert resources from elective services to support the care of patients with COVID-19, limiting access to elective surgery.

Recommendations for pituitary surgery

  • All patients undergoing pituitary surgery should undergo screening for COVID-19, until a vaccine is developed.
  • Isolation of positively testing patients for up to 2 weeks before surgery, delaying surgery until patients no longer have symptoms and have a negative swab test result.
  • Urgent and emergency cases should take priority, with other less threatening conditions scheduled as later elective cases.
  • In most cases, transsphenoidal surgery remains the safest, most effective, and most efficient approach to pituitary tumours
  • In the long term, resumption of full elective workloads depends on wider factors- including widespread testing, and vaccination

Pituitary diseases diagnosis and management

  • Acromegaly and Cushing’s disease are considered to be the conditions most needing to be diagnosed and treated as soon as possible, as both these conditions are associated with having co-morbidities which increases risk of complications from Covid-19. Patients with active Cushing’s are particularly vulnerable as high levels of cortisol induces immunosuppression.
  • Patients with Cushing’s have increased rates of depression, anxiety and can have decreased quality of life, even when in long-term remission. in the challenging circumstances of the current pandemic it is it even more important to focus on psychological evaluation during virtual endocrinology visits, with referral to virtual counselling as needed.
  • Other conditions mentioned in the paper are Prolactinomas, non- secreting adenomas, hypopituitarism, and TSH secreting tumours, and individual suggestions are made for the management of each of these- remembering they are classed as less urgent in terms of treatment earlier in the paper.