Is life-long treatment necessary and what precautions are necessary?
If the pituitary gland is permanently damaged, proper hormone replacement usually requires life-long treatment. The optimal dose is then considered the “maintenance” dose, and it should become a regular part of daily life. However, some deficiencies can be transient. For example, after undergoing pituitary surgery, some patients experience temporary hormone deficiencies which recover over time. DI may also occur for just a few days or weeks after pituitary surgery.
All patients taking cortisol or desmopressin should carry a Steroid Alert or MedicAlert Card with them or wear a MedicAlert bracelet or necklace at all times. These serve to notify attending doctors and health care professionals that the patients have a pituitary hormone deficiency and are taking steroids. All patients taking steroids must increase their daily dose if they become ill or have any condition for which they would normally seek medical advice (e.g., urinary tract or chest infection, severe stress). The nature of the stress dictates the degree of increase necessary. For instance, very severe stress such as abdominal surgery requires high daily doses usually given by injection. Lesser degrees of stress such as a high fever might require a doubling of the dose, whereas a cold may require only a small increase or no change in dose. Vomiting and/or severe diarrhea reduces absorption of oral steroid tablets; in this situation patients should seek medical attention urgently for intravenous or intramuscular steroids.
Once a patient’s dose has been increased, the patient should remain at the boosted dose until the condition resolves before returning to the usual maintenance dose. Patients should consult their physician before changing their steroid dose.
