Moderator: What are the characteristics of rehabilitation and what patients need to pay attention to?
Gu Feng: Pituitary tumor rehabilitation is also a very important part of pituitary tumor disease management, we know that before the diagnosis, after the diagnosis to take certain treatment methods, rehabilitation is divided into several kinds, the most common is the post-operative rehabilitation, 70%, 80% of patients need surgery.
Gou Chenggang, Rehabilitation Center of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine
The most important postoperative rehabilitation is the perioperative rehabilitation and long-term follow-up treatment. The perioperative period is usually spent in the hospital, and the hospital will give general hormone supplementation at this time.
After recovery, we can generally stop using prednisone three months or two months after surgery, but for patients with long-term pituitary adenoma decompensation, we can use it for a long time. At least within six months, adrenocortical function cannot be restored and we generally believe that long-term replacement therapy is needed. Other hormones should also be taken into account, why? Because we know that the pituitary gland is a hormone-secreting organ, and after any operation, we have to take into account the hormone secretion itself.
If the pituitary gland function is normal, there will be few recurrences. If the pituitary gland does not recover in 6, 9 or 12 months, these patients need long-term replacement therapy, which is generally three kinds of hormones, the most important is adrenocorticotropic hormone, the most commonly used is prednisone, this is the replacement therapy, the general physiological dose of replacement therapy is half a tablet to one and a half.
Another more important hormone is thyroid hormone, which can be used to supplement patients with decreasing thyroid function, and the common dose of this hormone is also half to one and a half tablets. There is another hormone, gonadotropin. Generally, the most common hypofunction of pituitary tumors, especially large tumors, is sex hormone.
For young men and women, except for pituitary tumors caused by prolactinomas, if they have fertility requirements and the tumor has not recurred, we can give them replacement hormones for women or men six months after surgery. In case of prolactinoma, if the level of prolactin does not drop to normal and bromelain therapy is needed, we usually treat this patient with sex hormones because we know that prolactin therapy is dependent.
For patients over 60 years old or 50 years old who do not have particularly high quality of life requirements, generally speaking, our hormone supplementation is based on the patient’s condition, and we will supplement if he asks for it, but we will not supplement if he does not ask for it. In addition, we know that female hormones can have physiological cycles and fertility requirements, and lack of female hormones will cause many symptoms, including coronary heart disease, osteoporosis, and some aging conditions, so we will supplement female hormones accordingly according to the patient’s condition.
The same goes for male hormones, because if we lack male hormones, the patient will not only have no fertility requirements, but also no sexual desire requirements. In addition, the patient will suffer from osteoporosis, a weakening of muscle strength, and a weakening of the patient’s physical self-confidence.
When supplementing male hormones in older men, we must pay attention to liver function, as we know that male hormones work in the liver. If the prostate gland is positive, we should be careful of prostate cancer, as too much male hormone can lead to prostate cancer, and we will check the prostate antigen before using this patient.
As for the other hormone decreases, including thyroid hormone, we also need to make up for it. There is also a growth hormone, if this patient has a growth hormone decrease, we do not pay much attention to the original, the lack of growth hormone during the growth of children will not grow, this patient can make up for it. If an adult is completely deficient in growth hormone, now we find that he will have many symptoms, such as obesity, fat central distribution, small muscle volume, no strength, diminished sexual function, reduced self-confidence in life, lack of self-confidence, and some patients will have anxiety. Growth hormone will solve these problems for patients.
Wang Renzhi: When it comes to rehabilitation treatment, it is divided into two categories. The first category is like what Professor Gu Feng just said, that is, for the pituitary function, appropriate hormone supplementation, which is probably a very important part of our rehabilitation, and also requires patients to come to the hospital for long-term follow-up and supplement these hormones under the guidance of doctors.
Hormone supplementation is necessary, but too much is not good, and too little is not good, so the amount is very important, and some people do not adjust well on their own, so hormone supplementation must be done under the guidance of a doctor. There is another type of recovery that we are talking about: pituitary adenoma, whether it is treated with drugs or surgery, the recurrence rate is different, some people report that it is very high, probably from 4% to 40% or 50%, not that pituitary adenoma can be cured by regular hospital treatment, surgery or drug treatment, it also has a recurrence problem. There is also the problem of recurrence.
For patients with recurrence, they must be closely followed up and observed, and if recurrence is found, appropriate treatment must be given, because the treatment of patients with recurrence is more complicated and more difficult.
Gu Feng: There is another most important issue not mentioned just now, that is, when pituitary hormone replacement therapy, especially prednisone treatment we have some precautions, because adrenocorticotropic hormone is a very strong emergency hormone, our normal fever and cold body corticotropic hormone is a 5-fold, 10-fold increase in resistance to disease. After pituitary tumor patients have their pituitary gland removed, their emergency reserve is poor, and when we have fever, cold or fatigue, they cannot protect themselves, so at this time we have to explain to all patients that as long as there is a decreasing alternative treatment of adrenocorticotropic hormone, we have to increase the treatment when the emergency treatment of fever, cold or acute co-morbidity, and increase the amount by two to five times.
Then we will reduce the amount in a short period of time. In general, the concept of taking hormones is very scary to the general public, that is a drug treatment, we are a physiological treatment, how much to eat. In case of emergency, the increase of two to five times is to protect your body, which is beneficial. Some patients are afraid to use the medicine, he will die after not using the medicine, his life is in danger, his resistance, his reserve is poor. This is very important.
Wang Renzhi: When the pituitary gland is low, once the patient has a cold, he often can not tolerate the change, he will have a lot of problems, and even death, we sometimes encounter this situation in the emergency room. Our emphasis is on standardized treatment, and standardized treatment includes our standardized diagnosis and standardized treatment.