Sample Discharge Instructions for Patients who have had Pituitary Surgery

Your physicians have determined that it is reasonably safe to discharge you from the hospital following pituitary surgery. A number of important situations may arise, however, following discharge and you should be aware of these. We are delighted that you are invested in your healthcare.  Please call us when necessary and follow the general guidelines below to promote good health and safety.


Call your health care team for help right away if you have any of the following: 

• Severe or increasing headaches, particularly if they occur when standing or are better when lying down. Headache, facial, and sinus pain are not uncommon following pituitary surgery. As you may have noted, the pain and discomfort typically improve on a daily basis following surgery.

Worsening headache, fever, chills, yellowish-green nasal discharge, and neck stiffness may all signify an infectious process complicating your surgery. Infections usually require immediate attention.

• Persistent bloody, clear watery, or yellowish-green nasal discharge, and even a smelly nasal discharge, should prompt an immediate call to us. Do not wait to see if it will get better before placing the call to our offices.

• Development of abnormalities in your vision should prompt an urgent call so that we can initiate an evaluation and action plan.

• Chest pain or discomfort, shortness of breath, swelling of one or both of your legs, and passage of dark black, tarry stools may represent extremely rare and unusual medical complications in patients who undergo surgery of any type. Contact us should any of these symptoms or signs occur.

• Some patients develop disorders of salt and water metabolism following pituitary surgery. Headache, nausea, vomiting, confusion, impaired concentration, and muscle aches might be due to hyponatremia (low blood sodium levels). This disorder typically occurs 7 to 10 days after surgery and is more common in patients who have had surgery for Cushing’s disease. If you develop these symptoms, contact us immediately. Excessive urination,
thirst, and the need to ingest large quantities of fluids might be related to the onset of diabetes insipidus or diabetes mellitus. These disorders put you at risk for dehydration. These symptoms require urgent evaluation and determination of the underlying cause so that appropriate treatment may be 


Go to the closest emergency room if you have any of the following: 

• A nose bleed does not stop in two to three minutes.

• A body temperature greater than 101° Fahrenheit in association with the nasal discharge, severe headaches, next stiffness.

• A change in alertness, confusion, or neck stiffness, especially in association with the fever. • Chest pain in the region of the breast bone, the left side of the chest, or anywhere on the left side of the upper body and shortness of breath

Care of the nose:
• DO NOT blow your nose or rub it vigorously for one month after you are discharged from the hospital.

• Almost every patient has mucus drainage and “sinus headaches” during the first few weeks. You will be given a decongestant and saline nose spray to help with these symptoms.

• Continue taking the decongestants until your congestion is completely gone. You will also be given a saline nose spray, starting the day after surgery, to be used four times a day to keep your nose from getting to dry. These will help minimize sinus headaches and are necessary to permit the mucous and old blood produced by the operation to drain away.

• Occasionally, though quite rare, a patient may develop a sinus infection after pituitary surgery. As above, call us if you notice a bad odor from your nose or if you have thick yellow or green drainage from your nose, facial pain and congestion, and fever.


Facial swelling: 

• You may notice swelling and bruising on your face and particularly around the nose. This will be worse on the second day after surgery and will gradually disappear within two to four weeks after surgery.

Care of the abdominal incision:

The stitches are under the skin and will dissolve on their own.

• You may remove the outer plastic dressing on the second day after surgery. There will be “steri strips” (paper stitches) under that, which should curl up and fall off on their own.

• You may shower, but do not soak in a bath or hot tub for 10 days.

• You may remove the steri strips if they are still on after two weeks.



• Do not lift heavy objects (over 10 pounds) for two weeks.
• Avoid bending and, especially, placing your head below the level of your heart for two weeks. Doing so can produce headaches and dizziness. • Do not travel by airplane for three days after surgery. Also, refrain from air travel if you develop a sinus infection. If you intend to fly during the first month after surgery, use a decongestant one hour prior to flying and nasal saline spray during the flight as needed. 

• You may be up and around as tolerated. Guide your activity by your progress. 

• Gradually increase your activity so that you’re back to your normal routine within three to
six weeks after surgery.

• When you feel tired or have headaches please stop and rest. It is a good idea to “schedule” an afternoon nap during the first two weeks after surgery.


Fluid intake: 

• If you develop excessive and frequent urination of large volumes accompanied by increased thirst then drink water or similar fluids to satisfy your thirst and call us right away. We would also expect to hear from you if you are waking up to use the bathroom more than two to three times each night. 

• Unless specified by your physician, try to limit your total fluid intake to one quart daily during the first two weeks after surgery. We recommend juice (tomato, V-8), Gatorade, or soda.


Hormone treatments: 

• You may or may not have been prescribed hormones at the time of discharge. If so, you should take these medications, without interruption, precisely as prescribed by your physician. The schedule of hormone medications should have been reviewed with you at the time of discharge. If it is not clear what you should be taking then please call us.

• If you are taking a glucocorticoid hormone such as dexamethasone, prednisone, or hydrocortisone, then you will have been provided a separate information sheet. Read and understand the information and understand that you may need to increase the dose to cover the stress of illness, fever, significant stress, or medical procedures. Call us if you have any questions about this matter. If you cannot keep the medication down due to a stomach illness then notify us immediately.

• You may be asked to withhold your dose of glucocorticoid replacement at the time of your first postoperative follow-up visit. Contact us for advice on this matter if specific instructions have not been provided. Above all, contact your physicians if you have any questions whatsoever about any one of your medications.

• If you take dDAVP then you will have been provided a separate information sheet regarding this medication. It is important that you familiarize yourself with the proper use of the medication. Ask questions if you do not understand.


Follow-up visit: 

• In general, the first postoperative follow-up visit will be scheduled to occur four to six weeks after surgery. You will be scheduled to see neurosurgeon and a neuroendocrinologist.

• If problems develop prior to the time of the usual postoperative visit, you may be asked to return to the office for evaluation.

• Subsequent follow-up is tailored to the individual needs of each patient and, in part, depends upon the diagnosis, presence of residual disease, likelihood of recurrent disease, extent and type of hormonal disorders, etc. In most cases, lifelong follow-up is necessary.  You should ensure that you receive appropriate follow-up by physicians knowledgeable regarding the diagnosis and management of pituitary disorders.

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