Question

In a 7 year old child following surgery for craniopharyngioma, which hormone should be given first?

• A. Growth hormone
• B. Steroids
• C. Prolactin
• D. Thyroxine

Hint:

Replace cortisol before thyroxine to avoid precipitating adrenal crisis.

Answer 1

The Correct Option is B

Step 1: Understand the clinical setting. Surgery for a craniopharyngioma frequently damages the hypothalamic pituitary axis, producing panhypopituitarism. Several hormones may need replacement, so the question is about the correct ORDER of replacement.
Step 2: Identify the life threatening deficiency. The most urgent and potentially fatal deficiency after pituitary or hypothalamic injury is adrenal insufficiency from lack of ACTH, which leads to cortisol deficiency. This can cause hypotension and adrenal crisis.
Step 3: Apply the replacement sequence. Glucocorticoid (steroid) replacement must be started FIRST. Only after steroids are on board should thyroxine be added.
Step 4: Understand why steroids precede thyroxine. Giving thyroxine first in an unrecognized cortisol deficient patient increases metabolic demand and cortisol clearance and can precipitate an acute adrenal crisis. Steroids first prevent this.
Step 5: Place the other hormones. Growth hormone and sex steroids are replaced later, and prolactin is not therapeutically replaced.
Conclusion: The correct answer is option B, steroids.