All patients should ideally be seen by an endocrinologist before admission for transsphenoidal pituitary surgery. Once admitted, hormone evaluation for cortisol status is the most important test. Depending on the preoperative cortisol adequacy, insufficiency, excess, or unknown status, perioperative and postoperative treatment with hydrocortisone is often indicated. Peri- and postoperative treatment should also include monitoring and treatment for diabetes insipidus or inappropriate secretion of antidiuretic hormone. Close monitoring of water and sodium balance is required. Finally, the patient should follow up with an endocrinologist 1–2 weeks after surgery so that pituitary hormone status can be reevaluated and proper treatment and follow-up arranged.