Hypopituitarism surgery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]
Overview:
The feasibility of surgery depends on the clinical condition and underlying etiology. Conditions that need a surgical consideration may include pituitary apoplexy, microadenomas with growth hormone (GH) or adrenocorticotrophic hormone (ACTH) hypersecretion and debulking macroadenomas with mass symptoms and resistant to medical therapy.
Surgery
- A study showed that non-functioning pituitary adenomas may be prevented from recurrence by gross-total resection and/or adjuvant radiotherapy.[1]
- Literature review has shown better outcomes with endoscopic trans-sphenoidal surgery when compared to microscopic technique in gross tumor removal as it lowers the risk of CSF leak, septal perforation, infection, hematoma, hypopituitarism, recurrence, and overall mortality. [2][3][4]
- Neurological decompression is done once the patient is hemodynamically stable. Surgery relieves pressure on the pituitary and improves visual field defects and ocular palsy.[5][6]
- The nature of surgical approach depends upon the presentation of the patient and can be either trans-sphenoidal approach (more common) or open craniotomy.[7]
Indications
Conditions that need a surgical consideration may include:
- Pituitary apoplexy
- Microadenomas with growth hormone (GH) or adrenocorticotropin hormone (ACTH) hypersecretion
- Debulking macroadenomas with mass symptoms and resistant to medical therapy
References
- ↑ Lee MH, Lee JH, Seol HJ, Lee JI, Kim JH, Kong DS, Nam DH (2016). “Clinical Concerns about Recurrence of Non-Functioning Pituitary Adenoma”. Brain Tumor Res Treat. 4 (1): 1–7. doi:10.14791/btrt.2016.4.1.1. PMC 4868810. PMID 27195254.
- ↑ Esquenazi Y, Essayed WI, Singh H, Mauer E, Ahmed M, Christos PJ, Schwartz TH (2017). “Endoscopic Endonasal Versus Microscopic Transsphenoidal Surgery for Recurrent and/or Residual Pituitary Adenomas”. World Neurosurg. 101: 186–195. doi:10.1016/j.wneu.2017.01.110. PMID 28185971.
- ↑ Li A, Liu W, Cao P, Zheng Y, Bu Z, Zhou T (2017). “Endoscopic Versus Microscopic Transsphenoidal Surgery in the Treatment of Pituitary Adenoma: A Systematic Review and Meta-Analysis”. World Neurosurg. 101: 236–246. doi:10.1016/j.wneu.2017.01.022. PMID 28104521.
- ↑ Zhu M, Yang J, Wang Y, Cao W, Zhu Y, Qiu L, Tao Y, Xu Y, Xu H (2014). “[Endoscopic transsphenoidal surgery versus microsurgery for the resection of pituitary adenomas: a systematic review]”. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi (in Chinese). 49 (3): 236–9. PMID 24820497.
- ↑ Tu M, Lu Q, Zhu P, Zheng W (2016). “Surgical versus non-surgical treatment for pituitary apoplexy: A systematic review and meta-analysis”. J. Neurol. Sci. 370: 258–262. doi:10.1016/j.jns.2016.09.047. PMID 27772771.
- ↑ Semple, Patrick L.; Webb, Michael K.; de Villiers, Jacques C.; Laws, Edward R. (2005). “Pituitary Apoplexy”. Neurosurgery. 56 (1): 65–73. doi:10.1227/01.NEU.0000144840.55247.38. ISSN 0148-396X.
- ↑ Arafah BM, Harrington JF, Madhoun ZT, Selman WR (1990). “Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy”. J. Clin. Endocrinol. Metab. 71 (2): 323–8. doi:10.1210/jcem-71-2-323. PMID 2166068.
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