Secondary adrenal insufficiency surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

The mainstay of treatment for secondary adrenal insufficiency is medical therapy. Surgery is usually reserved for tumor of the pituitary which is causing secondary adrenal insufficiency due to mass effect and is resistant to medical therapy.

Surgery

The mainstay of treatment for secondary adrenal insufficiency is medical therapy. Surgery is usually reserved for tumor of the pituitary which is causing secondary adrenal insufficiency due to mass effect and is resistant to medical therapy.
The nature of surgical approach depends on patient presentation and can be either trans-sphenoidal approach (more common) or open craniotomy. ^[1]
The outcome is better 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]

References

↑ 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.
↑ 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.

Overview