Hypopituitarism surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hypopituitarism}} | {{Hypopituitarism}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{IQ}} | ||
==Overview:== | |||
The feasibility of surgery depends on the clinical condition and underlying [[etiology]]. Conditions that need a surgical consideration may include [[pituitary apoplexy]], [[Microadenoma of the pituitary gland|microadenomas]] with [[growth hormone]] ([[Growth hormone|GH]]) or [[Adrenocorticotropic hormone|adrenocorticotrophic hormone]] ([[Adrenocorticotropic hormone|ACTH]]) hypersecretion and debulking [[Macroadenoma of the pituitary gland|macroadenomas]] with mass [[symptoms]] and resistant to medical therapy. | |||
== | ==Surgery== | ||
*A study showed that [[Non-functioning pituitary adenoma|non-functioning pituitary adenomas]] may be prevented from recurrence by gross-total [[resection]] and/or [[adjuvant]] [[radiotherapy]].<ref name="pmid27195254">{{cite journal |vauthors=Lee MH, Lee JH, Seol HJ, Lee JI, Kim JH, Kong DS, Nam DH |title=Clinical Concerns about Recurrence of Non-Functioning Pituitary Adenoma |journal=Brain Tumor Res Treat |volume=4 |issue=1 |pages=1–7 |year=2016 |pmid=27195254 |pmc=4868810 |doi=10.14791/btrt.2016.4.1.1 |url=}}</ref> | |||
*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 [[Cerebrospinal fluid|CSF]] leak, septal perforation, [[infection]], [[hematoma]], [[hypopituitarism]], recurrence, and overall [[mortality]]. <ref name="pmid28185971">{{cite journal |vauthors=Esquenazi Y, Essayed WI, Singh H, Mauer E, Ahmed M, Christos PJ, Schwartz TH |title=Endoscopic Endonasal Versus Microscopic Transsphenoidal Surgery for Recurrent and/or Residual Pituitary Adenomas |journal=World Neurosurg |volume=101 |issue= |pages=186–195 |year=2017 |pmid=28185971 |doi=10.1016/j.wneu.2017.01.110 |url=}}</ref><ref name="pmid28104521">{{cite journal |vauthors=Li A, Liu W, Cao P, Zheng Y, Bu Z, Zhou T |title=Endoscopic Versus Microscopic Transsphenoidal Surgery in the Treatment of Pituitary Adenoma: A Systematic Review and Meta-Analysis |journal=World Neurosurg |volume=101 |issue= |pages=236–246 |year=2017 |pmid=28104521 |doi=10.1016/j.wneu.2017.01.022 |url=}}</ref><ref name="pmid24820497">{{cite journal |vauthors=Zhu M, Yang J, Wang Y, Cao W, Zhu Y, Qiu L, Tao Y, Xu Y, Xu H |title=[Endoscopic transsphenoidal surgery versus microsurgery for the resection of pituitary adenomas: a systematic review] |language=Chinese |journal=Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi |volume=49 |issue=3 |pages=236–9 |year=2014 |pmid=24820497 |doi= |url=}}</ref> | |||
*[[Neurological]] decompression is done once the patient is [[hemodynamically]] stable. [[Surgery]] relieves pressure on the [[Pituitary gland|pituitary]] and improves [[Visual field defect|visual field defects]] and [[ocular]] [[palsy]].<ref name="pmid27772771">{{cite journal |vauthors=Tu M, Lu Q, Zhu P, Zheng W |title=Surgical versus non-surgical treatment for pituitary apoplexy: A systematic review and meta-analysis |journal=J. Neurol. Sci. |volume=370 |issue= |pages=258–262 |year=2016 |pmid=27772771 |doi=10.1016/j.jns.2016.09.047 |url=}}</ref><ref name="SempleWebb2005">{{cite journal|last1=Semple|first1=Patrick L.|last2=Webb|first2=Michael K.|last3=de Villiers|first3=Jacques C.|last4=Laws|first4=Edward R.|title=Pituitary Apoplexy|journal=Neurosurgery|volume=56|issue=1|year=2005|pages=65–73|issn=0148-396X|doi=10.1227/01.NEU.0000144840.55247.38}}</ref> | |||
*The nature of surgical approach depends upon the presentation of the [[patient]] and can be either trans-sphenoidal approach (more common) or open [[craniotomy|craniotomy.]]<ref name="pmid2166068">{{cite journal |vauthors=Arafah BM, Harrington JF, Madhoun ZT, Selman WR |title=Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy |journal=J. Clin. Endocrinol. Metab. |volume=71 |issue=2 |pages=323–8 |year=1990 |pmid=2166068 |doi=10.1210/jcem-71-2-323 |url=}}</ref> | |||
== | ===Indications=== | ||
Conditions that need a surgical consideration may include: | |||
* [[Pituitary apoplexy]] | |||
* [[Microadenoma of the pituitary gland|Microadenomas]] with [[Growth hormone|growth hormone (GH)]] or [[Adrenocorticotropic hormone|adrenocorticotropin hormone (ACTH)]] hypersecretion | |||
* Debulking [[Macroadenoma of the pituitary gland|macroadenomas]] with mass symptoms and resistant to medical therapy | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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{{WH}} | |||
{{WS}} | |||
[[Category: | [[Category:Medicine]] | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:Up-To-Date]] | |||
Latest revision as of 22:19, 29 July 2020
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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.