Hypopituitarism surgery: Difference between revisions
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==Overview:== | ==Overview:== | ||
The feasibility of surgery depends on the clinical condition and underlying etiology. Following conditions need a surgical consideration: pituitary apoplexy , microadenomas with GH or ACTH hyper secretion and debulking macroadenomas with mass symptoms and resistant to medical therapy | The feasibility of surgery depends on the clinical condition and underlying etiology. Following conditions need a surgical consideration: [[pituitary apoplexy]] , [[Microadenoma of the pituitary gland|microadenomas]] with [[Growth hormone|GH]] or [[Adrenocorticotropic hormone|ACTH]] hyper secretion and debulking [[Macroadenoma of the pituitary gland|macroadenomas]] with mass [[symptoms]] and resistant to medical therapy. | ||
==Surgery== | ==Surgery== | ||
*A study showed that 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> | *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 transsphenoidal 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. <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> | *Literature review has shown better outcomes with [[endoscopic]] transsphenoidal 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> | ||
==Indications== | ==Indications== | ||
Following conditions need a surgical consideration: | Following conditions need a surgical consideration: | ||
* Pituitary apoplexy | * [[Pituitary apoplexy]] | ||
* Microadenomas with GH or ACTH hyper secretion | * [[Microadenoma of the pituitary gland|Microadenomas]] with [[Growth hormone|GH]] or [[Adrenocorticotropic hormone|ACTH]] hyper secretion | ||
* Debulking macroadenomas with mass symptoms and resistant to medical therapy | * Debulking [[Macroadenoma of the pituitary gland|macroadenomas]] with mass symptoms and resistant to medical therapy | ||
==References== | ==References== | ||
Revision as of 16:05, 13 September 2017
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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. Following conditions need a surgical consideration: pituitary apoplexy , microadenomas with GH or ACTH hyper secretion 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 transsphenoidal 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]
Indications
Following conditions need a surgical consideration:
- Pituitary apoplexy
- Microadenomas with GH or ACTH hyper secretion
- 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.