Hypopituitarism surgery: Difference between revisions
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==Indications== | ==Indications== | ||
Following conditions need a surgical consideration: | Following conditions need a surgical consideration: [[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:<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> | ||
*Transsphenoidal approach (more common) | |||
*Open [[craniotomy]] | |||
* [[Pituitary apoplexy]] | * [[Pituitary apoplexy]] | ||
* [[Microadenoma of the pituitary gland|Microadenomas]] with [[Growth hormone|GH]] or [[Adrenocorticotropic hormone|ACTH]] hyper secretion | * [[Microadenoma of the pituitary gland|Microadenomas]] with [[Growth hormone|GH]] or [[Adrenocorticotropic hormone|ACTH]] hyper secretion | ||
Revision as of 14:42, 20 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: 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:[7]
- Transsphenoidal approach (more common)
- Open craniotomy
- 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.
- ↑ 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.