SURGICAL APPROACH IN PITUITARY TUMOURS: THE ROLE OF ENDOCRINE PROFILE

Mara Carsote1,2, Simona Elena Albu1,3, Adina Ghemigian1,2, Carmen Georgescu4,5, Ana Valea4,5

1"Carol Davila" University of Medicine and Pharmacy  
2"C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
3The University Emergency Hospital, Bucharest, Romania
4"Iuliu Hatieganu" University of Medicine and Pharmacy 
5Clinical County Hospital, Cluj Napoca, Romania

Corresponding author: Mara Carsote
Phone no.  0040213172041
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

The surgical approach in the pituitary secreting or non-secreting tumours had a complex development during the last century up to the microscopic transsphenoidal or endoscopic techniques. This is a mini-review of endocrine features in adenomas requiring their remove starting from a case presentation. A 54-year-old female is admitted for endocrine evaluation because of her medical history. At the age of 45 she presented secondary amenorrhea, mild right eye proptosis, and persistent diffuse headache. A pituitary adenoma of 21 by 19 mm was found. Selective transnasal trasnsphenoidal hypophysectomy was performed. The surgery went well without any incidents. The patient was hospitalised for 14 days. She was released without hypopituitarism, or diabetes insipidus. The immunohistochemistry report showed a weak reaction for GH but the adenoma was considered non-functioning. In 2015 severe headache was progressively seen and it became mostly unresponsive to usual analgesic medication so amitriptylin, and gabapentin were introduced in order to control the pain. MRI showed a right pituitary tumour of 12 by 19 by 13 cm with right cavernous sinus invasion. A second selective pituitary surgery was recommended but the patient still delays it.  Hypophysectomy represent the first line of treatment in all the hormonally active pituitary masses (except for the majority of prolactionomas) and in non-secretor macroadenomas. Close endocrine and imagery check-up is indicated at diagnosis and later on even in cases with complete neurosurgical remove, as seen in this case, because the risk of relapse is presented even after a few years. Repeating the surgical procedure is advisable due to compression and local invasion risks, as well as the risk of hypopituitarism.

 

Keywordshypophysectomy, pituitary adenoma, visual field defects

We have 32 guests and no members online

Monday the 23rd.