Treatment Of Pituitary Microadenoma Research Articles

CT virtual endoscopy for transsphenoidal microsurgical treatment of pituitary microadenomas

Objective To evaluate the value of CT virtual endoscopy(CTVE)for microsurgery of pituitary microadenomas via transsphenoidal approach.Methods In 18 patients with pituitary micmadenomas underwent microsurgery via transsphenoidal approach,the presurgical CT data was transfered to work station,the anatomies of the sphenoid sinus were then reconstructed by CTVE.The CTVE images were used to make the preoperative planning and indentify sphenoid sinus, sellar floor,and the position of the tumor during surgery.The CTVE images and the views from intraoperative microscope were compared. Results CTVE could display the anotomoties of sphenoid sinus in a three-dimentional mode.The display rates of superfical antomies such as sphenoid septa,sellar floor,carotid prominence,optic prominence and opticocarotid recess were 344.4%,100%,41.7%,36.1%and 58.3%respectively and the visual fields of these anatomic landmarks were larger than the views from the intraoperative microscope. CTVE could depcit the anatomies of the enhanced carotid ateries and pituitary tissue and some optic canals underlying the sellae by transparent function or heighten the threshold.The sites of the tumor could be marked correctly on CTVE images.CTVE could simulate the operative approach and some operating procedures properatively. Conclusion CTVE can display the anatomies of sphenoid sinus in a three-dimensional mode. In transsphenoidal treatment of pituitary microadenoma,CTVE can help to make preoperative planning,locate the intraoperative structures and make a precise bone window during surgery. Key words: CT virtual endoscopy; Microsurgical operation; Transsphenoidal approach; Pituitary; Microadenomas

Diagnosis and treatment of pituitary microadenoma: report of 80 cases

Objective: To analyse and discuss the diagnosis and treatment of pituitary microadenoma.Subjects and methods: Eighty cases of pituitary microadenoma treated with transsphenoidal approach in our department were analysed retrospectively during the last 2 years.Results: During following-up of 13.0 ± 3.2 months, neither remained tumor was found except one patients with microprolactinoma, nor recurrence. Diabetes insipidus occurred in 19 patients, among which 15 patients recovered in 1 week, three in 1 month and one in 7 months. The adrenocorticotrophic hormone deficiency was found in nine of 63 patients with PRL-, GH- and non-functioning microadenoma (12%), but hypoadrenalemia recovered in all patients. Among these nine patients, seven recovered in 3 months and two in 6 months. Dysosphesia occurred in 32 cases: 30 recovered in 1 month and two in 4 months. Thirteen of 15 patients (86.7%) with ACTH-secreting microadenoma achieved chemical remission judged by plasma cortisol levels ≤2 μg/dl within 72 hours of surgery. During the mean 13.0 months of follow-up, the symptoms of amenorrhea, galactorrhea, headache, obesity and sexual disturbance were improved greatly. In total, 93.7% (45/48) of patients had normal post-operative PRL levels in the patients who had no pre-operative treatment history of long time medical therapy and large dose medical therapy in short time.Conclusions: (1) Transsphenoidal surgery (TSS) is safe and effective treatment for pituitary microadenoma; (2) TSS is considered to be definitive treatment for ACTH- and GH-secreting microadenoma once the diagnosis is established; (3) in order to obtain better effects, TSS could be offered as first-line treatment for patients with locally non-invasive PRL-secreting microadenoma (tumor larger than 3 mm in diameter) and non-functioning microadenoma.

Hyperprolactinaemia: Diagnosis and Management

The patient with hyperprolactinaemia most commonly presents with infertility, menstrual irregularities, and/or gallactorrhoea. A complete history, physical examination, and measurement of prolactin and thyroid stimulating hormone (TSH) levels are the initial investigations. Hyperprolactinaemia can be physiologie, idiopathic, drug induced or secondary to numerous underlying disorders. When a cause cannot be found, radiological investigation with computed tomography (CT scan) or magnetic resonance imaging (MRI) of the hypothalamic pituitary area should be carried out. The choice of therapy depends on the pathological cause and the goals of the patient. When hypothyroidism is the cause, thyroid replacement therapy will correct the prolactin level. Treatment of pituitary micro-adenomas and idiopathic hyperprolactinaemia is aimed at the symptoms, Pituitary macro-adenomas should be treated for life with a dopamine agonist such as bramocriptine or pergolide. Two new drugs, quinagolide (CV205-502) a non-ergot dopamine agonist, and cabergoline, a long-acting dopamine agonist are currently undergoing clinical trials. They offer promising alternatives for the future treatment of hyperprolactinaemia. Surgery should be the second line of treatment if dopamine agonist therapy fails or is poorly tolerated. Macro-adenomas tend to regrow alter surgery and radio therapy may be warranted. Pregnancy can be achieved with dopamine agonist therapy. If this is not tolerated, administration of gonadotrophin releasing harmone (GnRH) by pump is effective. Therapy can be discontinued during pregnancy, although teratogenic effects have not been reported. Macro-adenomas should be kept under surveillance during pregnancy with routine history and physical examinations, and with bimonthly visual field examinations.

Detection, evaluation, and treatment of pituitary microadenomas in patients with galactorrhea and amenorrhea

Over a period of two and a half years, 34 women with galactorrhea or amenorrhea, all with an abnormal sellar polytomogram, underwent transsphenoidal microsurgical exploration of the sella. Eighteen women had microadenomas (≤ 1 cm. in diameter), seven had macroadenomas (>1 cm. in diameter), and five had unidentified lesions. Only one woman had a normal pituitary gland. Three women had cryosurgery without biopsy. Preoperatively, hyperprolactinemia occurred in 24 of 25 women with adenomas and two of five with nonadenomatous lesions. There were no operative deaths. Significant morbidity occurred in only three patients, none of whom had microadenomas. Postoperatively, menses resumed in 16 of the 17 women with microadenomas and in two of the seven with macroadenomas who presented with amenorrhea. Galactorrhea disappeared in 15 of the 17 women with microadenomas and in four of the seven with macroadenomas who presented with galactorrhea. In five patients with unidentified lesions, a retum of menses occurred in two of four with previous amenorrhea, and galactorrhea abated in two of three who presented with lactation. We conclude that sellar polytomography in women with hyperprolactinemia is a useful technique for the diagnosis of pituitary adenomas, a lesion which may occur more frequently than previously realized. In addition, transsphenoidal microresection of microadenomas is safe and effective.