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Surgery

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • transsphenoidal surgery is the mainstay of treatment

  • if the tumour is small (< 1 cm in diameter) then surgery is likely to result in postoperative growth hormone levels of < 5 mU/l
    • small non-invasive tumours carry a favourable surgical prognosis with 80 per cent of microadenoma (<1cm diameter) removals achieving serum GH levels below 5mU per litre
    • this compares with, acceptable serum GH levels being achieved in less than 50 per cent of subjects following pituitary macroadenoma removal
  • factors influencing postsurgical GH concentration include:
    • pituitary tumour size
    • degree of extrasellar extension (particularly into the cavernous sinus)
    • high presurgery serum GH levels.

  • 30% chance of loss of pituitary function when surgery for large intrasellar and extrasellar tumours

  • mortality from pituitary surgery is low and postoperative complications such as hypopituitarism, diabetes insipidus and cerebrospinal fluid leaks or meningitis are uncommon

  • surgical ‘cure’ rates for pituitary macroadenomas are at best 60 per cent
    • however debulking remains important as the probability of additional treatments achieving acceptable serum GH levels is dependent on circulating GH levels at the time this treatment is commenced
    • note that if optic chiasm compression is present, surgical debulking is of major importance in restoring or protecting vision

Reference:

  1. Prescriber (2003): 14(13):55-62.

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