The use of pituitary surgery for patients with over-production of
growth hormone,
corticotrophin and
prolactin is reviewed. The value of specialized neuroradiological techniques is discussed including computerized tomography, air-encephalography and cavernous sinus venography. The indications for transcranial as opposed to trans-sphenoidal surgery are considered. The place of trans-sphenoid surgery in the treatment of
acromegaly is emphasized and the indications for surgical treatment are reviewed. The two syndromes due to over-production of
ACTH are considered--
Cushing's disease and Nelson's syndrome. The increasing use of pituitary surgery for the treatment of
Cushing's syndrome due to increased
ACTH production is noted, but a warning is given about the small
ACTH-secreting pulmonary
carcinoid tumour that may closely mimic
Cushing's disease. The difficulties encountered in trying to treat patients with Nelson's syndrome are stressed. It is recommended that in the rate case where total
adrenalectomy is required in
Cushing's disease,
pituitary irradiation should be given before or shortly after
adrenalectomy. The present position relating to the surgical treatment of the small
prolactin-secreting pituitary tumour is reviewed. Published data and personal experience suggests that for many of these patients, treatment with
bromocriptine is preferable to trans-sphenoidal surgery. Large
prolactinomas usually need transfrontal surgery and
X-ray therapy, sometimes followed by
bromocriptine treatment. The need for
steroid cover for pituitary surgery is discussed and it is suggested that a
glucocorticoid with less
salt-retaining action than
cortisol should be used. The importance of post-operative endocrine assessment is emphasized and a convenient method suggested. The incidence of complications after transsphenoidal surgery is low, although
panhypopituitarism occurred in 14% of the cases reported.