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PubMed1989

[Clinical symptoms and duration of anamnesis in patients with hypophyseal tumors].

In 88 patients with operated pituitary tumours a retrospective statement of the duration of the disease up to the beginning of the therapy was carried out. In the case of the prolactin secreting tumours the times of anamnesis are approximately only half as long as in the comparable data of literature. The cause of this may by the large proportion of macroprolactinomas among our patients. In acromegaly the duration of the disease is from 3/4 to 25 years. By their insiduous clinical progression hormone-inactive tumours render an exact dating of the beginning of the disease impossible. Issuing from the still too long times of anamnesis the clinical symptoms of the endocrine-active and endocrine-inactive pituitary tumours relevant to practice are demonstrated. Including these symptoms into differential-diagnostic consideration an early diagnosing should be possible at least in endocrine-active tumours.

Acromegaly↗
PubMed1987

Craniopharyngioma in adults.

Twenty-nine adults operated on for craniopharyngioma between 1970 and 1981 are described. Headache and/or endocrine symptoms often preceded the diagnosis by several years. There were 3 surgical deaths. One patient died accidentally 4 years after surgery. The 5-year survival was 5/5 after total removal, 10/11 after partial removal, 0/3 after palliative surgery; 1/1 after total removal and radiotherapy, 0/2 after partial removal and radiotherapy and 3/3 after palliative surgery and radiotherapy. Visual acuity improved in 9 of 23 patients and deteriorated in 1 patient. Visual fields improved in 8 of 21 patients and deteriorated in 7. Surgery increased the degree of hypopituitarism. Relative body weight increased greater than or equal to 10% by 3 months after surgery in 8 of 15 patients. The prognosis would probably be improved by earlier diagnosis.

Adult↗
PubMed1979

The rhinologist and the management of pituitary disease.

Since the early days of pituitary surgery, a variety of transnasal approaches have been used to gain access to the sella turcica. Each of these approaches requires crossing the sphenoid sinus, hence the transsphenoidalnoidal designation of these methods. Since the growth and refinement of microsurgery as a distinct surgical discipline, there has been a coincidental maturation of transsphenoidal microsurgical techniques for the management of a variety of pituitary disorders. The present paper reviews the historical events leading to the current methods of transphenoidal pituitary surgery. Detailed descriptions of each method are given, with the advantages and disadvantages of each. The author's method is described and illustrated in a step-by-step manner, and the criteria which determine operability by transsphenoidal versus transfrontal craniotomy are discussed. The advantages which transsphenoidal techniques offer over transfrontal methods are emphasized. The paper deals with pituitary disorders on a clinical and pathological basis. The work-up of pituitary lesions is discussed, with a detailed presentation of the endocrine evaluation. Further emphasis is given to the value of tomography of the sphenosellar complex in planning operative approaches for removal of pituitary lesions, particularly when the lesion is a so-called "microadenoma," producing no obvious expansion nor erosion of the cellar floor. The author's experience in the management of 125 lesions of the pituitary or associated sella turcica is presented and complications are discussed. Because of the relatively brief period of follow-up, no conclusive evidence can be offered regarding cures in the author's series. However, on the basis of reported experience by others working in the same area, one may expect acceptable long-term improvement or cures in selected pituitary lesions operated on by transshpenoidal methods. The team management of pituitary disorders is stressed. In particular, emphasis is given to the contributions which the current day otorhinolaryngologist can make, because of his knowledge and experience in rhinological and microsurgical techniques. There is no other surgical specialty so uniquely qualified to provide operative treatment of pituitary lesions using transsphenoidal surgical pathways.

Adenoma↗