Impact of selective pituitary gland incision or resection on hormonal function after adenoma or cyst resection.

Abstract

OBJECTIVE:

With the resection of pituitary lesions, the anterior pituitary gland often obstructs transsphenoidal access to the lesion. In such cases, a gland incision and/or partial gland resection may be required to obtain adequate exposure. We investigate this technique and determine the associated risk of post-operative hypopituitarism.

METHODS:

All patients who underwent surgical resection of a pituitary adenoma or Rathke cleft cyst (RCC) between July 2007 and January 2013 were analyzed for pre- and post-operative hormone function. The cohort of patients with gland incision/resection were compared to a case-matched control cohort of pituitary surgery patients. Total hypophysectomy patients were excluded from outcome analysis.

RESULTS:

Of 372 operations over this period, an anterior pituitary gland incision or partial gland resection was performed in 79 cases (21.2 %). These include 53 gland incisions, 12 partial hemi-hypophysectomies and 14 resections of thinned/attenuated anterior gland. Diagnoses included 64 adenomas and 15 RCCs. New permanent hypopituitarism occurred in three patients (3.8 %), including permanent DI (3) and growth hormone deficiency (1). There was no significant difference in the rate of worsening gland dysfunction nor gain of function. Compared to a control cohort, there was a significantly lower incidence of transient DI (1.25 vs. 11.1 %, p = 0.009) but no significant difference in permanent DI (3.8 vs. 4.0 %) in the gland incision group.

CONCLUSION:

Selective gland incisions and gland resections were performed in over 20 % of our cases. This technique appears to minimize traction on compressed normal pituitary gland during removal of large lesions and facilitates better visualization and removal of cysts, microadenomas and macroadenomas.

• Authors: Garni Barkhoudarian, Aaron R Cutler, Sam Yost, Bjorn Lobo, Amalia Eisenberg, Daniel F Kelly
• Journal: Pituitary (Pituitary) Vol. 18 Issue 6 Pg. 868-75 (Dec 2015) ISSN: 1573-7403 [Electronic] United States
• PMID: 26115709 (Publication Type: Journal Article)

Topics

• Adult
• Central Nervous System Cysts (surgery)
• Diabetes Insipidus (etiology)
• Female
• Humans
• Hypopituitarism (etiology)
• Male
• Middle Aged
• Pituitary Gland (pathology, surgery)
• Pituitary Neoplasms (surgery)
• Postoperative Period
• Treatment Outcome