Pituitary surgery

Question 1

1. Identify the types of pituitary tumors that most often require surgical treatment.

Answer 1

Medical therapy:
Prolactinomas- medical only

GH secreting tumors (usually after surgical debulking)

Tumors that secrete both prolactin and growth hormone generally are candidates for surgical intervention

Surgery
Radiation
Careful observation

Question 2

2. Recognize the potential for complications from surgery on the pituitary gland.

Answer 2

Post-operative spinal fluid leakage
Requires placement of spinal drain with increased hospital stay to 4-5 days.

Diabetes Insipidus
Injury to the posterior pituitary gland with inability to concentrate urine. Requires use of DDAVP. Usually transient.

Injury to Optic Nerves- rare

Injury to the Carotid Artery (Stroke)-rare

Injury to the Normal Pituitary Gland

Chronic sinusitis

Meningitis-rare

Question 3

Surgical goals

Answer 3

Control tumor growth/mass effects
Preserve pituitary function 
Prevent recurrence
Relieve symptoms
Control hormone hypersecretion
Improve mortality rates

Question 4

Sx of mass effect:

Answer 4

Headache
Vision loss
Pituitary hormone dysfunction
Cranial Nerve Abn.