Surgical tx

Question 1

sx of mass effect

Answer 1

1. HA
2. Vision loss
3. Pituitary H dysfxn
4. CN abnormality
   - 3,4,6

Question 2

tx for pituitary tumors

- exception?

Answer 2

Surgery as first line tx for all pituitary tumors
EXCEPT for tumors that secrete prolactin

*tumors that secrete BOTH prolactin and GH are candidates for surgery

Question 3

Approaches to pituitary surgery

Answer 3

Trans-nasal
microscopic approach

two person team endoscope approach
- most useful for tx of tumors outside of pituitary gland

Question 4

Cushing disease

• micro or macroadenoma?
• MRI help?

Answer 4

Microadenoma

MRI normal most of the time

Question 5

Risks of surgery

Answer 5

1. Post-op spinal fluid leakage
   - requires placement of spinal drain with increased hospital stay 4-5 days

2. Diabetes Insipidus
(inability of kidney to [ ] water)
- injury to the posterior pituitary gland with inabillity to [ ] urine
- Requires used of DDAVP
- Usually transient

3. Injury to Optic N
4. Injury to carotid artery (stroke)
5. Injury to the normal pituitary gland
6. Chronic sinusitis
7. Meningitis