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The management of pituitary tumours and post-operative visual deterioration

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Summary

The indications and results of transsphenoidal surgery for pituitary adenomas are analysed. The advantages and disadvantages of Bromocriptine and radiotherapy are considered. Transsphenoidal surgery does not damage pre-existing pituitary function. It produces excellent results in micro and mesoadenomas, curing about 70–80% of patients irrespective whether the tumour produces ACTH,prolactin or growth hormone. Moreover there is a very small relapse rate.

Macroadenomas of non-functioning type are also well treated by transphenoidal surgery, with a small recurrence rate as judged by CT scan follow-up. But macroadenomas secreting prolactin or growth hormone are less effectively treated by transsphenoidal surgery, only about 40% being cured. Invasive macro prolactinomas are not helped by surgery and should be treated with Bromocriptine and radiotherapy.

Radiotherapy should be used sparingly and has inevitable complications. Post-operative delayed visual deterioration is caused either by recurrent tumour or radiotherapy. There is no good evidence to support the secondary empty sella syndrome as a cause of such delayed visual deterioration.

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Authors and Affiliations

  1. Department of Neurological Surgery, Radcliffe Infirmary, Oxford, UK

    C. B. T. Adams

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  1. C. B. T. Adams
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Based on the Cairns Memorial lecture of the Cairns Society of South Australia, given at Oxford on 14th April 1988.

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Adams, C.B.T. The management of pituitary tumours and post-operative visual deterioration. Acta neurochir 94, 103–116 (1988). https://doi.org/10.1007/BF01435863

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