Skip to main content

Funktionseinschränkungen der adenohypophyse bei der neuroadenolyse zur behandlung schwerster schmerzzustände bei multiplen Knochenmetastasen

Restricted adenohyphophyseal function after neuroadenolysis for severe pain due to bony metastases

Der Schmerz volume 3, pages 113–117 (1989)Cite this article

Abstract

Neuroadenolysis of the pituitary (NALP) is an efficient measure for treatment of severe pain in patients with bony metastases. It is especially recommended for primary carcinomas of the breast or prostate. The procedure, transsphenoidal puncture of the pituitary under radiographic control and instillation of up to 2 ml 95% alcohol, is simple. The pathomechanism of the analgesic effect is still unknown. Extensive determinations of the anterior pituitary hormones LH, FSH, HPRL, ACTH, and HGH were done before and up to 14 days after NALP in six consecutive patients receiving this treatment. The pituitary was stimulated with releasing hormones LHRH (100 μg) and TRH (200 μg) before and 3 days after NALP. Determinations of hormone parameters were done 25 and 60 min after injection. The results showed that hormone production by the adenohypophysis becomes unevenly suppressed. The following results are significant (P<0.05): (1) LH: poststimulation values are extremely suppressed; (2) FSH: basal values decrease; (3) ACTH: basal values decrease after the 6th day. The antalgic effect of NALP is independent of its hormonal consequences. NALP produces hormonal suppressions of various degrees, and is not a “chemical hypophysectomy”.

Zusammenfassung

An sechs Patienten, die wegen stärkster Schmerzen bei multiplen Knochenmetastasen eine Alkoholinstillation in die Hypophyse (NALP) bekamen, wurden extensive Hormonspiegeluntersuchungen vor und bis 14 Tage nach dem Eingriff gemacht. Untersucht wurden LH, FSH, HPRL, ACTH, STH and TSH. Am Tag 1 unmittelbar vor der NALP und am Tag 4 nach dem Eingriff wurde außerdem mit den Releasinghormonen LH-RH (100 μg) und TRH (200 μg) stimuliert und der Effekt der Stimulation durch Bestimmung der Hormonparameter 25 und 60 Minuten nach der Stimulation erfaßt. Die Hormonproduktion der Adenohypophyse wird ungleichmäßig supprimiert. Es ergeben sich folgende signifikante Änderungen: Die Stimulierbarkeit des LH nimmt stark ab, die Basalwerte von FSH sinken ab, die Basalwerte von ACTH sinken ab dem 6. Tag ab. Die analgetische Wirkung der NALP ist unabhängig von der hormonellen Suppression. Es kommt durch die NALP zu einer hormonellen Bremsung, aber nicht zu einer völligen Ausschaltung der Hypophyse.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Literatur

  1. Editorial (1981) Pituitary ablation for pain relief. Lancet I:1348

  2. Evans PJD, Lloyd JW, Moore RA, Smith RF (1982) Pituitary function following hypophysectomy for pain relief. Br J Anaesth 54:921

    Article  CAS  PubMed  Google Scholar 

  3. Lipton S, Miles J, Williams N, Bark-Jones N (1978) Pituitary injection of alcohol for widespread cancer pain. Pain 5:73

    Article  CAS  PubMed  Google Scholar 

  4. Miles J (1979) Chemical hypophysectomy. In: Bonica JJ, Ventafridda V (eds) Advances in pain research and therapy vol 2. Raven Press, New York, p 373

    Google Scholar 

  5. Moricca G (1974) Neuroadenolysis for the antalgic treatment of advanced cancer patients. In: Bonica JJ, Procacci P, Pagni C (eds) Recent advances on pain. Williams & Wilkins, Springfield, Ill., p 313

    Google Scholar 

  6. Moricca G (1976) Neuroadenolysis for diffuse unbearable cancer pain. In: Bonica JJ, Albe-Fessard D (eds) Advances in pain research and therapy, vol 1. Raven Press, New York, p 863

    Google Scholar 

  7. Moricca G (1977) Pituitary neuroadenolysis in the treatment of intractable pain from cancer. In: Lipton S (ed) Persistant pain, Academic Press, London, p 149

    Google Scholar 

  8. Ostertag CH, Steffens J, Zwergel U (1988) Schmerzen bei Prostata-Ca: Hypophyse zerstören! Med Tribune 45:40

    Google Scholar 

  9. Williams NE, Miles JB, Lipton S, Hipkin LJ, Davies JC (1980) Pain relief and pituitary function following injection of alcohol into the pituitary fossa. Ann R Coll Surg 62:204

    Google Scholar 

  10. Yanagida H, Corssen G (1981) Role of endorphin to control cancer pain in man following pituitary adenolysis-an experimental study of beta-endorphin activity in hypophysectomized rats. Schmerz 3:101

    Google Scholar 

  11. Yanagida H, Corssen G, Trouwborst A, Erdmann W (1984) Relief of cancer pain in man: alcohol induced neuroadenolysis versus electrical stimulation of the pituitary gland. Pain 19:133

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Klinik für Anästhesie und Allgemeine Intensivmedizin der Universität, Florianigasse 1, A-1080, Wien

    P. Porges

  2. Hormonlaboratorium und Ludwig-Boltzmann-Institut für Pränatale und Experimentelle Genomanalytik an der I. Universitäts-Frauenklinik, Wien

    J. Spona

  3. Institut für Medizinische Statistik und Dokumentation, Wien

    H. Raimann

  4. Abteilung für Medizinische Statistik und Dokumentation, Wien

    F. Zdrahal

  5. Hormonlaboratorium der II. Medizinischen Universitätsklinik, Wien

    H. Templ

  6. Abteilung für Nuklearmedizin der II. Medizinischen Klinik, Wien

    M. Weissel

  7. TA, I. Chirurgische Klinik der Universität, Wien

    Ch Hlozanek

Authors
  1. P. Porges
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Spona
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Raimann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Zdrahal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Templ
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Weissel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ch Hlozanek
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Porges, P., Spona, J., Raimann, H. et al. Funktionseinschränkungen der adenohypophyse bei der neuroadenolyse zur behandlung schwerster schmerzzustände bei multiplen Knochenmetastasen. Schmerz 3, 113–117 (1989). https://doi.org/10.1007/BF02527388

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02527388