Stereotactic Chemical Hypophysectomy

  • Allan B. Levin
Part of the Topics in neurological surgery book series (TINS, volume 1)


The role of hypophysectomy in the treatment of cancer pain has been debated for several years. Although transcranial hypophysectomy for the treatment of malignant tumors was first described in 1952 [24, 29], it was originally conceived as a means of achieving objective regression of metastatic prostate and breast carcinoma. This procedure was a logical extension of the hormonal manipulation by gonadectomy and/or adrenalectomy pioneered by Charles Huggins [10]. It was soon found that hypophysectomy, like its antecedent operations, produced pain relief in cases of metastatic breast and prostate carcinoma more consistently than it caused objective tumor regression [26, 30]. With the advent of stereotactic and open transsphenoidal hypophysectomy, pituitary ablation could be accomplished with greater safety. Similarly, the introduction of chemical hypophysectomy by Moricca in 1963 [22] offered another nonoperative route for pituitary destruction. These types of surgery and their variations then became a practical option for providing pain relief, not only for patients who were too debilitated by advanced cancer to undergo craniotomy, but also for patients who were candidates for craniotomy.


Pain Relief Cancer Pain Diabetes Insipidus Dermoid Cyst Pituitary Stalk 
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  1. 1.
    Akil H, Richardson DE, Hughes J, et al: Enkephalin-like material elevated in ventricular cerebrospinal fluid of pain patients after analgesic focal stimulation. Science201: 463–465, 1978PubMedCrossRefGoogle Scholar
  2. 2.
    Daniel PM, Prichard MML: The human hypothalamus and pituitary stalk after hypophysectomy or pituitary stalk section. Brain 95: 813–824, 1972PubMedCrossRefGoogle Scholar
  3. 3.
    Eddy RL, Gilliland PF, Ibana JD Jr, et al: Human growth hormone release: Comparison of provocative test procedures. Am J Med 56: 179–185, 1974PubMedCrossRefGoogle Scholar
  4. 4.
    Fairman D: Hypothalamotomy as a new perspective for alleviation of intractable pain and regression of metastatic malignant tumors. In Fusek I and Kunc Z (eds): Present Limits of Neurosurgery. Prague: Avicenum, 1972, pp 525–528Google Scholar
  5. 5.
    Gros C, Frerbeau P, Privat JM, et al: Place of hypophysectomy in the neurosurgical treatment of pain. In Penzholz H, Brock M, Hamer J, Klinger M, Spoerri O (eds): Advances in Neurosurgery, Vol 3. Heidelberg: Springer-Verlag, 1975, pp 264–272Google Scholar
  6. 6.
    Guillemin R, Vargo T, Rossier J, et al: Beta-endorphin and adrenocorticotropin are secreted concomitantly by the pituitary gland. Science 197: 1367–1369, 1977PubMedCrossRefGoogle Scholar
  7. 7.
    Hill RG: The status of naloxone in the identification of pain control mechanisms operated by endogenous opioids. Neuroscience Lett 21: 217–222, 1981CrossRefGoogle Scholar
  8. 8.
    Hosobuchi Y, Adams JE, Linchitz R: Pain relief by stimulation of the central gray matter in humans and its reversal by naloxone. Science 197: 183–186, 1977PubMedCrossRefGoogle Scholar
  9. 9.
    Houghten RA, Swann RW, Li CH: Beta-endorphin: Stability, clearance behavior, and entry into the central nervous system after intravenous injection of the tritiated peptide in rats and rabbits. Proc Natl Acad Sci USA 77: 4588–4591, 1980PubMedCrossRefGoogle Scholar
  10. 10.
    Huggins C: Endocrine induced regression of cancers: Nobel prize lecture 1966. Cancer Res 27: 1925–1930, 1966Google Scholar
  11. 11.
    Kapur TR, Dalton GA: Transsphenoidal hypophysectomy for metastatic carcinoma of the breast. Br J Surg 56: 332–337, 1969PubMedCrossRefGoogle Scholar
  12. 12.
    Kennedy BJ: Hormonal therapy of mammary carcinoma. In Pack GT, Ariel I (eds): Treatment of Cancer and Allied Disorders, Vol 4: The Breast, Chest, and Esophagus. New York: Harper, 1960, pp 178–204Google Scholar
  13. 13.
    LaRossa JT, Strong MS, Melby JC: Endocrino-logically incomplete transethmoidal, transsphenoidal hypophysectomy with relief of bone pain in breast cancer. N Engl J Med 298: 1332–1335, 1978PubMedCrossRefGoogle Scholar
  14. 14.
    Levin AB, Katz J: Treatment of diffuse cancer pain by instillation of alcohol into the sella turcica. Anesthesiology 46: 115–121, 1977PubMedCrossRefGoogle Scholar
  15. 15.
    Levin AB, Katz J, Benson RC, et al: Treatment of pain of diffuse metastatic cancer by stereotactic chemical hypophysectomy: Long term results and observations on mechanism of action. Neurosurgery 6: 258–262, 1980PubMedCrossRefGoogle Scholar
  16. 16.
    Levin AB, Ramirez LF, Katz J: The use of stereotaxic chemical hypophysectomy in the treatment of thalamic pain syndrome. J Neurosurg 59: 1002–1006, 1983PubMedCrossRefGoogle Scholar
  17. 17.
    Lipton S, Miles J, Williams N, et al: Pituitary injection of a alcohol for widespread cancer pain. Pain 5: 73–82, 1978PubMedCrossRefGoogle Scholar
  18. 18.
    Madrid JL: Chemical hypophysectomy. In Bonica JJ, Ventafridda V (eds): Advances in Pain Research and Therapy, Vol 2. New York: Raven Press, 1979, pp 381–391Google Scholar
  19. 19.
    Miles J: Chemical hypophysectomy. In Bonica JJ, Ventafridda V (eds): Advances in Pain Research and Therapy, Vol 2. New York: Raven Press, 1979, pp 373–380Google Scholar
  20. 20.
    Minoto JP, Bronn DG, Kibbey WE: L-dopa effect in painful bony metastases. N Engl J Med 294:340, 1976 (Letter)Google Scholar
  21. 21.
    Misfeldt DS, Goldstein A: Hypophysectomy relieves pain not via endorphins. N Engl J Med297: 1236–1237, 1977PubMedGoogle Scholar
  22. 22.
    Moricca G: Neuroadenolysis for diffuse unbearable cancer pain. In Bonica JJ, Albe-Fessard D (eds): Advances in Pain Research and Therapy, Vol 1. New York: Raven Press, 1976 pp 863–866Google Scholar
  23. 23.
    Norrell H, Albes AM, Winternitz WW, et al: A clinicopathologic analysis of cryohypophysectomy in patients with advanced cancer. Cancer25: 1050–1060, 1970PubMedCrossRefGoogle Scholar
  24. 24.
    Perrault M, Lebeau J, Klotz B, et al: L’hypophysectomie totale dan le traitment du cancer sein: Premier cas francais: avenir de la method. Therapie 7: 290–300, 1952PubMedGoogle Scholar
  25. 25.
    Przewlocki R, Millan MJ, Gramsch CH, et al: The influence of selective adeno-and neurointermedio-hypophysectomy upon plasma and brain levels of beta-endorphin and the response to stress in rats. Brain Res 242: 107–117, 1982PubMedCrossRefGoogle Scholar
  26. 26.
    Ray BS, Pearson OH: Hypophysectomy in the treatment of disseminated breast cancer. Surg Clin NorthAm 42: 419–433, 1962Google Scholar
  27. 27.
    Rossier J, Vargo TM, Minnick S, et al: Regional dissociation of beta-endorphin and enkephalin content in rat brain and pituitary. Proc Natl Acad Sci USA 74: 5162–5165, 1977PubMedCrossRefGoogle Scholar
  28. 28.
    Sano K: Intralaminar thalamotomy and posteromedial hypothalamotomy in the treatment of intractable pain. Prog Neurolog Surg 8: 50–103, 1977Google Scholar
  29. 29.
    Scott WW: Endocrine management of disseminated prostate cancer, including bilateral adrenalectomy and hypophysectomy. Trans Am Assoc Genito-Urinary Surgeons 44: 101–104, 1952Google Scholar
  30. 30.
    Scott WW, Schirmer HKA: Hypophysectomy for disseminated prostatic cancer. In On Cancer and Hormones. Chicago: University of Chicago Press, 1962, pp 175–204Google Scholar
  31. 31.
    Sweet WH: Central mechanisms of chronic pain. In Bonica JJ (ed): Pain Research Publications New York: Raven Press, 1980, ARNMD 58, pp 287–303Google Scholar
  32. 32.
    Tindall GT, Payne NS, Nixon DW: Transsphenoidal hypophysectomy for disseminated carcinoma of the prostate gland. J Neurosurg 50: 275–282, 1979PubMedCrossRefGoogle Scholar
  33. 33.
    Turkington RW, Underwood LE, Van Wyk JJ: Elevated serum prolactin levels after pituitary stalk section in man. N Engl J Med 285: 707–710, 1971PubMedCrossRefGoogle Scholar
  34. 34.
    Vermes I, Mulder GH, Berkenbosch F, et al: Release of beta-lipotropin and beta-endorphin from rat hypothalami in vitro. Brain Res 211: 248–254, 1981PubMedCrossRefGoogle Scholar

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© Martinus Nijhoff Publishing, Boston 1988

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  • Allan B. Levin

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