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Selective removal of hypersecreting pituitary adenomas?

An analysis of endocrine function, operative and microscopical findings in 101 cases

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Summary

The aim of this study of 101 pre- and postoperatively controlled hypersecreting pituitary adenomas (80 acromegalies, 15 Cushing's diseases, 6 Nelson's syndromes) was to establish in what cases a selective adenoma extirpation by the transnasal route is possible and advisable.

In primary operations on acromegalics with small and medium size tumours 92% were postoperatively GH normal. Eighty five per cent of these had intact pituitary function. The results with larger tumours were worse (72%). During a control period of 1.5–5.5 years a renewed elevation of GH levels was observed in three cases, all in the first year, but never after clearly selective adenomectomy. These results, and the anterior lobe biopsies, which showed no GH cell hyperplasia, favour selective adenoma extirpation.

In contrast to acromegaly, nodular ACTH cell hyperplasia in the anterior lobe was found in most cases of Cushing's disease, and therefore complete hypophysectomy was performed. The cortisol levels became either normal or, in most cases, lower than normal. A selective operation was performed on 6 Nelson tumours. The ACTH values became normal in about 50% of the patients but there was a tendency towards recurrence. Our experiences with Cushing's disease and Nelson's syndrome lead us to recommend total hypophysectomy.

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Author notes

  1. D. Lüdecke & R. Kautzky

    Present address: Department of Neurosurgery, University of Hamburg, Federal Republic of Germany

  2. W. Saeger

    Present address: Pathological Institute, University of Hamburg, Federal Republic of Germany

  3. D. Schrader

    Present address: Second Medical Clinic, University of Hamburg, Federal Republic of Germany

Authors and Affiliations

  1. Department of Neurosurgery, University of Hamburg, Federal Republic of Germany

    W. Saeger & D. Schrader

  2. Pathological Institute, University of Hamburg, Federal Republic of Germany

    D. Lüdecke, R. Kautzky & D. Schrader

  3. Second Medical Clinic, University of Hamburg, Federal Republic of Germany

    D. Lüdecke, R. Kautzky & W. Saeger

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  1. D. Lüdecke
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  2. R. Kautzky
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Supported by Deutsche Forschungsgemeinschaft, SFB 34.

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Lüdecke, D., Kautzky, R., Saeger, W. et al. Selective removal of hypersecreting pituitary adenomas?. Acta neurochir 35, 27–42 (1976). https://doi.org/10.1007/BF01405930

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