Pituitary Surgery

Indications

  1. Mass effect, especially on the optic apparatus.
  2. Hormonal excess states: acromegaly (GH production), Cushing’s (ACTH production), and secondary hyperthyroidism (TSH production).
  3. Second-line therapy for prolactinomas, in the following cases:
    1. Tumours that don’t respond adequately to dopamine-agonists (10-15% of prolactinomas).
    2. Patients who cannot tolerate dopamine-agonists or who prefer surgery over medical therapy.

Surgical Approaches

The choice of surgical approach depends on the technical aspects of the case and the experience of the surgeon. The three main approaches are: craniotomy, transsphenoidal microsurgery, and the transsphenoidal endoscopic approach. The transsphenoidal approach is associated with lower morbidity and a lower rates of incomplete resection.

Perioperative Endocrine Management