Type of Surgery
Last updated: 02/17/2009
The risks associated with hypophysectomy are numerous. Procedures are painstakingly selected to minimize risk and maximize benefit. A special risk associated with surgery on the pituitary is the risk of destroying the entire gland and leaving the entire...
endocrine system without regulation. Historically, this was the purpose of hypophysectomy, when the procedure was performed to suppress hormone production. After the procedure, the endocrinologist, a physician specializing in the study and care of the endocrine system, would provide the patient with all the hormones needed. Patients with no pituitary function did and still do quite well because of the available hormone replacements.
Other specific risks include;
- Hypopituitarism. Following surgery, if the pituitary gland has normal activity, it may become underactive and the patient may require hormone replacement therapy. Diabetes insipidus (DI) (excessive thirst and excessive urine) is not uncommon in the first few days following surgery. The vast majority of cases clear but a small number of individuals need hormone replacement.
- Cerebrospinal fluid (CSF) leakage. CSF leakage from the nose can occur following hypophysectomy. If it happens during surgery, the surgeon will repair the leak immediately. If it occurs after the nasal pack is removed, it may require diversion of the CSF away from the site of surgery or repair.
- Infection. Infection of the pituitary gland is a serious risk as it may result in abscess formation or meningitis. The risk is very small and the vast majority of cases are treatable by antibiotics. Patients are usually given antibiotics during surgery and until the nasal pack is removed.
- Bleeding. Nasal bleeding or bleeding in the cavity of the tumor after removal may occur. If the latter occurs it may lead to deterioration of vision as the visual nerves are very close to the pituitary region.
- Nasal septal perforation. This may also occur during surgery, although it is very uncommon.
- Visual impairment. A very rare occurrence, but still a risk.
- Incomplete tumor removal. Tumors may not be completely removed, due to their attachment to vital structures.
Hypophysectomy is the surgical removal of the pituitary gland, also called hypophysis. It is most commonly performed to treat tumors, especially craniopharyngioma tumors. Sometimes it is used to treat Cushing's syndrome due to pituitary adenoma.
As a urologist, I've found it's easier to do the PSA test and then sit down with the patient and say here's what the results mean for you. Given what we know right now, that seems a very sensible approach.
-Dr. Evan Vapnek
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