In order to establish a more reasonable therapeutic guide line for giant pituitary adenomas, the authors analyzed 31 cases of giant pituitary adenoma which were operated on between January, 1985 and July, 1987. The term, 'giant' applies primarily to a pituitary adenoma with a size of 4 cm or more in diameter. The two most common chief complaints were visual disturbance(18 cases) and headache(6 cases). Endocrinoloically, 17 cases(55%) were non-functioning and 14 cases(45%) produced hypersecretion syndrome:prolactionoma(8 cases), acromegaly(5 cases), and Nelson's syndrome(1 case). Twenty-eight cases showed marked suprasellar extension. Surgical treatment was given to 16 cases by transphenoidal approach and 15 cases by transcranial approach. Postoperative radiation therapy was given to 22 cases. Surgical results in the transsphenoidal group were better than in the transcranial group as there were fewer and less severe postoperative complications without a deterioration of vision. For the treatment of the giant pituitary adenoma, decompression of the tumor through transsphenoidal approach at first followed by postoperative radiation therapy, was effective. The transcranial approach was considered to be recommendable in cases of recurrence.
Decompression ; Pituitary Neoplasms* ; Postoperative Complications ; Recurrence

Endoscopic surgery opened new fields in pituitary tumor surgery, not only by direct endonasal access, but also by affording a panoramic view inside the sphenoidal sinus and the sellar turcica. It provides an extremely sharp image with high resolution. We describe our initial experience in using the endonasal endoscopy for the pituitary tumor surgery. Seven operations were performed by the endonasal endoscopy. The endoclinologic diagnosis were prolactinoma in four cases and GH secreating adenoma in three. Four cases were macroadenoma and three were microadenoma. Among the three patients with GH secreting adenomas, two improved clinically with normal serum GH level, one improved clinically with elevated serum GH levels postoperatively. Of the four patients with prolactinomas, all four improved clinically elevated with serum prolactin levels. Two patients developed postoperative complications; one was transient cerebrospinal fluid(CSF) leakage and the other was transient diabetes insipedus(DI). The use of the endoscope allowed close inspection of sella and parasellar structures as well as differentiation between tumor tissue and normal pituitary gland. Gross total removal was possible with the help of angled view of the telescope even in the cases of moderate supra-and parasellar extensions. Although from short and early experience, endoscopic endonasal approach seems to be a valuable and safe procedure for removing pituitary adenomas. With improved techniques and an accumulation in operative experience, endoscopic pituitary surgery will gain in importance and present new horizons in pituitary surgery.
Adenoma ; Diagnosis ; Endoscopes ; Endoscopy ; Humans ; Pituitary Gland ; Pituitary Neoplasms* ; Postoperative Complications ; Prolactin ; Prolactinoma ; Telescopes

OBJECTIVETo explore factors influencing the recurrence of patients with Cushing's disease after transsphenoidal surgery.

METHODSWe retrospectively analyzed the clinical data of 182 patients treated by transsphenoidal surgery with Cushing's disease in our department in PUMC Hospital from 1992 to 2002.

RESULTSThe recurrence rates were significantly different when patients had different radiological findings (P = 0.001), operative methods (P = 0.001), histological findings (P = 0.04), and postoperative cortisol levels (P = 0.02); however, such difference was not found in term of tumor size (P = 0.43).

CONCLUSIONRadiological findings, operative methods, histological findings, and postoperative cortisol estimates may be the factors influencing the recurrence of patients treated by transsphenoidal surgery.

Adenoma ; complications ; surgery ; Female ; Humans ; Hypophysectomy ; methods ; Male ; Pituitary ACTH Hypersecretion ; etiology ; surgery ; Pituitary Neoplasms ; complications ; surgery ; Recurrence ; Retrospective Studies

Pituitary adenoma is one of the important etiologies of male infertility. The early diagnosis of pituitary adenoma that caused infertility is not difficult with the help of modem incretion examination and imaging technique. The treatment focused on pituitary adenoma is no doubt the optimal choice of this kind of male infertility.
Growth Hormone-Secreting Pituitary Adenoma ; complications ; therapy ; Humans ; Infertility, Male ; diagnosis ; etiology ; therapy ; Male ; Pituitary Neoplasms ; complications ; therapy

The purpose of study was to analysis the clinical manifestation and treatment protocol of acute promyelocytic leukemia (APL) accompanied by craniopharyngioma so as to promote the understanding of this disease. The APL was diagnosed by morphologic examination of bone marrow cells, the leukemia bone marrow cells were analyzed by immunophenotyping technique, the qualitative and quantitative changes of PML-PARα fusion gene before and after treatment were monitored by using molecular biological test; the cytogenetic features were analyzed by using conventional karyotype and FISH analysis. The results indicated that the clinical manifestation of this disease was diverse and disease status was complex. The good therapeutic efficacy could be achieved, the misdiagnosis and delayed treatment could be avoided through early detection, timely treatment and multidisciplinary cooperation. It is concluded that when other clinical symptoms reappear after APL achieves remission, the possibility of second tumor must be considered, the clinical presentation should be carefully monitored, the early detection and timely treatment should be performed to improve the survival of patients.
Craniopharyngioma ; complications ; Humans ; Leukemia, Promyelocytic, Acute ; complications ; Male ; Middle Aged ; Pituitary Neoplasms ; complications

Cushing's disease (CD) is a relatively rare disease,characterized by pathological hypercortisolism secondary to excessive adrenocorticotrophic hormone that is secreted by pituitary adrenocorticotrophic hormone adenoma or hyperplasia. In addition to the typical clinical symptoms such as moon face,buffalo hump,and central obesity,the CD patients may also experience mental disorders and cognitive dysfunction. This review mainly focuses on the cognitive state of CD patients,the mechanisms of cognitive impairment caused by high cortisol levels,and the imaging findings (especially magnetic resonance imaging) for the evaluation of cognitive functions.
Adenoma ; complications ; Cognition ; Cognitive Dysfunction ; complications ; diagnosis ; Cushing Syndrome ; complications ; Humans ; Hyperplasia ; Magnetic Resonance Imaging ; Pituitary ACTH Hypersecretion ; Pituitary Neoplasms ; complications

Adult ; Fibrous Dysplasia, Polyostotic ; complications ; Follow-Up Studies ; Humans ; Male ; Pituitary Neoplasms ; complications

Pituitary adenoma with cerebrospinal fluid rhinorrhea is rare clinically. In this paper, through the analysis of a pituitary adenoma patient with initial symptom of cerebrospinal fluid rhinorrhea, we look forward to provide evidence for clinical diagnosis, so that we can avoid misdiagnosis.
Adenoma ; complications ; diagnosis ; Cerebrospinal Fluid Rhinorrhea ; etiology ; Humans ; Pituitary Neoplasms ; complications ; diagnosis

Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome caused by the sudden enlargement of a pituitary adenoma secondary to hemorrhage or infarction. Pituitary apoplexy after cardiac surgery is a very rare perioperative complication. Factors associated with open heart surgery that may lead to pituitary apoplexy include hemodynamic instability during cardiopulmonary bypass and systemic heparinization. We report a case of pituitary apoplexy after mitral valvuloplasty with cardiopulmonary bypass. After early pituitary tumor resection and hormonal replacement therapy, the patient made a full recovery.
Cardiopulmonary Bypass ; Hemodynamics ; Hemorrhage ; Heparin ; Humans ; Infarction ; Mitral Valve Insufficiency ; Pituitary Apoplexy* ; Pituitary Neoplasms ; Postoperative Complications ; Thoracic Surgery

OBJECTIVE: To improve the surgical outcome of pituitary adenomas by identifying and preserving the pituitary stalk and the gland during surgery. METHODS: From October 2010 to September 2012, the author from the Department of Neurosurgery of Xiangya Hospital, Central South University operated on 51 patients with pituitary adenoma. During the operations, we carefully identified the normal adenohypophysis, pituitary stalk, neurohypophysis and the abnormal tissues either by direct observation or by medical images, aiming to excise the tumor thoroughly, protect the pituitary function and reduce the postoperative complications. RESULTS: Totally 37 patients (72.5%, 37/51) had total resection of the tumor, 12 (23.5%, 12/51) had subtotal tumor resection and the other 2 had major removal. The gland and the pituitary stalk were well identified and reserved. Detection of hormone content proved that the operation had little effect on the free triiodothyronine (FT3) and adrenocorticotropic hormone (ACTH), while for free tetraiodothyronine (FT4) and thyroid stimulating hormone (TSH) and postoperative followup significant alleviation was found. There was no significant fluctuation for the testosterone in the men preoperatively and postoperatively (all the above results were obtained without hormone replacement therapy). The main postoperative complications were as follows: temporary diabetes insipidus in 5 patients (9.8%, 5/51); electrolyte disorder (the appearance of hyponatremia) in 17 (33.3%, 17/51); and cerebrospinal fluid rhinorrhea and postoperative intracranial infection in 1 (2%, 1/51). No one died during the perioperation period. CONCLUSION Microscopic transsphenoidal surgery is effective for pituitary adenomas including tumors violating the cavernous sinus. Accurate identification of the pituitary stalk, the gland and the abnormal tissue during the microscopic transsphenoidal operation plays a critical role in preserving the pituitary function and promoting postoperative rehabilitation.
Adenoma ; surgery ; Humans ; Male ; Microsurgery ; Neurosurgical Procedures ; methods ; Pituitary Gland ; surgery ; Pituitary Hormones ; blood ; Pituitary Neoplasms ; surgery ; Postoperative Complications ; Treatment Outcome