Pituitary Surgery

Question 1

Sx of mass effect

Answer 1

Headache
vision loss
pituitary hormone dysfunction
Cranial nerve abnormalities

Question 2

Surgery is first line tx for what pituitary tumors?

Answer 2

All except for tumors secreting prolactin

-Medical therapy:
Prolactinomas
GH secreting tumors (usually after surgical debulking)

(With both Prolactin plus GH: candidate for surgical intervention)

Question 3

Surgical approaches

Answer 3

transnasal endoscopic (2 surgeon)

transnasal microscopic

*both= transnasal

Question 4

Risks to surgery

Answer 4

Post-operative spinal fluid leakage:
Requires placement of spinal drain with increased hospital stay to 4-5 days.

Diabetes Insipidus:
Injury to the posterior pituitary gland with inability to concentrate urine. Requires use of DDAVP. Usually transient.

Injury to Optic Nerves (very RARE with transnasal approach)

Injury to the Carotid Artery (Stroke)

Injury to the Normal Pituitary Gland

Chronic sinusitis

Meningitis