Microsurgical treatment for large pituitary adenomas / 中国微创外科杂志

Objective To explore the microsurgical treatment for large pituitary adenomas. Methods Surgical approaches were determined according to sites of tumor, texture, hormone level, and T 2 signals of MRI. Transpterional sinus approach was adopted in 82 cases, transinferior frontal approach in 22 ones, transsphenoidal sinus approach in 6 ones and subfrontal transsphenoidal sinus approach in 3 ones. All cases underwent radiotherapy after operation. Results Total resection of tumors was obtained in 102 cases (90 3%), and subtotal resection of tumors in 11 cases (9 7%) under microscope. 2 cases died after operation (1 8%). Postoperative vision and visual field were improved in 98 cases (86 7%) and no change in 15 cases (13 3%). 6 cases relapsed in 5 years postoperatively(6 3%). Conclusions Selecting different surgical approaches based on features of tumor by microsurgery combined with comprehensive therapy are key factors to improve total resection rate and decrease mortality and recurrence rate for large pituitary adenomas.

A Case of Cushing's Disease due to Large Pituitary Adenoma Treated by Surgery in Combination with Radiotherapy / 대한내분비학회지

Large pituitary adenomas causing Cushings disease are uncommon, and usually present with mild manifestations of Cushings syndrome. Large adenomas may have rapid growth and quickly reach a size large enough to become clinically apparent. These tumors are more frequently invasive than microadenomas, their widespread extensions make radical surgical removal difficult and the ultimate clinical course malignant. We report a case of 37 year-old women presenting amenorrhea, weight gain, and moon face. Sellar magnetic resonance imaging(MRI) demonstrated a large lobulating tumor measuring 3.5cm in diameter, arising from sella turcica, extending up to suprasellar area and invading the cavernous sinuses. Transfrontal adenectomy was performed to remove a mass, but residual mass was remained after surgery. Subsequent external brain radiotherapy(total dose 5400cGy) was performed. Histology revealed an adrenocorticotrophin(ACTH) secreting pituitary adenoma. After treatment, her menstration was started, body weight was reduced, and moon face was disappeared.