Surgical Treatment and Analysis of Pituitary Hormone with Serial Hormonal: Radioimmunoassay in Pituitary Tumor

ABSTRACT

There were 11 cases of pituitary tumors and 2 cases of craniopharyngiomas, who were admitted to the Department of Neurosurgery of the Catholic Medical Center from July 1976 to April 1977. The authors analyzed changes of the hormone related with the hypophyses before and after surgery, and radiation using the radioimmunoassay according to Schalch and Parker's double antibody method. The hormonal assays were performed as follows 5 samplings of growth hormones were given at a fasting state, at 8 AM, 830 AM, 10 AM and 11 AM, also the oral glucose tolerance test simulataneously after the patients were given 100 gm of surgar, associated with the insulin tolerance test (0.15 unit/kg). Two specimens of blood for the prolactin were withdrawn at 8 AM and 4 PM on that day. A specimen for LH, FSH, TSH, T3, T4 and cortisol was taken at 8 AM. The 8 surgery cases of the pituitary tumors associated with post-operative radiation underwent 3 transsphenoidal approaches, 3 transfrontal and 2 transtemporal approaches, and all of the surgery cases were alive. The transtemporal approach was for all craniopharyngiomas, and all of them died following surgery. One patient in this chromophile adenoma group had radiation therapy only. Following the clinical improvement after the treatment, the endocrinological symptoms, i. e. diminished libido and amenorrhea, were improved in the acromegalic group. The visual disturbance in the chromophobe adenoma group was markedly improved and the menstruation had started in one case. In inoperative patients, the visual disturbance and the endocrinological disarrangements were aggravated. In the chromophile adenoma group accompanying the acromegaly, the mean value of the plasma growth hormone was markedly increased to 61.3 ng/ml and greatly decreased to 36.8 ng/ml after the surgery and radiation, but increased rather than before radiation in the one case of radiation only. The mean prolactine value was also increased to 60.6 ng/ml and not changed after the therapy. The gonadotropin was within normal limits and tended to decrease slightly after the treatment. The TSH, T3, T4 cortisol were within normal values. In the chromophobe adenoma group, the mean growth hormone values were within normal limits, 7.27 ng/ml, and not altered after the therapy. The mean prolactin value was increased to 57.8 ng/ml and not changed after the treatment. The gonadotropin, TSH, T4 and cortisol were within normal limits before and after the treatment, but the T3 value was slightly higher than normal. In the craniopharyngioma group, the mean growth hormone value was within normal limits, 7.4 ng/ml and not altered after the surgery. The mean prolactin gonadotropin, TSH, T3 and T4 were within normal limits but the cortisol value was increased to 13.7 ng/ml after the surgery.