Journal of Clinical Endocrinology & Metabolism, Vol 79, 348-354, Copyright © 1994 by Endocrine Society

ARTICLES

Immediate recovery of pituitary function after transsphenoidal resection of pituitary macroadenomas

BM Arafah, SH Kailani, KE Nekl, RS Gold and WR Selman
Division of Clinical and Molecular Endocrinology, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Mild hyperprolactinemia frequently accompanies the hypopituitarism associated with pituitary macroadenomas not secreting PRL. Because of this association, hypopituitarism was postulated to be due to compression of portal vessels. We postulate that resumption of hypothalamic control over pituitary function occurs immediately after adenomectomy. To test this hypothesis, we examined pituitary function before and after transsphenoidal adenomectomy in 26 ACTH-deficient patients and 23 subjects with normal adrenal and thyroidal functions (control group). Glucocorticoids, given only to ACTH-deficient subjects, were withdrawn 36 h after surgery. ACTH, cortisol, and PRL levels were measured twice daily in all patients. Both ACTH and PRL levels increased hours after surgery in controls and returned to baseline over 4 days. In all hypopituitary subjects, PRL levels decreased by 50% within hours of adenomectomy and remained so until discharge. ACTH levels, measured simultaneously, increased within hours in 17 of 26 hypopituitary patients, all of whom recovered normal adrenal function before discharge. Nine additional patients had low ACTH levels and required cortisol replacement. The reciprocal changes in PRL and ACTH levels measured simultaneously, hours after surgery, support the hypothesis that hypopituitarism is reversible and largely caused by compression of the protal vessels and the resulting interruption of delivery of hypothalamic hormones. The persistence of hypopituitarism in some patients suggests that ischemic necrosis of the anterior pituitary could limit recovery.

This article has been cited by other articles:

				O. M. Dekkers, A. M. Pereira, and J. A. Romijn Treatment and Follow-Up of Clinically Nonfunctioning Pituitary Macroadenomas J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3717 - 3726. [Abstract] [Full Text] [PDF]

				R. N. Nawar, D. AbdelMannan, W. R. Selman, and B. M. Arafah Analytic Review: Pituitary Tumor Apoplexy: A Review J Intensive Care Med, March 1, 2008; 23(2): 75 - 90. [Abstract] [PDF]

				O M Dekkers, S Hammer, R J W de Keizer, F Roelfsema, P J Schutte, J W A Smit, J A Romijn, and A M Pereira The natural course of non-functioning pituitary macroadenomas Eur. J. Endocrinol., February 1, 2007; 156(2): 217 - 224. [Abstract] [Full Text] [PDF]

				B. M. Arafah Hypothalamic Pituitary Adrenal Function during Critical Illness: Limitations of Current Assessment Methods J. Clin. Endocrinol. Metab., October 1, 2006; 91(10): 3725 - 3745. [Abstract] [Full Text] [PDF]

				M. E. Molitch, D. R. Clemmons, S. Malozowski, G. R. Merriam, S. M. Shalet, M. L. Vance, and for The Endocrine Society's Clinical Guidelines Su Evaluation and Treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., May 1, 2006; 91(5): 1621 - 1634. [Abstract] [Full Text] [PDF]

				A. S. Dumont, E. C. Nemergut II, J. A. Jane Jr, and E. R. Laws Jr Postoperative Care Following Pituitary Surgery J Intensive Care Med, May 1, 2005; 20(3): 127 - 140. [Abstract] [PDF]

				D. H. Zayour, W. R. Selman, and B. M. Arafah Extreme Elevation of Intrasellar Pressure in Patients with Pituitary Tumor Apoplexy: Relation to Pituitary Function J. Clin. Endocrinol. Metab., November 1, 2004; 89(11): 5649 - 5654. [Abstract] [Full Text] [PDF]

				M. P. Nasrallah and B. M. Arafah The Value of Dehydroepiandrosterone Sulfate Measurements in the Assessment of Adrenal Function J. Clin. Endocrinol. Metab., November 1, 2003; 88(11): 5293 - 5298. [Abstract] [Full Text] [PDF]

				W. J. Inder and P. J. Hunt Glucocorticoid Replacement in Pituitary Surgery: Guidelines for Perioperative Assessment and Management J. Clin. Endocrinol. Metab., June 1, 2002; 87(6): 2745 - 2750. [Abstract] [Full Text] [PDF]

				H. S. Dökmetas, R. Çolak, F. Kelestimur, A. Selçuklu, K. Ünlühizarci, and F. Bayram A Comparison between the 1-{micro}g Adrenocorticotropin (ACTH) Test, the Short ACTH (250 {micro}g) Test, and the Insulin Tolerance Test in the Assessment of Hypothalamo-Pituitary-Adrenal Axis Immediately after Pituitary Surgery J. Clin. Endocrinol. Metab., October 1, 2000; 85(10): 3713 - 3719. [Abstract] [Full Text]

				B. M. Arafah, D. Prunty, J. Ybarra, M. L. Hlavin, and W. R. Selman The Dominant Role of Increased Intrasellar Pressure in the Pathogenesis of Hypopituitarism, Hyperprolactinemia, and Headaches in Patients with Pituitary Adenomas J. Clin. Endocrinol. Metab., May 1, 2000; 85(5): 1789 - 1793. [Abstract] [Full Text]