What is the role of surgery in the treatment of hyperpituitarism?

Updated: Oct 24, 2016
  • Author: Alicia Diaz-Thomas, MD, MPH; Chief Editor: Robert P Hoffman, MD  more...
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Answer

Transsphenoidal surgery is the treatment of choice for Cushing disease in children. Initial remission rates of 70-98% of patients and long-term success rates of 50-98% have been reported. [9]

The preferred primary treatment for the patient with acromegaly is surgery, with a surgical cure rate at 10 years approaching 83% in the largest reported series. [9] Such surgery should be performed at large centers with documented experience, including published outcome and adverse event profiles.

For prolactinomas, surgery has good outcome with a long-term (10-year) surgical cure rate approaching 82% in the largest reported series with very low morbidity and no mortality.

Irradiation is reserved for the few patients who are intolerant of medication. Irradiation of the pituitary gland in children is not recommended, because it can lead to panhypopituitarism, optic nerve and optic chiasm injury, delayed radiation injury of the brain, increased risk of a second brain tumor, and epilation.


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