Endoscopic Surgery in Pituitary Tumors

By | 29 March 2021

Endoscopic Surgery in Pituitary Tumors

It is a hormone gland located in the very center of the head and under the brain.

Endoscopic Surgery in Pituitary Tumors

WHAT IS HIPPHYSIS?

It is a hormone gland located in the very center of the head and under the brain.

Hormones secreted from the pituitary gland and their functions are:

  • Adrenocorticotropic hormone: regulates the secretion of cortisone from the adrenal glands and is effective in controlling sensations such as sleep-wakefulness, body metabolism, fear, and anger.
  • Growth hormone: promotes growth in various tissues of the body
  • Prolactin: provides milk secretion from the breast
  • Thyroid-stimulating hormone: regulates the secretion of thyroid hormones from the thyroid gland. These hormones are important in maintaining the balance of body metabolism.

Pituitary tumors make up about 15% of brain tumors. Most of these tumors are benign. 75% of tumors originating from the pituitary gland secrete more hormones than normal. As a result, the following situations may occur:

  • Cushing’s syndrome
  • Acromegaly
  • Prolactinoma
  • Hypothyroidism

As the tumors grow, the hormone secretion function of the pituitary gland deteriorates and hormone deficiency (hypopituitarism) occurs. Large tumors can also cause visual disturbances due to the compression they put on the visual nerve.

Symptoms:

  • Facial enlargement, swollen eyes
  • Enlarged hands and feet
  • Facial shape changes: enlargement of the jaw, tongue, and facial bones
  • Weight changes: weight gain or loss
  • Constipation
  • Coarse or thinning hair, loss of body hair, thinning of eyebrows
  • Skin changes
  • Intolerance to cold or heat
  • Low blood pressure
  • Personality changes (restlessness or unwillingness)
  • Abnormal breast discharge or milk flow in women, menstrual irregularities, hair growth on the body
  • Breast enlargement in men, sexual anorexia
  • Headache
  • Tendency to sleep
  • Nausea, vomiting
  • Visual disturbances: double vision, vision loss
  • Transferring a wire transfer

Diagnosis:

When a pituitary tumor is suspected as a result of the examination, magnetic resonance (MR) imaging is performed.

Also, to determine the hormone activity of the tumor, various hormone levels in the blood (cortisol, FSH, LH, IGF-1, prolactin, testosterone, estradiol, TSH, T4, etc.) and visual examinations should be performed.

These evaluations should be carried out by experts from more than one medical field. Since the symptoms of pituitary tumors are mostly related to the function of hormones, the first evaluation is usually done by internal medicine and endocrinology specialists. Visual evaluations are carried out by an ophthalmologist.

If it is decided that surgical treatment is required, the person who will perform this surgery is a neurosurgeon (neurosurgeon). The role of an Otorhinolaryngologist is to assist the neurosurgeon (neurosurgeon) in some pituitary gland surgeries performed through the nose. The cooperation between these two surgical specialties is valid in endoscopic pituitary surgeries, which are increasingly applied today.

Treatment:

Pituitary tumors are mostly benign; however, when they grow up, they can cause serious problems by compressing important nerves and vessels. Pituitary tumors that secrete prolactin or growth hormone can be reduced or grown in size with drug treatments. Apart from this, surgery is often required for treatment. Most pituitary tumors can be removed through the nose; However, sometimes skull surgeries are needed.

There are several methods used in nasal surgery:

  • Transseptal-transsphenoidal hypophysectomy performed through the nasal septum and sphenoid sinus
  • Sublabial-transsphenoidal hypophysectomy with an incision made under the upper lip
  • Endoscopic transnasal-transsphenoidal hypophysectomy

The endoscopic method is increasingly preferred due to its superior imaging advantages. The benefits of this method for the patient are less damage to normal tissues in the nose and faster recovery, no need for nasal pads, or the need for a smaller and shorter pad, and fewer complications.