Comentários neurocirúrgicos e fisiológicos sobre a secção da haste pituitária em seres humanos (miscotomia)

Le Beau, J.; Foncin, J. F.; Nicolaidis, S.

doi:10.1590/S0004-282X1967000400001

Resumos

Nossa primeira hipofisectomia para tratamento de carcinoma metastático do seio foi feita em novembro de 1951 e a secção da haste pituitária (miscotomia) para o mesmo fim foi iniciada em novembro de 1956. Quando se consegue impedir a regeneração vascular hipotálamo-hipofisária os resultados gerais da miscotomia são pouco diferentes daqueles obtidos com a hipofisectomia. Empregamos a miscotomia sempre que, por condições locais ou gerais, a remoção total da hipófise parece constituir grande risco cirúrgico. Temos publicado estudos anatomo-fisiológicos desde 1958 mostrando: (a) as variações da necrose do lobo anterior da hipófise que não são totais nem definitivas (regeneração pituitária) e a importância das artérias trabeculares a este respeito; b) a grande capacidade de regeneração vascular a partir do hipctálamo e dirigindo-se para a parte restante do lobo anterior da hipófise, o que constitui um novo sistema anatomo-funcional portal; c) após isolamento permanente da pituitária ocorre proliferação das células de prolactina (células orangeófilas) e hipertrofia compensadora da pars tuberalis. A remoção cirúrgica de tecido hipofisário normal nos permitiu descrever, pela primeira vez no ser humano, as células ACTH (1964) e as células FSH (1966).

Our first hypophysectomy in a metastatic carcinoma of the breast was performed in November 1951 and the section of the pituitary stalk (mischotomy) for the same purpose was started in November 1955, the first results being published in 1956. When one succeeds in preventing the hypothalamohypophyseal vascular regeneration the general results of mischotomy are little different from those obtained with hypophysectomy. We adopt mischotomy when total pituitary removal seems to be a too great surgical risk. Anatomo-physiological studies are being published since 1958, showing: (a) The variations of the anterior lobe necrosis which is neither total nor definite (pituitary regeneration) and the importance of the trabecular arteries in that respect; (b) The striking ability of vascular regeneration from the hypothalamus to the anterior lobe remnants thus creating a new anatomical and functional portal system; (c) After permanent pituitary isolation, the proliferation of prolactin (orangeophile) cells and the compensatory hypertrophy of pars tuberalis. Removal of normal pituitary tissue obtained during the operation allowed us to describe for the first time in man the ACTH cells (1964) and the FSH cells (1966).

Neurological and physiological comments on the section of the pituitary stalk in humans (Mischotomy)

Comentários neurocirúrgicos e fisiológicos sobre a secção da haste pituitária em seres humanos (miscotomia)

J. Le Beau; J. F. Foncin; S. Nicolaidis

Laboratoire de Physiologie et de Psychologie Neuro-Chirurgicales de l'École Pratique des Hautes Études (Directeur: Prof. J. Le Beau), Service de Neurochirurgie de l'Hôpital de la Salpêtrière

SUMMARY

Our first hypophysectomy in a metastatic carcinoma of the breast was performed in November 1951 and the section of the pituitary stalk (mischotomy) for the same purpose was started in November 1955, the first results being published in 1956. When one succeeds in preventing the hypothalamohypophyseal vascular regeneration the general results of mischotomy are little different from those obtained with hypophysectomy. We adopt mischotomy when total pituitary removal seems to be a too great surgical risk.

Anatomo-physiological studies are being published since 1958, showing: (a) The variations of the anterior lobe necrosis which is neither total nor definite (pituitary regeneration) and the importance of the trabecular arteries in that respect; (b) The striking ability of vascular regeneration from the hypothalamus to the anterior lobe remnants thus creating a new anatomical and functional portal system; (c) After permanent pituitary isolation, the proliferation of prolactin (orangeophile) cells and the compensatory hypertrophy of pars tuberalis.

Removal of normal pituitary tissue obtained during the operation allowed us to describe for the first time in man the ACTH cells (1964) and the FSH cells (1966).

RESUMO

Nossa primeira hipofisectomia para tratamento de carcinoma metastático do seio foi feita em novembro de 1951 e a secção da haste pituitária (miscotomia) para o mesmo fim foi iniciada em novembro de 1956. Quando se consegue impedir a regeneração vascular hipotálamo-hipofisária os resultados gerais da miscotomia são pouco diferentes daqueles obtidos com a hipofisectomia. Empregamos a miscotomia sempre que, por condições locais ou gerais, a remoção total da hipófise parece constituir grande risco cirúrgico.

Temos publicado estudos anatomo-fisiológicos desde 1958 mostrando: (a) as variações da necrose do lobo anterior da hipófise que não são totais nem definitivas (regeneração pituitária) e a importância das artérias trabeculares a este respeito; b) a grande capacidade de regeneração vascular a partir do hipctálamo e dirigindo-se para a parte restante do lobo anterior da hipófise, o que constitui um novo sistema anatomo-funcional portal; c) após isolamento permanente da pituitária ocorre proliferação das células de prolactina (células orangeófilas) e hipertrofia compensadora da pars tuberalis.

A remoção cirúrgica de tecido hipofisário normal nos permitiu descrever, pela primeira vez no ser humano, as células ACTH (1964) e as células FSH (1966).

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Service de Neuro-chirurgie Hôpital de la Salpêtrière 47, Boulevard de 1'Hôpital Paris 13e, France.

1. ADAMS, J. H. DANIEL, P. M. & PRICHARD, M. M. L. Transection of the pituitary stalk in man: anatomical changes in the pituitary glands of 21 patients J. Neurol. Neurosurg. a. Psychiat. 29:545, 1966.
2. ASSENMACHER, I. & TIXIER-VIDAL, A. Repercussion de la section des veines portes hypophysaires sur la préhypophyse du canard pékin mâle entier ou castré. Arch. Anat. Microsc. et Morphol. Exper. 53:83, 1964.
3. DE VOE, W. F. RAMIREZ, Z. E. & McKANN, S. M. Production of mammary secretion by hypothalamic lesion in male rats. Endocrinology 78:158, 1966.
4. DUGGER, G. S. VAN WYK, J. J. & NEWSOME, J. F. The effect of pituitary stalk section in thyroid function and gonadotrophic-hormone excretion in women with mammary carcinoma. J. Neurosurg. 19:589, 1962.
5. EHNI, G. & ECKLES, N. E. Interruption of the pituitary stalk in the patient with mammary cancer. J. Neurosurg. 16:628, 1959.
6. EVERETT, J. W. & KUINN, D. L. Differential hypothalamic mechanism inciting ovulation and pseudopregnancy in the rat. Endocrinology 78:141, 1966.
7. FONCIN, J. F. & LE BEAU, J. Étude en microscopie optique et électronique d'un tumeur hypophysaire ŕ fonction adrenocorticotrope. C. R. Soc. Biol. 157:249, 1963.
8. FONCIN, J. F. & LE BEAU, J. Identification au microscope électronique des cellules adrénoorticotropes de l'hypophyse humaine. C. R. Soc. Biol. 158: 2276, 1966.
9. FONCIN, J. F. & LE BEAU, J. Cellules de castration et cellules FSH dans l'hypophyse humaine vues au microscope électronique. J. Microscopie 5:523, 1966.
10. GIROUD, C. J. P. STACHENKO, I. & VENNING, E. H. Secretion of aldosterone by zona glomerulosa of rat adrenal glands incubated in vitro. Proc. Soc. Exper. Biol. Med. 92:855, 1956.
11. HARRIS, G. W. Neural Control of the Pituitary Gland. Edward Arnold, London, 1955.
12. HERLANT, M. LINQUETTE, N. LAINE, E. FOSSATI, P. MAY, J. P. & LEFEBURE, I. Adénome hypophysaire ŕ cellules thyréotropes avec syndrome aménorrhée-galactorrhée chez une malade porteuse d'un myxoedčme congénital par ectopie thyroidičnne. Endocrinology 27:57, 1966.
13. KORDON, C. Recherches sur le controle hypothalamique des fonctions gonadotropes femelles du rat. Thčse Sciences, Paris, 1966.
14. KORDON, C. Controle nerveux du cycle ovarien. Arch. Anat. Microscop. et Morph. Exper. 1967 (sous presse).
15. LACOUR, F. Recherches sur la relation entre les cellules hypophysaires ŕ granulations orangées (cellules epsilon de Romeis) et les phénomčnes de lactation. C. R. Soc. Biol. Paris 144:248, 1950.
16. LE BEAU, J. & FONCIN, J. F. Anatomical study of anterior pituitary remnants after stalk section and hypophysectomy. Acta Psychiat. et Neurol. Scandinavica 35:13, 1960.
17. LE BEAU, J. NICOLAIDIS, S. & FONCIN, J. F. Étude anatomique et biologique de 16 cas de mischotomie pour cancers hormonodépendents. Acta Endocrinol. 4čme Série: 227, 1963.
18. LE BEAU, J. PERRAULT, M. & TESTARD, E. A propos de l'hypophysectomie dans le traitement du cancer du sein. Bull, et Mém. des Hôp. de Paris 21, 22, 23:663, 1956.
19. LE BEAU, J. Laboratory findings and clinical results of pituitary stalk section in the treatment of breast cancer. J. Neurol. Neurosurg. a. Psychiat. 23:81, 1960.
20. LE BEAU, J. L'Hypophysectomie dans le Traitement du Cancer. Editions Doin, Paris, 1958.
21. LE BEAU, J. La section de la tige de l'hypophyse en particulier dans le traitement du cancer du sein. Neurochirurgie 6:128, 1960.
22. LUFT, R. & OLIVECRONA, H. Experiences with hypophysectomy in man. J. Neurosurg. 10:301, 1953.
23. MEITES, J. Control of prolactin secretion. Arch. Anat. Microse. et Morphol. Exper. 1967 (sous presse).
24. NICOLAIDIS, S. Section de la Tige Pituitaire chez l'Homme. Étude anatomique et biologique. These Médicine, Paris. Le Tendre, Caen, 1962.
25. PERRAULT, M. LE BEAU, J. KLOTZ, B. SICARD, J. & CLAVEL, B. L'hypophysectomie totale dans le traitement du cancer du sein. Premier cas français. Avenir de la méthode. Thérapie 7:290, 1952.
26. PASTEELS, J. L. Sičge cellulaire de la secretion de prolactine par l'hypophyse humaine. He Réunion Europ. Anat., Bruxelles. Excerpta Medica, 70, 40:141, 1963.
27. PASTEELS, J. L. Recherches morphologiques et experimentales sur la sécrétion de prolactine. Arch. Biol. (Ličge) 74:439, 1963.
28. PURVES, H; D. & BASSET, E. G. The staining reactions of pars intermedia cells and their differenciation from pars anterior cells. InCytologie de l'Adénohypophyse. C. N. R. S. Paris 1963, pág. 231.
29. RAUSKOLB, E. W. & FARREL, G. L. Evidence for diencephalic regulation of aldosterone secretion. Endocrinology 59:526, 1956.
30. RAY, B. & PEARSON, O. Hypophysectomy in the treatment of an advanced cancer of the breast. Ann. Surgery 144:394, 1956.
31. ROMEIS, B. Hypophyse. Hdb. Mikr. Anat. des Menschen (v. Müllendorf) II Teil, Springer Verlag, Berlin, 1940.
32. SCHELIN, U. Chromophobe and acidophil adenomas of the human pituitary gland. A light and electron microscopic study. Acta Path. Microbiol. Scandinavica, Suppl. 158, 1962.
33. STUTINSKI, F. A quelles structures hypothalamiques peut-on attribuer l'origine des "releasing factors"? Rev. Europ. Endocrinol. 4, 1967 (sous presse).
34. XUEREB, G. P. PRICHARD, M. M. L. & DANIEL, P. M. The hypophyseal portal system of vessels in man. Quart. J. Exp. Physiol. 39:199-217 and 219-230, 1954.

Datas de Publicação

Publicação nesta coleção
21 Maio 2013
Data do Fascículo
Dez 1967

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[1] 1. ADAMS, J. H. DANIEL, P. M. & PRICHARD, M. M. L. Transection of the pituitary stalk in man: anatomical changes in the pituitary glands of 21 patients J. Neurol. Neurosurg. a. Psychiat. 29:545, 1966.

[2] 2. ASSENMACHER, I. & TIXIER-VIDAL, A. Repercussion de la section des veines portes hypophysaires sur la préhypophyse du canard pékin mâle entier ou castré. Arch. Anat. Microsc. et Morphol. Exper. 53:83, 1964.

[3] 3. DE VOE, W. F. RAMIREZ, Z. E. & McKANN, S. M. Production of mammary secretion by hypothalamic lesion in male rats. Endocrinology 78:158, 1966.

[4] 4. DUGGER, G. S. VAN WYK, J. J. & NEWSOME, J. F. The effect of pituitary stalk section in thyroid function and gonadotrophic-hormone excretion in women with mammary carcinoma. J. Neurosurg. 19:589, 1962.

[5] 5. EHNI, G. & ECKLES, N. E. Interruption of the pituitary stalk in the patient with mammary cancer. J. Neurosurg. 16:628, 1959.

[6] 6. EVERETT, J. W. & KUINN, D. L. Differential hypothalamic mechanism inciting ovulation and pseudopregnancy in the rat. Endocrinology 78:141, 1966.

[7] 7. FONCIN, J. F. & LE BEAU, J. Étude en microscopie optique et électronique d'un tumeur hypophysaire ŕ fonction adrenocorticotrope. C. R. Soc. Biol. 157:249, 1963.

[8] 8. FONCIN, J. F. & LE BEAU, J. Identification au microscope électronique des cellules adrénoorticotropes de l'hypophyse humaine. C. R. Soc. Biol. 158: 2276, 1966.

[9] 9. FONCIN, J. F. & LE BEAU, J. Cellules de castration et cellules FSH dans l'hypophyse humaine vues au microscope électronique. J. Microscopie 5:523, 1966.

[10] 10. GIROUD, C. J. P. STACHENKO, I. & VENNING, E. H. Secretion of aldosterone by zona glomerulosa of rat adrenal glands incubated in vitro. Proc. Soc. Exper. Biol. Med. 92:855, 1956.

[11] 11. HARRIS, G. W. Neural Control of the Pituitary Gland. Edward Arnold, London, 1955.

[12] 12. HERLANT, M. LINQUETTE, N. LAINE, E. FOSSATI, P. MAY, J. P. & LEFEBURE, I. Adénome hypophysaire ŕ cellules thyréotropes avec syndrome aménorrhée-galactorrhée chez une malade porteuse d'un myxoedčme congénital par ectopie thyroidičnne. Endocrinology 27:57, 1966.

[13] 13. KORDON, C. Recherches sur le controle hypothalamique des fonctions gonadotropes femelles du rat. Thčse Sciences, Paris, 1966.

[14] 14. KORDON, C. Controle nerveux du cycle ovarien. Arch. Anat. Microscop. et Morph. Exper. 1967 (sous presse).

[15] 15. LACOUR, F. Recherches sur la relation entre les cellules hypophysaires ŕ granulations orangées (cellules epsilon de Romeis) et les phénomčnes de lactation. C. R. Soc. Biol. Paris 144:248, 1950.

[16] 16. LE BEAU, J. & FONCIN, J. F. Anatomical study of anterior pituitary remnants after stalk section and hypophysectomy. Acta Psychiat. et Neurol. Scandinavica 35:13, 1960.

[17] 17. LE BEAU, J. NICOLAIDIS, S. & FONCIN, J. F. Étude anatomique et biologique de 16 cas de mischotomie pour cancers hormonodépendents. Acta Endocrinol. 4čme Série: 227, 1963.

[18] 18. LE BEAU, J. PERRAULT, M. & TESTARD, E. A propos de l'hypophysectomie dans le traitement du cancer du sein. Bull, et Mém. des Hôp. de Paris 21, 22, 23:663, 1956.

[19] 19. LE BEAU, J. Laboratory findings and clinical results of pituitary stalk section in the treatment of breast cancer. J. Neurol. Neurosurg. a. Psychiat. 23:81, 1960.

[20] 20. LE BEAU, J. L'Hypophysectomie dans le Traitement du Cancer. Editions Doin, Paris, 1958.

[21] 21. LE BEAU, J. La section de la tige de l'hypophyse en particulier dans le traitement du cancer du sein. Neurochirurgie 6:128, 1960.

[22] 22. LUFT, R. & OLIVECRONA, H. Experiences with hypophysectomy in man. J. Neurosurg. 10:301, 1953.

[23] 23. MEITES, J. Control of prolactin secretion. Arch. Anat. Microse. et Morphol. Exper. 1967 (sous presse).

[24] 24. NICOLAIDIS, S. Section de la Tige Pituitaire chez l'Homme. Étude anatomique et biologique. These Médicine, Paris. Le Tendre, Caen, 1962.

[25] 25. PERRAULT, M. LE BEAU, J. KLOTZ, B. SICARD, J. & CLAVEL, B. L'hypophysectomie totale dans le traitement du cancer du sein. Premier cas français. Avenir de la méthode. Thérapie 7:290, 1952.

[26] 26. PASTEELS, J. L. Sičge cellulaire de la secretion de prolactine par l'hypophyse humaine. He Réunion Europ. Anat., Bruxelles. Excerpta Medica, 70, 40:141, 1963.

[27] 27. PASTEELS, J. L. Recherches morphologiques et experimentales sur la sécrétion de prolactine. Arch. Biol. (Ličge) 74:439, 1963.

[28] 28. PURVES, H; D. & BASSET, E. G. The staining reactions of pars intermedia cells and their differenciation from pars anterior cells. InCytologie de l'Adénohypophyse. C. N. R. S. Paris 1963, pág. 231.

[29] 29. RAUSKOLB, E. W. & FARREL, G. L. Evidence for diencephalic regulation of aldosterone secretion. Endocrinology 59:526, 1956.

[30] 30. RAY, B. & PEARSON, O. Hypophysectomy in the treatment of an advanced cancer of the breast. Ann. Surgery 144:394, 1956.

[31] 31. ROMEIS, B. Hypophyse. Hdb. Mikr. Anat. des Menschen (v. Müllendorf) II Teil, Springer Verlag, Berlin, 1940.

[32] 32. SCHELIN, U. Chromophobe and acidophil adenomas of the human pituitary gland. A light and electron microscopic study. Acta Path. Microbiol. Scandinavica, Suppl. 158, 1962.

[33] 33. STUTINSKI, F. A quelles structures hypothalamiques peut-on attribuer l'origine des "releasing factors"? Rev. Europ. Endocrinol. 4, 1967 (sous presse).

[34] 34. XUEREB, G. P. PRICHARD, M. M. L. & DANIEL, P. M. The hypophyseal portal system of vessels in man. Quart. J. Exp. Physiol. 39:199-217 and 219-230, 1954.

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Comentários neurocirúrgicos e fisiológicos sobre a secção da haste pituitária em seres humanos (miscotomia)

Neurological and physiological comments on the section of the pituitary stalk in humans (Mischotomy)

Resumos

Datas de Publicação