Acessibilidade / Reportar erro

Somatotrophic and corticotrophic function outcome after transesphenoidal surgery in patients with sellar tumors and pre-operative endocrine deficits

Evolução das funções somatotrófica e corticotrófica após cirurgia transesfenoidal em pacientes com tumores selares e deficits endócrinos pré-operatórios

Abstracts

Sixteen patients with sellar tumors that were treated surgically and who had pre-operative somatotrophic and corticotrophic function deficits were submitted to pre- and early post-operative insulin tolerance tests (ITTs). Seven patients had non-functioning adenomas, 5 had prolactinomas, 3 had craniopharyngioma and 1 had cordoma of the clivus. All patients had macro-tumors and none received radiotherapy within the studied period. Seven patients had GH, 4 had Cortisol and 5 had both GH/cortisol function pre-operative deficit. Five patients with isolated GH, 4 with isolated Cortisol and 3 with both GH/cortisol deficiencies showed a postoperative functional recovery. New Cortisol secretion deficits were observed in 2 patients postoperatively and both required long-term steroid replacement. These data suggest that preoperative endocrine deficits may be reversible after surgical decompression of the sellar region and that new endocrine deficits are rarely seen after surgery. All such patients should be tested postoperatively from an endocrinological point of view to reevaluate the need for replacement therapies.

pituitary tumors; transesphenoidal surgery; endocrine deficits


Dezesseis pacientes com tumores da região selar que foram tratados cirurgicamente e que possuíam deficits funcionais dos eixos somatotrófico ou corticotrófico foram submetidos a teste de tolerância à insulina pré- e pós-operatoriamente. Sete pacientes possuíam adenomas não-funcionantes, 5 possuíam prolactinomas, 3 craniofaringiomas e 1 possuía cordoma de clivus. Todos os pacientes possuíam macrotumores e nenhum deles foi submetido a radioterapia durante o período do estudo. Sete pacientes possuíam deficiência isolada do setor somatotrófico, 4 isolada do setor corticotrófico e 5 possuíam deficiência de ambos os setores. Cinco pacientes com deficiência isolada do setor somatotrófico, 4 com deficit isolado do setor corticotrófico e 3 com deficiência nos dois setores obtiveram melhora funcional pós-operatoriamente. Novos deficits do setor corticotrófico ocorreram em 2 pacientes, que necessitaram reposição de esteróides por longo prazo. Estes dados sugerem que deficits endócrinos pré-operatórios podem ser revertidos pela descompressão cirúrgica da região selar e que novos deficits causados pela cirurgia são raros. Estes pacientes devem ser retestados pós-operatoriamente do ponto de vista endócrino para se determinar a necessidade de terapia de reposição hormonal.

tumores pituitários; cirurgia transesfenoidal; deficits endócrinos


Somatotrophic and corticotrophic function outcome after transesphenoidal surgery in patients with sellar tumors and pre-operative endocrine deficits

Evolução das funções somatotrófica e corticotrófica após cirurgia transesfenoidal em pacientes com tumores selares e deficits endócrinos pré-operatórios

Fernando R. Pimentel-FilhoI; Luis Roberto SalgadoI; Arthur CukiertII; Bernardo LibermanI

IServiços de Endocrinologia, Hospital Brigadeiro, São Paulo

IINeurocirurgia do Hospital Brigadeiro, São Paulo

ABSTRACT

Sixteen patients with sellar tumors that were treated surgically and who had pre-operative somatotrophic and corticotrophic function deficits were submitted to pre- and early post-operative insulin tolerance tests (ITTs). Seven patients had non-functioning adenomas, 5 had prolactinomas, 3 had craniopharyngioma and 1 had cordoma of the clivus. All patients had macro-tumors and none received radiotherapy within the studied period. Seven patients had GH, 4 had Cortisol and 5 had both GH/cortisol function pre-operative deficit. Five patients with isolated GH, 4 with isolated Cortisol and 3 with both GH/cortisol deficiencies showed a postoperative functional recovery. New Cortisol secretion deficits were observed in 2 patients postoperatively and both required long-term steroid replacement. These data suggest that preoperative endocrine deficits may be reversible after surgical decompression of the sellar region and that new endocrine deficits are rarely seen after surgery. All such patients should be tested postoperatively from an endocrinological point of view to reevaluate the need for replacement therapies.

Key words: pituitary tumors, transesphenoidal surgery, endocrine deficits.

RESUMO

Dezesseis pacientes com tumores da região selar que foram tratados cirurgicamente e que possuíam deficits funcionais dos eixos somatotrófico ou corticotrófico foram submetidos a teste de tolerância à insulina pré- e pós-operatoriamente. Sete pacientes possuíam adenomas não-funcionantes, 5 possuíam prolactinomas, 3 craniofaringiomas e 1 possuía cordoma de clivus. Todos os pacientes possuíam macrotumores e nenhum deles foi submetido a radioterapia durante o período do estudo. Sete pacientes possuíam deficiência isolada do setor somatotrófico, 4 isolada do setor corticotrófico e 5 possuíam deficiência de ambos os setores. Cinco pacientes com deficiência isolada do setor somatotrófico, 4 com deficit isolado do setor corticotrófico e 3 com deficiência nos dois setores obtiveram melhora funcional pós-operatoriamente. Novos deficits do setor corticotrófico ocorreram em 2 pacientes, que necessitaram reposição de esteróides por longo prazo. Estes dados sugerem que deficits endócrinos pré-operatórios podem ser revertidos pela descompressão cirúrgica da região selar e que novos deficits causados pela cirurgia são raros. Estes pacientes devem ser retestados pós-operatoriamente do ponto de vista endócrino para se determinar a necessidade de terapia de reposição hormonal.

Palavras-chave: tumores pituitários, cirurgia transesfenoidal, deficits endócrinos.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 9-abril-1997.

Dr. Arthur Cukiert - Rua Nova York 744 apto 131 - 04560-001 São Paulo SP - Brasil.

  • 1. Arafah BM. Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 1986;62:1173-1179.
  • 2. Arafah BM, Harrington FJ, Mudhoun ZT, Selman WR. Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy. J Clin Endocrinol Metab 1990;71:323-328.
  • 3. Arafah BM, Kailani SH, Nekl KE, Gold RS, Selman WR. Immediate recovery of pituitary function after transesphenoidal resection of pituitary macroadenomas. J Clin Endocrinol Metab 1994:79:348-354.
  • 4. Barreca T, Perria C, Francaviglia N, Rolandi E. Evaluation of anterior pituitary function in adult patients with craniopharyngiomas. Acta Neurochirurgica 1984;71:263-272.
  • 5. Baskin DS, Wilson CB. Surgical management of craniopharyngiomas. J Neursurg 1986;65:22-27.
  • 6. Baum HBA, Biller BMK, Katznelson L. Assessment of growth hormone (GH) secretion in men with adult-onset GH deficiency compared with that in normal men: a clinical research center study. J Clin Endocrinol Metab 1996;81:84-92.
  • 7. Boer H, Blok G-J, Veen EAVD. Clinical aspects of growth hormone deficiency in adults. Endocrine Rev 1995;16:63-85.
  • 8. Brauner R, Malandry F, Rappaport R, Pierre-Kahn A, Hirsch JF. Craniopharyngiomas de l'enfant. Arch Franc Ped 1987;44:765-769.
  • 9. Chang RJ, Keye WR Jr, Monroe SE, Jaffe RB. Prolactin-secreting pituitary adenomas in women. Pituitary function in amenorrhea associated with normal or abnormal serum prolactin and sellar polytomography. J Clin Endocrinol Metab 1980;51:830-835.
  • 10. Degerblad M, Elgindy N, Hall K, Sjoberg HE, Thoren M. Potent effect of recombinant growth hormone on bone mineral density and body composition in adults with panhypopituitarism. Acta Endocrinol (Copenh) 1992;126:387-393.
  • 11. Harris PE, Afshar F, Coates P, Doniach I, Wass JAH, Besser G.M, Grossman A. The effects of transesphenoidal surgery on endocrine function and visual fields in patients with functionless pituitary tumours. Quart J Med 1989;71:417-427.
  • 12. Hoffman DM, O'Sullivan AJ, Baxter RC, Ho KKY. Diagnosis of growth-hormone deficiency in adults. Lancet 1994;343:1064-1068.
  • 13. Hout WB, Arafah BM, Salazar R, Selman WR. Evaluation of the hypothalamic-pituitary-adrenal axis immediately after pituitary adenomectomy: is perioperative steroid therapy necessary? J Clin Endocrinol Metab 1988;66:1208-1212.
  • 14. Kikuchi K, Fujisawa I, Momoi T . Hypothalamic-pituitary function in growth hormone-deficient patients with pituitary stalk transection. J Clin Endocrinol Metab 1988;67:817-823.
  • 15. Lees PD, Pickard JD. Hyperprolactinemia, intrasellar pituitary tissue pressure, and the pituitary stalk compression syndrome. J Neurosurg 1987;67:192-196.
  • 16. Newman CB, Levine LS, New MI. Endocrine function in children with intrasellar and suprasellar neoplasms. Am J Dis Child 1981;135:259-262.
  • 17. Orme SM, Sebastian JP, Oldroyd B, Stewart SP, Grant PJ, Stickland MH, Smith MA, Belchetz PE. Comparison of measures of body composition in a trial of low dose growth hormone replacement therapy. Clin Endocrinol 1992;37:453-459.
  • 18. Paja M, Lucas T, Garcia-Uria J, Salame F, Barceló B, Estrada J. Hypothalamic-pituitary dysfunction in patients with craniopharyngioma. Clin Endocrinol 1995;42:467-473.
  • 19. Pelkonen R, Grahne B, Hirvonen E, Karonen S-L, Salmi J, Tikkanen M, Valtonen S. Pituitary function in prolactinoma: effect of surgery and postoperative bromocriptine therapy. Clin Endocrinol 1981;42:467-473.
  • 20. Poppovic V, Damhanovic S, Micic D, Djurovic M, Dieguez C, Casanueva FF. Blocked growth hormone-releasing peptide (GHRP-6)-induced GH secretion and absence of the synergic action of GHRP-6 plus GH-releasing hormone in patients with hypothalamopituitary disconnection: evidence that GHRP-6 main action is exerted at the hypothalamic level. J Clin Endocrinol Metab 1995;80:942-947.
  • 21. Reutens AT, Hoffman DM, Leung K-C, Ho KKY. Evaluation and application of a highly sensitive assay for serum growth hormone (GH) in the study of adult GH deficiency. J Clin Endocrinol Metab 1995;80:480-485.
  • 22. Rosen T, Bosaeus I, Tolli J, Lindstedt G, Bengtsson BA. Increased body fat mass and decreased extracellular fluid volume in adults with growth hormone deficiency. Clin Endocrinol 1993;38:63-71.
  • 23. Salomon F, Cuneo RC, Hesp R, Sonksen PH. The effects of treatment with recombinant human growth hormone on body composition and metabolism in adults with growth hormone deficiency. N Engl J Med 1989;321:1797-1803.
  • 24. Thomsett MJ, Conte FA, Kaplan SL, Grumbach MM. Endocrine and neurologic outcome in childhood craniopharyngioma: review of effect of treatment in 42 patients. J Pediatr 1980;97:728-735.
  • 25. Whitehead HM, Boreham C, Mcllrath EM, Sheridan B, Kennedy L, Atkinson AB, Hadden DR. Growth hormone treatment of adults with growth hormone deficiency: results of a 13 month placebo controlled cross-over study. Clin Endocrinol 1992;36:45-52.

Publication Dates

  • Publication in this collection
    18 Oct 2010
  • Date of issue
    Sept 1997
Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org