1st order
- Transnasal (“through the nose“)/transsphenoidal adenoma removal for hypothalamic/pituitary Cushing’s disease, possibly hemihypophysectomy (partial removal of the pituitary gland).
- Adrenalectomy – removal of the adrenal gland; is indicated for hormonally active tumors.
- Bilateral (on both sides) adrenalectomy* is indicated when.
- Bilateral micronodular hyperplasia (small-nodular enlargement of the tissue) is present
- There is no evidence of tumor in an ectopic ACTH syndrome
- In case of recurrence (recurrence) after second transsphenoidal adenoma removal (term from neurosurgery. It means removal of the adenoma “through the sphenoid bone (Os sphenoidale).”
* If necessary, also radiotherapy of the pituitary gland (e.g., for recurrence of Cushing’s disease, in primarily inoperable patients).
Possible complications of surgery for pituitary adenoma:
- Diabetes insipidus – hormone deficiency-related disorder in hydrogen metabolism leading to extremely high urine excretion (polyuria; 5-25 l/day) due to impaired concentrating capacity of the kidneys; incidence: 6-11%.
- Anterior pituitary insufficiency (HVL insufficiency) – failure of endocrine functions (hormone function) of the anterior pituitary lobe (HVL); frequency: 6-15 %.
- Epistaxis (nosebleeds) frequency: 1-3 %.
- Injury to the internal carotid artery Frequency: 0-1.3%.
