Indications for Surgical Resection of a Pituitary Adenoma

 

Indications for surgery:

(1) severe mass effect

(2) severe hypopituitarism (pituitary insufficiency)

(3) pituitary apoplexy associated with hemorrhage or infarction

(4) relief of endocrinopathy

(4a) acromegaly with growth hormone secreting adenoma

(4b) Cushing syndrome with ACTH secreting tumor

(5) failure of medical therapy

Mass Effect	Clinical Features
compression at the optic chiasm	bitemporal visual field defect with decreased visual acuity
compression of the trigeminal nerve (cranial nerve V)	facial pain
compression of cranial nerves III, IV and/or VI	diplopia, anisocoria (unequal pupils), and/or ptosis (drooping of the upper eyelid)
pressure on the dura	headache
compression of the hypothalamus	disturbances in eating, behavior and vigilance
compression on the temporal lobes	partial seizures

 

Clinical findings with hypopituitarism:

(1) diminished libido

(2) fatigue

(3) weakness

(4) hypothyroidism

 

Clinical findings in pituitary apoplexy:

(1) sudden onset of mass effect (above)

(2) subarachnoid hemorrhage with severe headache

(3) severe hypotension

(4) decreased level of consciousness ranging from drowsiness to coma