Endocrine Abstracts

Introduction: Pharmacological treatments are available for all functioning pituitary adenomas, but found to be only ideal in prolactinomas. Therefore, at least in ACTH- and GH-microadenomas we have to strive to achieve 100% remission with transnasal surgery. Our question is, which combination of an increasing arsenal of pre- and peri-operative methods will bring the pituitary surgeons to this result without increasing complications.

Materials and methods: Data from published series of the author will be compared with new data from recent series. All patients had been operated, when MRI and direct transnasal micro-surgery were established. Special diagnostic methods: pretreatment with somatostatins and GH-receptor blocker; intra- and early postoperative hormone measurements; intra-operative micro-histology; micro-doppler; neuro-navigation; as well as the importance of a micro-suction irrigation system for visualization and minimization of trauma, will be described and illustrated.

Results: ACTH-micro-adenomas: since introducing more refined diagnostic tests and cavernous sinus sampling, nearly all micro-adenomas were initially detected. Nevertheless, in a few cases early re-surgeries became necessary to achieve remissions. This was especially evident and important in children with Cushing (n=100).

GH-microadenomas: in 2001 we published 100% remission in patients pretreated with somatostatin analogs vs 93% without pretreatment. This was statistically not significant, but of importance for the patients. Only rarely were intra-operative GH measurements influential in the group of microadenomas. In the last series from 2001–2005 without intra-operative GH-measurement and a long follow-up (mean >5 years), a clear biochemical remission was surgically achieved in all 25 microadenomas. The majority was pretreated with somatostatins. Complications were rare, minor and transient.

Conclusions: Using advanced surgical micro-techniques, enhanced by immediate feedback of the surgical success with hormone measurements, our long-term remission rates are definitely superior to most published data with medical and/or radio-surgical treatment. There is a great benefit for patients and minimizes costs.