Endocrine Abstracts

Stereotactic hypothalamotomy in the treatment of morbid sexual deviation was first performed by Prof. Dr. Fritz Roeder 1966 in Univ. Göttingen and installed in University Hamburg-Eppendorf (UKE) by Neuropathologist Dr. Dieter Müller (DM) in the late 1970s. Dr. Dieter Lüdecke (DKL) agreed with Prof. Herrmann, Director of Neurosurgery, to give the Professor position to DM to join the Unit. It was known that the sex behaviour centre in the ventromedial nucleus of Cajal was distinct from the centre in the median eminence controlling pituitary secretion. The aim was to investigate the effect of hypothalamic stereotactic stimulation of the preoptic area (POA) and ventromedial nucleus (VMN) on the regulation of pituitary secretion in 27 patients referred for hypothalamotomy to cure hypersexuality. 27 patients (one female) were referred by a group of psychiatrists and a psychologist; 24 for compulsive hypersexualism. Neurosurgical access including air encephalography and hormonal investigations were performed by DKL and his Neuroendocrine Laboratory; including basal GH, ACTH, LH, FSH and prolactin and pre- and post-operative hormone responses to Metyrapone and Insulin Tolerance Tests. Patients were initially anaesthetised then woken up during the procedure. Electrostimulation to determine the exact location and to perform hypothalamotomy were both done by DM. All 27 patients could be improved. Four mild relapses occurred and three patients requested repeat stereotaxis. Only one woman was seen with extreme, debilitating hypersexuality. She also had severe acromegaly but hypersexuality had persisted after GH normalisation and in spite of multiple psychiatric medications. She returned to normal after a controlled partial hypothalamotomy.

Endocrine results: GH and ACTH rose after stimulation of the optic chiasma but stimulation of the pre-optic area POA and VMN suppressed GH secretion, showing for the first time the location of GH down-regulation in man. A distinct GH release was provoked by stimulation of the basolateral amygdala. ACTH response to metyrapone was impaired in the first seven patients but resolved by 6 months. Subsequent patients had lesions 1 mm more dorsally with normal ACTH responses. Slight increases in prolactin and decreases in testosterone were seen but still within the normal range. Importantly, no patient needed hormone replacement. Side effects were transient diabetes insipidus in 2/3 patients and one patient had an epileptic seizure after surgery. This well controlled series of medial hypothalamotomies was accepted with success at the World Congress of Neurosurgery, Sao Paulo 1977 and shows that the procedure has major psychiatric benefits with minimal side-effects.