[Surgery in endocrine disorders. 1. Pituitary tumors]

Microsurgical refinement of classical transsphenoidal pituitary surgery facilitated selective adenomectomy with preservation of normal residual pituitary, thus becoming the first choice in the management of functioning pituitary adenomas. However, lack of tumor capsule and invasive nature of the adenoma make its total removal still difficult. Peritumoral wedge resection is most recommended from our experiences. Surgical results of acromegaly have become quite satisfactory and normal postoperative serum GH levels have been obtained in nearly 100% of the cases with micro or enclosed-adenoma. Pituitary irradiation and/or bromocriptine therapy are, however, yet necessary in half of the cases with marked suprasellar extension or invasion into the surrounding tissues. In the management of macroprolactinoma, surgical excision should precede bromocriptine therapy, because fibrous changes of the adenoma caused by the drug make surgical intervention much difficult. Microprolactinoma can be treated satisfactorily either by surgery or by bromocriptine. Just follow-up observation may be indicated to the cases having no hope for baby. All impaired pituitary functions in Cushing's disease can be converted normal by selective adenomectomy. However, highly qualified microsurgical technique and systematical survey for microadenoma are mandatory, otherwise it is often elusive.