[Experiences on stereotaxic hypophysectomy for recurrent breast carcinoma; with particular reference to its pain...

Stereotaxic hypophysectomy was performed in nine patients with advanced breast carcinoma. Only one patient showed an objective remission in the form of decreased size of the chest wall ulcer after the operation. However, all but one patient did get relief of pain lasting for months. In one of these cases, where hypophyseal ablation was carried out under local anesthesia, pain relief was ascertained immediately after the ablation, i.e., during the operation. Such an instantaneous pain relief, which to the author's knowledge has never been described elsewhere, was considered to be the result of an influence on the hypothalamus rather than the pituitary itself. Mechanism of lasting pain relief was ascribed to endorphins which have recently attracted attention as endogenous peptides with opiate-like activities. Pituitary ablation of the present authors were noted to be incomplete either seen from hormonal assessment or from morphological evaluation. It was stressed that significant pain relief could be gained by the apparently incomplete hypophyseal ablation, whereas complete destruction does not necessarily guarantee a hundred percent relief of pain. A deduction was made that although endorphins may play an important role in alleviating pain, integrity of its productive system and/or its receptors could also be important as well. Stereotaxic hypophyseal ablation might be the procedure of choice in certain patients with advanced breast carcinoma suffering from excruciating pain.