Artikel
The value of pituitary testing after non-pituitary intracranial operations
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Autoren
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S. Fleck
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Greifswald
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T. Junge
- Klinik für Innere Medizin A, Universitätsklinikum Greifswald
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C. Albrecht
- Klinik für Innere Medizin A, Universitätsklinikum Greifswald
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H.W.S. Schroeder
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Greifswald
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H. Wallaschofski
- Klinik für Innere Medizin A, Universitätsklinikum Greifswald
| Veröffentlicht: | 20. Mai 2009 |
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Gliederung
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Objective: The awareness and detection rate of hypopituitarism after traumatic brain injury and subarachnoid hemorrhage increased over the last years. Moreover, recent studies also showed a high rate of pituitary insufficiency after intracranial operations and after irradiation for non-pituitary tumors.
The authors sought to further clarify the prevalence, pattern, risk factors and severity of endocrine disturbances after non-pituitary intracranial procedures using basal and advanced dynamic pituitary testing.
Methods: 46 patients with a mean age of 55 years (28 female, 18 male) underwent prospective evaluation of basal parameters and dynamic testing (GHRH+arginine test, ITT, low dose ACTH test) following 5 to 168 months (median 47 months) after intracranial operation (2 patients with additional combined irradiation and chemotherapy, 1 patient with additional irradiation).
Results: We detected an overall rate of hypopituitarism with distinct magnitude in 58.7% (solitary 41.3%, multiple 17.4%, no complete). Adrenocorticotropic insufficiency was displayed in 45.6% (partial 32.6%, complete 13.0%), somatotropic in 28.3% (partial 23.9%, complete 4.4%), whereas a partial thyreotropic deficit was ascertained in one patient (2.2%, no complete). The prevalence of hypogonadism was 2.2%. Furthermore, total, multiple and isolated pituitary deficits were present in 0%, 17.4% and 41.3%, respectively. Pituitary deficits were associated with operations near to the sella turcica as well as in other regions. ITT could be performed safely in patients without a history of seizures.
Conclusions: Hypopituitarism occurs more frequently then previously believed in patients who have undergone neurosurgical intracranial procedures for other pathologies than pituitary tumors. The results show the value of pituitary testing after neurosurgical intracranial procedures. Pituitary function testing and adequate substitution may be warranted in patients after intracranial (non-pituitary) operations, at least in patients suffering from unexplained and diffuse complaints.
