transsphenoidal surgery is the mainstay of treatment
if the tumour is small (< 1 cm in diameter) then surgery is likely to result in postoperative growth hormone levels of < 5 mU/l
small non-invasive tumours carry a favourable surgical prognosis with 80 per cent of microadenoma (<1cm diameter) removals achieving serum GH levels below 5mU per litre
this compares with, acceptable serum GH levels being achieved in less than 50 per cent of subjects following pituitary macroadenoma removal
degree of extrasellar extension (particularly into the cavernous sinus)
high presurgery serum GH levels.
30% chance of loss of pituitary function when surgery for large intrasellar and extrasellar tumours
mortality from pituitary surgery is low and postoperative complications such as hypopituitarism, diabetes insipidus and cerebrospinal fluid leaks or meningitis are uncommon
surgical ‘cure’ rates for pituitary macroadenomas are at best 60 per cent
however debulking remains important as the probability of additional treatments achieving acceptable serum GH levels is dependent on circulating GH levels at the time this treatment is commenced
note that if optic chiasm compression is present, surgical debulking is of major importance in restoring or protecting vision
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