Transection of the pituitary stalk in man: anatomical changes in the pituitary glands of 21 patients

Abstract

In recent years hypophysectomy (Luft and Olivecrona, 1953) and adrenalectomy (which is nearly always combined with ovariectomy) have been used as methods of treating cases of advanced cancer of the breast (Atkins, Falconer, Hayward, MacLean, and Schurr, 1966) and the results of comparative trials suggest that hypophysectomy is slightly the more effective of these two operations (Atkins, Falconer, Hayward, MacLean, Schurr, and Armitage, 1960). As an alternative to hypophysectomy neurosurgeons have sometimes used the operation of pituitary stalk section for relieving such cases and also for treating patients with cancer of the prostate (see Schurr, 1966). In addition pituitary stalk section has been used for patients with advancing diabetic retinopathy (Field, Schepens, Sweet, and Appels, 1962;Cullen, Harris, Munro, and Duncan, 1965;Fager, Rees, and Bradley, 1966). In assessing the merits of this particular operation as a means of depressing pituitary function, it is important to know the extent to which the structure of the gland is altered and its functions impaired. There are few reports in the literature on the effects of stalk section on the human pituitary (Dandy and Goetsch, 1911;Russell, 1956; Daniel, Prichard, and Schurr, 1958;Le Beau and Foncin, 1960;Nicolaidis, 1962; Adams, Daniel, Prichard, and Schurr, 1963), although much information has now been obtained on the effects of the operation on several species of animal (Harris, 1950;Barrnett and Greep, 1951;Greep and Barrnett, 1951;Benoit and Assenmacher, 1953;Campbell and Harris, 1957;Daniel and Prichard, 1958;Holmes, 1961Holmes, , 1962 Laszlo, David, and Kovics, 1962; Adams, Daniel, and Prichard, 1963a, b, c; 1964a, b, c; 1966a, b; Jacobsohn, 1966). We have now had the opportunity of examining the glands of 21 human patients surviving for various periods of time after stalk section and in this paper we report our findings in these pituitary glands. MATERIAL AND METHODSThe pituitary glands from 21 patients were available for study. In 20 cases the operation was undertaken for the relief of carcinoma of the breast or prostate but in one (case 4 in Table I) the indication was a rapidly advancing diabetic retinopathy. Fourteen of the patients were females and seven were males. The age range was from 36 to 67 years. The pituitary stalk was approached by way of a frontal craniotomy, and in some cases the pituitary stalk was clipped before it was transected at as low a level as was technically possible. In the majority of cases an inert and impermeable barrier or 'plate' (composed usually of dental acrylic resin or tantalum) was placed between the cut ends of the stalk to prevent the re-establishment of the hypothalamo-hypophysial portal circulation.The period of survival after stalk section ranged from 30 hours to 11 months (see Table I). The necropsies on the majority of the cases were undertaken by P.M.D.or J.H.A. but in a few cases the pituitary glands were sent to us, and in these less detailed information is available. At necropsy care was taken to e...

Partial Growth Hormone Deficiency with Pituitary Stalk Transection.

“…Surgical transection of the pituitary stalk results in growth of posterior lobe tissue at the proximal stump [9][10][11] and various degrees of infarction within the anterior lobe [12]. If …”

Neurohypophyseal Ectopy in Growth Hormone Insufficiency

“…Regeneration of the nerve fibers originates in the supraoptic and paraventricular nuclei of the hypothala mus. Anterior lobe dysfunction can also be explained by pituitary stalk transection which may cause infarc tion within the anterior lobe [12]. Because of docu mented perinatal trauma, Kikuchi et al [6] suggested that injury to the pituitary stalk had occurred at birth in most of their patients with neurohypophyseal ecto py.…”

Comentários neurocirúrgicos e fisiológicos sobre a secção da haste pituitária em seres humanos (miscotomia)

“…But after mischotomy normally unimportant vessels raise their functional status. The artery of the trabecula, branch of the superior hypophyseal artery, plays then a definite pituitary feeding part (Nicolaidis, 1962;Adams et al, 1966). It is plausible then to suspect a physiological role misunderstood until now: indeed not only the ischaemia of the glandular parenchyma does not involve the areas in the immediate neighbourhood of the artery of the trabecula, but both the vascular and the cellular regenerations radiate from this vascular bed.…”

“…In side this large ischaemic area neocapillaries containing macrophages during the first days are in intimate contact with numerous indifferentiated cells which do not show orangeophile granules before the 17th day. Then there are two possibilities: (a) If the hypothalamo-pituitary interruption per sists the whole functional glandular parenchyma is made of these Azan oran geophile cells analogous to prolactin cells [1][2][3][4][5] . Furthermore it is now proved in human beings that the isolated pituitary produces the mammotrophic fac tor in excess 12 .…”