PROLACTIN-SECRETING microadenomas of the pituitary gland have been diagnosed on the basis of elevated serum prolactin concentrations and abnormal tomograms of the sella turcica.1 , 2 This diagnosis...

Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series.

The Pituitary adenoma

We undertook trans-sphenoidal microsurgical pituitary exploration in 20 consecutive patients with Cushing's disease, eight of whom had normal sellar polytomography Pituitary adenomas were selectively resected in 17 and histologically confirmed in 14 In one patient total hypophysectomy revealed a 15-mm basophilic adenoma, and in two patients vascular anomalies prevented sellar exploration Hypercortisolism was corrected in 17 patients (ie, in 16 of the 17 undergoing selective tumor removal and in the one with total hypophysectomy) Panhypopituitarism occurred only in this patient, and transient diabetes insipidus occurred in five Most patients became glucocorticoid deficient and required replacement therapy We conclude that pituitary tumors are present in the great majority of patient with Cushing's disease, even in the absence of demonstrable tomographic changes in the sella turcica, and that selective removal corrects hypercortisolism with little morbidity

Cushing's disease. Selective trans-sphenoidal resection of pituitary microadenomas.

Forty-two patients with cerebrospinal fluid (CSF) rhinorrhea presenting over a 5 year period were analyzed as to age, sex, etiology, anatomical and clinical findings, and methods of investigation and treatment. Eighty-eight were traumatic in origin, with the most common anatomical sites being ethmoid, frontal and sphenoid sinuses, and the cribriform plate region. Meningitis and pneumocephalus were the most frequently associated clinical findings each present in 31% of the cases. Chemical analysis of the CSF for protein was positive in 88% of cases vs. 13% when the protein content was quantitatively analyzed. The demonstration and localization of CSF leaks were most effective using metrizamide and CAT scanning when they were active and by indium cisternography when they were small, intermittent, or questionable. The clinical management was divided into medical and surgical approaches with the advantages and disadvantages discussed.

Jean L. Vezina

Papers

Prolactin-secreting pituitary microadenomas: roentgenologic diagnosis.

Co-existing pituitary adenoma and intrasellar arachnoid invagination.