Mehmet Erkan ÜSTÜN, Hüseyin BOZKURT, Densel ARAÇ, İsmail KAYA

HİPOFİZ ADENOMLARINDA TRANSSFENOİDAL MİKROCERRAHİNİN ENDOKRİNOLOJİK KÜR ÜZERİNE ETKİSİ

Amaç: Hipofiz adenomları lokal bası etkisi ve hormon salgıları nedeniyle ciddi morbidite ile seyretmektedirler. Tedavideki amaç ise bu bası etkisinin ortadan kaldırılması, hormon hipersekresyonunun normale getirilmesi, normal ön ve arka hipofiz fonksiyonlarının korunması ve olası rekürrens ihtimalinin ortadan kaldırılmasıdır. Gereç ve Yöntemler: Çalışmamızda hipofiz lojunda yer kaplayan lezyonu olan ve transsfenoidal mikrocerrahi yapılan 70 hastanın preoperatif, postoperatif erken dönem ve üçüncü ayda alınan hormon değerlerini, endokrinolojik remisyonları açısından incelemeyi amaçladık. Bulgular: Olguların en sık başvuru şikayeti baş ağrısı, galaktore, görme bozukluğu ve akromegalik semptomlardı. Tümör boyutları 70 olgunun 45'inde (64.28%) makroadenom, 25'inde (35.7%) mikroadenom olarak saptandı. Olguların 11 tanesi endokrin inaktif adenoma , 25 tanesi prolaktinoma, 17 tanesi GH hormon sekrete eden adenoma, 10 tanesi ACTH sekrete eden adenom ,6 tanesi GH ve prolaktinsekrete eden adenom , 1 olgu ACTH ve prolaktinoma sekrete eden adenom olarak değerlendirildi. TSC yöntemiyle opere edilen tüm hastalardaki endokrin kür oranları: akromegali olgularında % 76.4, akromegali ve prolaktinomalı olgularda %66.6, cushing olgularında %90 cushing ve prolaktinomalı olgularda %100, prolaktinomalı hastalarda %80 oranında bulunmuştur.Sonuç: Sonuç olarak transsfenoidal mikrocerrahi daha düşük mobidite ve mortalite oranı ile tümör çıkarılırken normal pitüiter bezin korunmasında güvenli ve etkin bir yöntem olarak bulunmuştur.

Effects of Transsphenoidal Microsurgery in Hypophysic Adenomas on Endocrinological Cure

Objective: Hypophyseal adenomas cause very high morbidity because of local mass effect and hypophyseal hormones secretion. Treatment goals are hormone secretion normalization, removing local mass effect, protection of both anterior and posterior hypophyseal functions and prevent recurrence. Meterial and Methods: In our study, we examined pre-operative, post-operative early days and three months after surgery hormonal values in 70 patients operated via transsphenoidal surgery to evaluate endocrinologic remission. Patients complaints were mostly headache, galactorrhea, vision problems and acromegaly.Results: Hypophyseal lesion size were macroadenoma in 45 (%64.28) patients, microadenoma in 25 (%35.7) patients. We evaluated 11 cases have endocrine inactive adenomas, 25 cases have prolactinomas, 17 cases have growth hormone secreting adenomas, 10 cases have ACTH secreting adenomas, 6 cases have GH and prolactin secreting adenomas and 1 case has ACTH and prolactin secreting adenoma. Endocrinologic remission rates in patients operated by transsphenoidal surgery were %76.4 in acromegaly cases, %66.6 in acromegaly and prolactinoma cases, %90 in Cushing cases, %100 in Cushing and prolactinoma cases and %80 in prolactinoma cases.Conclusion: At the end, transsphenoidal hypophyseal microsurgery was effective and reliable technique because of low morbidity and mortality rates and protection the normal pituitary function after surgery.

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