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Neuroendocrine Center Bulletin; A newsletter with information regarding pituitary tumors and neuroendocrine diseases and conditions. Information on acromegaly, Cushing's disease or syndrome, prolactinoma, chromophobe or nonfunctioning pituitary adenoma, and thyrotroph adenomas.

The Mass General Neuroendocrine and Pituitary Tumor Clinical Center Bulletin shares the latest information for health care professionals about clinical and research topics in neuroendocrine conditions.

Neuroendocrine Center Bulletin Archives


FAQs About Transphenoidal Surgery for Acromegaly, Cushing's Disease, Non-Functioning Pituitary Adenomas and Other Pituitary Abnormalities

Pituitary Home

by Michelle Gurel BSN & Karen JP Liebert BSN RN

NEPTCC Newsletter Volume 22, Issue 1, Fall 2015 [PDF version]

WHAT IS TRANSSPHENOIDAL PITUITARY SURGERY?

This is a neurosurgical procedure typically used to remove pituitary tumors. It is important that the operation be done by someone who is expert in the procedure, performing it on a regular basis, as this provides the best chance to remove the tumor while leaving the normal pituitary gland in place. The pituitary gland is located at the base of the brain and behind the bridge of the nose. The easiest access to the pituitary region is via a transsphenoidal approach. With this approach, an operative microscope or endoscope and surgical instruments are inserted in the nasal cavity (or less commonly, under the upper lip and through the upper gum) and a small incision is made in the bone behind the nasal cavity. Behind this opening is an air cavity, called the sphenoid sinus. The surgical tools are passed through the sphenoid sinus to an area directly behind the sphenoid sinus into the bony cavity of the sella turcica. The pituitary gland is located within the sella turcica.

HOW LONG DOES THE OPERATION TAKE?

The procedure itself usually takes about three hours. Following surgery, patients will usually spend about two to three hours in the recovery room and are then admitted to the hospital floor. There is usually no need to stay in an Intensive Care Unit. Most patients are discharged from the hospital one or two days following surgery. In certain circumstances, such as in a patient with another medical condition, or if there is a complication, the stay may be longer.

HOW WILL I FEEL RIGHT AFTER THE SURGERY?

The most frequent symptoms after surgery are a sinus headache, nasal congestion and mild fatigue, which will gradually improve over a few weeks

COMMON QUESTIONS ABOUT SYMPTOMS AFTER TRANSSPHENOIDAL SURGERY ARE:

WHAT DO I NEED TO KNOW ABOUT HEADACHES & NECK PAIN AFTER TSS?

It is normal to experience headaches after pituitary surgery. If headaches worsen or are unrelieved by over-thecounter pain medication, you should notify your physician/ neurosurgeon. If your neck feels stiff and is painful, you should notify your physician/neurosurgeon immediately.

WHAT IF I NEED TO SNEEZE/COUGH AFTER TSS?

If you need to sneeze or cough during the first week or two after surgery, you should stay relaxed and let it happen. Don’t hold your breath or pinch your nose. Avoid things that make you sneeze like dust, animal dander, and cigarette smoke. You should gently clear your nose initially. After three days, you can gently blow your nose.

WILL I HAVE SINUS CONGESTION?

Sinus congestion is normal and may persist for up 3 to 4 weeks after pituitary surgery. Nasal decongestants can be used anytime and saline is okay after the first week. If you think you have a sinus infection, you should notify your physician/neurosurgeon.

WHAT IF I EXPERIENCE NASAL DRAINAGE?

It is normal to have mucous or drainage that is dark redbrown or maroon in color. However, clear fluid, like water dripping from a faucet, or a lot of bright red blood, is not normal and you should notify your physician/ neurosurgeon immediately.

WHAT SHOULD I KNOW ABOUT NOSE BLEEDS?

Spotting of red blood, or bloody mucous, from the nose is normal. Brisk bleeding from the nose rarely occurs. The most common cause of a nose bleed is from a small vessel in the nose (not bleeding from the tumor or brain). As with all nose bleeds, apply gentle pressure to stop the bleeding. If this does not control the bleeding, then go to your local emergency room and ask them to notify your physician/ neurosurgeon.

WHAT SHOULD I DO IF I HAVE A FEVER?

If the fever is higher than 101°F, double the dose of steroids (prednisone/hydrocortisone), if you are are taking this type of medication, until the fever subsides. If during the first two weeks after surgery, the fever goes above 101°F, notify your physician/neurosurgeon.

CAN I DO BENDING & LIFTING OR WORK-OUT/EXERCISE?

During the first two weeks, avoid bending and do not lift more than 20 pounds. After four weeks, most patients can return to strenuous exercise.

WHEN WILL I BE ABLE TO?

  • ANYTIME -NO RESTRICTION-
    • DRIVE, FLY, WALK, GOLF, SEXUAL ACTIVITY
  • TWO WEEKS
    • RETURN TO WORK (GENERALLY, CONSULT PHYSICIAN) SWIM, JOG
  • FOUR WEEKS
    • GO ON AMUSEMENT PARK RIDES (LIKE A ROLLER COASTER) EXCERCISE VIGOROUSLY
FAQS SPECIFIC TO TRANSSPHENOIDAL SURGERY FOR CUSHING’S DISEASE

WHAT WILL IMPROVE IF I AM IN REMISSION AFTER TSS?

In most patients, the physical and emotional problems associated with Cushing’s disease improve and may resolve over the one to two years after remission.

IS THERE ANYTHING I CAN DO TO HELP WITH WEIGHT LOSS IF I AM IN REMISSION AFTER TSS?

Eating a healthy, well-balanced diet, limiting portion size and/or calories will help you lose weight once your cortisol levels are controlled. Lowering the steroid (prednisone/ hydrocortisone) replacement dose according to your endocrinologist’s instructions will also help. A gradually increasing program of exercise can contribute to weight loss, stamina and muscle strength.

HOW SOON WILL I FEEL BETTER AFTER TSS PUTS ME IN REMISSION FROM CUSHING’S DISEASE?

At first, patients may feel worse, rather than better, because the fall in cortisol can be associated with aches and fatigue. It is important to work closely with your endocrinologist to adjust your steroid (prednisone/hydrocortisone) dose so that you can be on the lowest dose that is safe for you (higher doses than you need can delay the recovery).

WHAT IS THE CHANCE OF THE CUSHING’S DISEASE COMING BACK?

Most patients do not experience a recurrence of Cushing’s disease, but it is important to know that this can eventually happen in about 10-25% of patients.

A recurrence may develop as early as six or 12 months after TSS, but can also take place after more than 25 years. For this reason, it is essential to remain under the care of an endocrinologist. You should see an endocrinologist soon after having transsphenoidal surgery and for routine followup visits on a regular basis. You should discuss with your endocrinologist any concerns that the Cushing’s disease might be returning.

WHAT IF I EXPERIENCE A RECURRENCE OF CUSHING’S DISEASE?

There are many good treatments available for patients who have a recurrence, including surgery, a number of medications and radiation (often given along with medication). Talk with your endocrinologist if you experience a recurrence.

WHAT IF MY CORTISOL LEVELS REMAIN ELEVATED AFTER SURGERY?

It is very important that cortisol levels be controlled to prevent the long-term complications of Cushing’s disease. If this is not possible with surgery alone, further treatment is needed. There are many treatments available for patients who are not in remission after TSS. Talk with your endocrinologist about these options to find the one that is right for you.

FAQS SPECIFIC TO TRANSSPHENOIDAL SURGERY FOR ACROMEGALY

WILL THE CHANGES IN MY BODY RETURN TO THE WAY THEY WERE BEFORE I HAD ACROMEGALY?

While bony changes will not return to normal, soft tissue swelling in the face, hands and feet can improve significantly. Rings and shoes may become loose and facial changes may diminish.

HOW QUICKLY MIGHT I SEE CHANGES IN MY BODY AFTER TSS?

Some patients experience very rapid improvement in soft tissue swelling as the levels of growth hormone fall after surgery, and may feel their rings and shoes getting looser within days. In other patients, the improvement may be more gradual.

COULD THERE BE IMPROVEMENT IN MEDICAL CONDITIONS SUCH AS DIABETES AND HYPERTENSION (HIGH BLOOD PRESSURE) AFTER TSS?

When growth hormone is lowered/controlled, medical conditions, such as diabetes and hypertension, may improve and even resolve. In some patients with diabetes, blood sugar may fall quickly, so that it is important to talk with the doctor treating your diabetes to learn whether a reduction in any medications is advised. Similarly, in patients with high blood pressure, a reduction in medications may be needed if blood pressure improves. Be sure to discuss this with the doctor who prescribes your blood pressure medications.

WHAT IF MY GROWTH HORMONE LEVELS REMAIN ELEVATED AFTER SURGERY?

It is very important that growth hormone levels, and the hormone called insulin-like growth hormone (IGF-I) be controlled, to prevent the long-term complications of acromegaly. If this is not possible with surgery alone, further treatment is needed. There are several types of medications available to treat acromegaly if a patient is not cured by surgery. Somatostatin analogs and a GH receptor antagonist (both given by injection) are the most commonly used medications. In mild cases, a dopamine agonist, which is given in pill form, may be tried. Sometimes these medications are used in combination. Discuss the many treatment options with your endocrinologist.


Disclaimer About Medical Information: The information and reference materials contained herein is intended solely for the information of the reader. It should not be used for treatment purposes, but rather for discussion with the patient's own physician. All visitors to this and associated sites from the Neurosurgical Service at MGH agree to read and abide by the the complete terms of legal agreement found at the Neurosurgery "disclaimer & legal agreements."

Physicians' Pituitary Information Service - Physicians with questions may contact Dr. Biller or Dr. Klibanski at 617.726.3965 or 1.888.429.6863 or via e-mail at - pituitary.info@partners.org :: Research Studies

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