HYPOPHYSECTOMY IN THE TREATMENT OF RETINOPATHY AND NEPHROPATHY IN SEVERE JUVENILE DIABETES

Abstract

Ten patients with juvenile diabetes and moderate Kimmelstiel-Wilson nephropathy, in most cases associated with advanced retinopathy, were hypophysectomized. There was no immediate operative mortality but one patient died from a cerebral abscess 3 months after operation. Postoperative follow-up time varied between 34 and 3 months during which there were periods of hypoglycemia, epileptic seizures, allergic manifestations in one case, and hypopotas-semia in another. There were periods of diabetes insipidus of varying duration requiring treatment with pitressin tannate in all but one case. Maintenance substitution therapy consisted of moderate doses of cortisone, small doses of desiccated thyroid, sex hormones, but no deoxycorticosterone acetate. The insulin requirement was reduced to about 50% of the preoperative dose. Hypophysectomy had in all cases been complete or almost complete judging from the changes in hormonal pattern. Proteinuria disappeared postoperatively in 3 cases. Endogenous creatinine clearance was unimpaired in all the surviving patients. Transection of the optic nerve of the almost blind eye had to be done in 8 cases. In 5 of these there was a postoperative defect in the visual field on the non-transected side with vision of the better eye unchanged or improved a little in 7 instances. Vision had decreased due to hemorrhages and other complications usually in connection with infections in 3 cases.