HYPOPITUITARISM: STUDIES IN PITUITARY TUMORS AND SIMMONDS' DISEASE

Abstract

Studies are reported on 14 cases of pituitary and parapituitary tumors (chromophobe adenomas, craniopharyngiomas) and 3 cases of "non-tumorous" panhypopituitarism. The degree of impairment of anterior pituitary function by the tumors varies from none to severe panhypopituitarism. The degree of impairment is entirely unrelated to the extent of mechanical-neurologic damage produced by the tumor. It is suggested that the structure and resistance of the diaphragm of the sella may be a decisive factor, some tumors readily overcoming the resistance of the diaphragm and growing upward before producing extensive compression of the nontumorous remnant of the anterior pituitary. Secretion of the various pituitary hormones is not necessarily impaired to the same degree; this leads to various combinations of hypothyroid, hypoadrenocortical and hypogonadal manifestations. Even the individual functions of the adrenal cortex, attributable to different types of adrenocortical steroids, are not always all impaired in the same individual, nor to the same degree. The occurrence of salt-hormone deficiency of the adrenal cortex in hypopituitarism adds to the evidence that, in humans, the secretion of salt-hormone (11-desoxycorticosterone) is under pituitary adrenocorticotropic control. Whereas this study was undertaken as a physiologic investigation of the human pituitary, the frequency of occurrence of subclinical deficiencies, especially of the adrenal cortex, found in patients with pituitary tumor warrants attention by the surgeon. Routine performance of appropriate tests followed by supportive preoperative and postoperative treatment with adrenocortical hormone is suggested in cases showing evidence of such deficiencies.