Selective anterior hypophysectomy in the treatment of diabetic retinopathy. A transsphenoidal microsurgical technique

Abstract

On the basis of Houssay''s phenomenon and of Poulsen''s report of a patient who had a selective necrosis of the anterior lobe of the hypophysis with a permanent cure of the diabetic retinopathy, it would seem that the most physiologic approach to the treatment of progressive diabetic retinopathy would be a selective and complete anterior hypophysectomy. A microsurgical technique for dissection of the hypophysis through a transspenoidal midline approach was developed and used in 17 consecutive cases. A selective anterior hypophysectomy was achieved in 11 patients. The other 6 patients had a total hypophysectomy. Significant reduction in the insulin requirements occurred in all of the patients. Diabetes insipidus occurred in 6 patients. Within the follow-up period of a few months to 2 years, it appeared that diabetic retinopathy might have been favorably influenced in 15 patients.