On the origin and nature of the pituitary gland capsule

1977 ◽  
Vol 46 (5) ◽  
pp. 596-600 ◽  
Author(s):  
Ivan Ciric
Keyword(s):  
Pituitary Gland ◽  
Anterior Lobe ◽  
Pituitary Stalk ◽  
Operating Microscope ◽  
Pia Mater ◽  
Content Type ◽  
Fine Print

✓ Observations under the operating microscope confirming the presence of a pituitary capsule are reported. This capsule envelops the anterior lobe of the pituitary, the neurohypophysis, and the pituitary stalk. It merges along the stalk with the intracranial pia mater. The origin and nature of this capsule are discussed in light of the known facts of development of the pituitary gland and surrounding structures. It is concluded that the pituitary gland capsule is a derivative of the primitive pia mater.

Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function

1997 ◽  
Vol 87 (3) ◽  
pp. 343-351 ◽  
Author(s):  
R. Bryan Mason ◽  
Lynnette K. Nieman ◽  
John L. Doppman ◽  
Edward H. Oldfield
Keyword(s):  
Cushing’S Disease ◽  
Pituitary Tumors ◽  
Optic Chiasm ◽  
Anterior Lobe ◽  
Pituitary Function ◽  
Pituitary Stalk ◽  
Cushing's Disease ◽  
Content Type ◽  
Suprasellar Cistern ◽  
Fine Print

✓ When the surgeon identifies an adenoma within the gland and selectively excises it, endocrine-active pituitary tumors are usually cured and pituitary function is preserved. Occasionally ectopic adenomas arise primarily in the pituitary stalk or arise superiorly in the midportion of the anterior lobe and extend upward within the stalk. To determine if these tumors can be selectively excised with preservation of pituitary function, the authors examined the outcome of selective adenomectomy in 10 patients with Cushing's disease with an ectopic adenoma originating in, and confined to, the stalk (four microadenomas) or an adenoma extending superiorly through the diaphragma sella and into the stalk (five microadenomas and one macroadenoma) from an operative series of 516 patients with Cushing's disease. To reach the adenoma transsphenoidally in these patients, the diaphragma sella was incised anteroposteriorly in the midline to the anterior edge of the stalk, the suprasellar cistern was entered, and the adenoma was selectively excised using care to limit injury to the infundibulum. After selective adenomectomy, Cushing's disease remitted in all patients. All patients were hypocortisolemic immediately after surgery and required hydrocortisone for up to 21 months. Apart from the adrenal axis, pituitary function was normal in five patients in the immediate postoperative period, including two patients with tumors confined to the stalk and three patients with preoperative hypothyroidism (one patient) and/or hypogonadism (three patients). Three others with transient postoperative hypothyroidism (one patient) or diabetes insipidus (two patients) had normal pituitary function within 7 months of surgery. One patient with hypothyroidism and one with hypogonadism before surgery had panhypopituitarism postoperatively. A patient with a microadenoma located high in the stalk next to the optic chiasm had bitemporal hemianopsia postoperatively. These results demonstrate the feasibility of achieving curative transsphenoidal resection and preservation of pituitary function in cases of pituitary adenomas that are confined to the pituitary stalk or tumors that extend superiorly within the stalk from an intrasellar origin.

Intraventricular craniopharyngioma Report of two cases

1971 ◽  
Vol 34 (1) ◽  
pp. 84-87 ◽  
Author(s):  
Ernest L. Cashion ◽  
Joseph M. Young
Keyword(s):  
Pituitary Gland ◽  
Third Ventricle ◽  
Pituitary Stalk ◽  
Content Type ◽  
The Third ◽  
Fine Print

✓ Craniopharyngiomas are usually considered to arise along the pituitary stalk and upper aspect of the pituitary gland. Two cases of craniopharyngioma confined to the third ventricle are reported.

Galactorrhea in males with tumors in the region of the pituitary gland

1971 ◽  
Vol 35 (6) ◽  
pp. 723-727 ◽  
Author(s):  
James E. Finn ◽  
Lester A. Mount
Keyword(s):  
Pituitary Gland ◽  
Pituitary Tumors ◽  
Pituitary Stalk ◽  
Content Type ◽  
Pituitary Tissue ◽  
Fine Print

✓ The pathophysiology of galactorrhea in males with pituitary tumors is discussed, two cases are presented, and previously-reported cases are reviewed. Hypersecretion of prolactin is probably the basis for the galactorrhea. Prolactin may be secreted by the tumor itself, or the remaining normal pituitary tissue may oversecrete if the hypothalamus or the pituitary stalk is compressed.

Gamma knife surgery of the pituitary: new treatment for thalamic pain syndrome

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 38-41 ◽  
Author(s):  
Motohiro Hayashi ◽  
Takaomi Taira ◽  
Taku Ochiai ◽  
Mikhail Chernov ◽  
Yuichi Takasu ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Gamma Knife ◽  
Pain Syndrome ◽  
Pain Reduction ◽  
Gamma Knife Surgery ◽  
Content Type ◽  
Thalamic Pain Syndrome ◽  
Thalamic Pain ◽  
Fine Print

Object. Although reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain. Methods. Inclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months. Conclusions. An initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.

Chronic cerebellar stimulation and developmental reflexes

1977 ◽  
Vol 46 (4) ◽  
pp. 506-511 ◽  
Author(s):  
Richard D. Penn ◽  
Mary Liz Etzel
Keyword(s):  
Cerebral Palsy ◽  
Anterior Lobe ◽  
Chronic Stimulation ◽  
Content Type ◽  
Motor Disabilities ◽  
Primitive Reflexes ◽  
Developmental Scale ◽  
Motor Retardation ◽  
Fine Print ◽  
Cerebellar Stimulation

✓ The changes in motor function in cerebral palsy patients produced by chronic anterior lobe cerebellar stimulation were documented with the Milani-Comparetti developmental scale, which allows comparison between functional gains and reflex patterns. Two patients with marked motor retardation and primitive reflexes were followed serially over several months of stimulation. Using these measures, the efficiency of chronic stimulation can be assessed, although many years will be needed to evaluate its role in treating motor disabilities.

Mouth guide for operating microscope

1976 ◽  
Vol 44 (5) ◽  
pp. 642-643 ◽  
Author(s):  
Eugene H. Holly
Keyword(s):  
Operating Time ◽  
Operating Microscope ◽  
Content Type ◽  
Fine Print

✓ An inexpensive mouth guide is described, which increases the mobility of the operating microscope and effectively shortens operating time.

Surgical experience with chromophobe adenomas of the pituitary gland

1971 ◽  
Vol 34 (6) ◽  
pp. 726-729 ◽  
Author(s):  
Bronson S. Ray ◽  
Russell H. Patterson
Keyword(s):  
Radiation Therapy ◽  
Pituitary Gland ◽  
Operative Mortality ◽  
Postoperative Radiation ◽  
Surgical Experience ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Chromophobe Adenoma ◽  
First Time ◽  
Fine Print

✓ Between 1950 and 1969, 165 operations were performed on 146 patients for the treatment of chromophobe adenoma of the pituitary gland unassociated with either acromegaly or Cushing's syndrome. The over-all operative mortality was 1.2%, and no deaths occurred in 138 cases operated on for the first time. In 106 of the patients who had not received prior treatment, vision was improved in 80% of cases and returned to normal in 50%. In the group of patients whose initial treatment was surgery, postoperative radiation therapy was administered in one-half of the cases. The rate of recurrence was 8% in those who received radiation and 22% in those who did not. Recurrence of symptoms within less than 1 year often was due to a hemorrhagic cyst which could be treated better by reoperation than by radiation therapy.

Acromegaly, diabetes insipidus, and visual loss caused by metastatic growth hormone—releasing hormone-producing malignant pancreatic endocrine tumor in the pituitary gland

1995 ◽  
Vol 83 (4) ◽  
pp. 719-723 ◽  
Author(s):  
Shigeru Genka ◽  
Hitoshi Soeda ◽  
Manabu Takahashi ◽  
Hideki Katakami ◽  
Naoko Sanno ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Metastatic Cancer ◽  
Growth Hormone Releasing Hormone ◽  
Serum Growth Hormone ◽  
Content Type ◽  
Releasing Hormone ◽  
Metastatic Growth ◽  
Fine Print

✓ The case of a 52-year-old woman with acromegaly, diabetes insipidus, and visual impairment caused by a metastatic growth hormone—releasing hormone (GRH)—produced pancreatic tumor is reported. Serum growth hormone (GH) and somatomedin C levels were elevated to 14 ng/ml (normal < 5 ng/ml), and 3.20 U/ml (normal < 1.88 U/ml), respectively. Paradoxical increases were observed in GH levels after glucose tolerance and thyrotropin—releasing hormone-stimulation tests. Biopsy of a pituitary tumor observed on computerized tomography scans and magnetic resonance studies revealed a metastatic cancer. When circulating GRH levels were measured, a marked increase in plasma GRH (1145 pg/ml; normal < 4—1 pg/ml) was observed. The patient died of cachexia due to metastases. Postmortem examination revealed that a primary tumor, a malignant endocrine lesion, was present in the pancreas, with metastatic tumors in the pituitary, lung, liver, and adrenal glands. Synthesis and production of GRH by the tumor was demonstrated by Northern blotting and immunohistochemical analysis. The pituitary gland showed hyperplastic, but not adenomatous changes. The authors stress the importance of both exploration for an ectopic source of GRH and the search for a GH-producing pituitary adenoma when unusual signs and symptoms are seen in patients with acromegaly.

The fine anatomy of the human spinal meninges

1988 ◽  
Vol 69 (2) ◽  
pp. 276-282 ◽  
Author(s):  
David S. Nicholas ◽  
Roy O. Weller
Keyword(s):  
Spinal Cord ◽  
Blood Vessels ◽  
Transverse Section ◽  
Human Cerebral Cortex ◽  
Pia Mater ◽  
Content Type ◽  
Inner Aspect ◽  
Dentate Ligament ◽  
Arachnoid Mater ◽  
Fine Print

✓ The fine anatomy of the human spinal meninges was examined in five postmortem spinal cords taken within 12 hours after death from patients aged 15 months to 46 years. Specimens of spinal cord were viewed in transverse section and from the dorsal and ventral aspects by scanning electron microscopy. Transverse sections of spinal cord and meninges were also examined by light microscopy. The arachnoid mater was seen to be closely applied to the inner aspect of the dura. An intermediate fenestrated leptomeningeal layer was observed attached to the inner aspect of the arachnoid mater and was reflected ventrally to form a series of dorsal septa. As it arborized laterally over the surface of the cord to surround nerves and blood vessels, the intermediate layer became highly fenestrated but remained distinct from the pia and arachnoid mater. The pia mater appeared to form a continuous layer which was reflected off the surface of the cord to coat blood vessels within the subarachnoid space in a manner similar to that described in the leptomeninges over the human cerebral cortex. Each dentate ligament consisted of a collagenous core which was continuous with the subpial connective tissue and was attached at intervals to the dura; pia-arachnoid cells coated the surface of the dentate ligaments. The present study suggests that the fine anatomy of the human spinal meninges differs significantly from that described in other mammals.

Diagnosis of an “isodense” pituitary microadenoma by dynamic CT scanning

1984 ◽  
Vol 60 (2) ◽  
pp. 424-427 ◽  
Author(s):  
Takeshi Hasegawa ◽  
Haruhide Ito ◽  
Katsuo Shoin ◽  
Yuzaburo Kogure ◽  
Toshihiko Kubota ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Adrenocorticotropic Hormone ◽  
Ct Scanning ◽  
Ct Scans ◽  
Dynamic Ct ◽  
Content Type ◽  
Pituitary Microadenoma ◽  
Enhanced Ct ◽  
Dynamic Ct Scanning ◽  
Fine Print

✓ A case of Nelson's syndrome with an adrenocorticotropic hormone-secreting pituitary chromophobe microadenoma is presented to demonstrate the potential capability of rapid sequential (dynamic) computerized tomography (CT) scanning for the diagnosis of a pituitary microadenoma that was isodense with the adjacent pituitary gland on conventional enhanced CT scanning. The dynamic CT scans showed transient high density in this microadenoma contrasting with the pituitary gland in the early-enhancement phase, and thereafter the contrast density was indistinguishable from that of the pituitary gland in the delayed-enhancement phase. For the detection of pituitary microadenoma, dynamic CT combined with subsequent delayed CT scanning can provide diagnostic and localizing information.

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