Hypophysectomy

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Hypophysis means “under” or “below”. Hypophysectomy is a surgical procedure used to treat polyps in the spleen, liver, gallbladder, bile ducts and other organs. It involves removing part of these organs to reduce their size.

The word hypophysectomy comes from Greek words meaning under or beneath. Hypophysectomies are performed when there is no cure for the disease and it cannot be cured with conventional medicine.

In general, the surgeon removes only one half of the organ. Sometimes the surgeon may remove both halves at once. Other times only part of the organ is removed.

Some surgeons perform partial hyposcopy (the removal of a small piece of tissue) before performing a full hyposectomy (removing all of the diseased tissue). A complete hyposescopy is sometimes done after surgery to make sure that everything has been removed correctly.

Sometimes a hyposcopy is not needed because the surgeon can see the whole thing through a microscope. For example, if the liver is enlarged and looks like a grapefruit, then a normal sized liver will look like that. If however the liver appears very large and pear shaped, then it might need to be examined further.

The surgeon may use various instruments to examine it more closely without having to cut into it too much.

In some cases, the diseased portion of a liver can be treated with a laser instead of cutting into it. This is a less traumatic and invasive procedure and can help the liver regenerate more quickly.

Patients who have undergone transsphenoidal hypophysectomy should rest for at least one week following their surgery. The patient may feel very tired as they body recovers from the procedure. This fatigue should gradually disappear within a few weeks.

In the meantime, the patient will have to take it easy.

If a complete hyposcopy was done, the surgeon may recommend follow-up contrast CT scans or MRI studies to make sure that all remnants of the tumor have been removed completely. If part of an organ has been removed a follow-up biopsy may be necessary to confirm this.

If the patient has had a transsphenoidal hypophysectomy, they should ask their physician when they can return to driving and resume normal activities.

The patient may want to take pain medication for any discomfort that they may experience. However, it is important to only take the medication as prescribed and not to “self-medicate” by taking more than what is necessary.

The patient will also have to make sure to follow the treatment plan that has been outlined for them by their medical team. It is very important that they take their medication on a regular basis and keep all of their follow-up visits. Not doing so could result in the return or worsening of their condition.

While surgery is often the best way to treat some conditions, it can also have serious side effects. Some of these side effects are short-term and go away on their own after a few weeks. Others may be long-term and require ongoing attention.

It is important for patients to be aware of these side effects so that they can prepare themselves accordingly.

The most common side effects of surgery are:

1. Bleeding and hemorrhage

This is probably the most common and serious side effect of any surgery. If there is a significant loss of blood, it can lead to death. To reduce the risk of bleeding, patients are typically given a drug called heparin, which makes the blood thicker and thus harder for it to escape the blood vessels.

However, this drug does not always work and patients may still experience bleeding.

Hemorrhage is typically treated with a procedure known as a blood transfusion. Blood is taken from one person and put into another. Blood typing and knowing what types are compatible with what has become an important science.

The patient’s doctors will be able to determine the type of blood that they will need based on their medical history and how much they typically bleed during and after surgery.

2. Infection

Anytime that skin is broken, there is a risk for infection. While infections can happen at any time, they are generally more likely to happen within the first few weeks after surgery and especially after trauma to the body. To prevent infection, the incision site will be cleaned and possibly medicated to prevent or fight off infection.

Patients may also be given antibiotics to fight off potential infections.

If an infection does set in, it will have to be treated with antibiotics. In some cases, the surgical site may have to be opened up again to thoroughly clean out any remaining infection so that it doesn’t spread beyond the incision site.

3. Breathing difficulties

During surgery the patient’s mouth may be held open and extended to help the surgeon work on the inside of the mouth. This can severely restrict the ability to breathe. The anesthesiologist will be monitoring the patient and will give them oxygen based on their need.

They may also have a tube inserted down their throat in order to ensure that they continue to receive enough oxygen.

4. Unconsciousness

During some surgical procedures, the surgeon will need to keep the patient fully awake in order to monitor how well they are doing and how well they are responding to the procedure. The anesthesiologist will use a number of techniques to keep the patient awake such as talking to them or applying pressure to certain parts of their body. If these techniques don’t work, doctors may give the patient drugs that would keep them awake during the procedure.

5. Hormonal imbalances

Surgeries which involve the hypothalamus or pituitary gland can cause hormonal imbalances in the body. For example, removal of a tumor in the pituitary gland may lead to an overproduction of hormones from other glands such as the thyroid. This overproduction of hormones may result in complications that would require additional treatment.

Patients should discuss these potential complications with their doctors so that they are prepared for them after the surgery.

6. Obstruction of the bowels

If a tumor is pressing on the bowels or if the surgeon had to cut through them during the procedure, there is a risk that their function may be impaired after surgery. A common complaint after this type of surgery is constipation followed by more serious complications such as obstruction of the bowel.

7. Dementia

This is a rare but serious consequence of surgery in this area. If the tumor was pressing on the hypothalamus, the surgeon may have had to cut through some areas in order to remove it. The removal of these areas can lead to tissue damage which can result in long-term or permanent changes in behavior or cognition.

Patients should discuss this with their doctors so that they are fully informed before making a decision on whether or not to have surgery.

8. Unsatisfactory results

If the removal of a tumor in the hypothalamus or pituitary gland does not completely cure the patient of their disease, this may be due to several reasons. The most common reason is that there may have been multiple tumors present in these areas. This would require additional surgery in order to completely remove all of the tumors.

It is also possible that the surgeon may not have been able to get to all of the tumors and they were left behind.

It is also possible for a patient’s disease to return after surgery due to stray tumor cells that were left behind or undiscovered tumors in other areas. This is why doctors will recommend regular follow-up visits and tests after the surgery.

9. Infertility

In men, removal of a pituitary tumor may lead to infertility due to a reduction in the production of reproductive hormones such as testosterone. If left untreated, the patient’s testosterone levels may become so low that he is no longer able to get his partner pregnant. If this is a concern, the patient should consult with their doctors about hormone replacement therapy in order to maintain adequate hormone levels.

In women, surgery to the area around the pituitary or hypothalamus may affect the ovaries and lead to infertility. This can be managed by taking birth control pills if the patient desires children in the future.

10. Vision loss

The optic nerves are located near the hypothalamus and pituitary gland. Tumors in this location may put pressure on these nerves and lead to vision loss or blindness in that eye. While the nerves themselves do not have any special regenerative capabilities, most patients that suffer from blindness as a result of their disease tend to regain some vision over time as the brain re-adjusts.

If a patient has already lost vision in both eyes, this surgery will not help to improve their vision.

Can I Still Get General Anesthesia?

If you suffer from any of the conditions on this list or have concerns, talk to your medical team about the benefits and risks of general anesthesia versus a local.

Who Can Perform a Craniotomy?

Craniotomies are major brain surgery procedures that require a specialized neurosurgical team and skills. Most cranial surgeries are performed by a team of doctors that specialize in brain and spinal surgeries. The medical team will include a neurosurgeon, surgical nurses, and a anesthesiologist.

If you suffer from any of the conditions on this list, you should consult a medical professional about your concerns. They will be able to assess your situation and tell you if surgery is an appropriate treatment for you.

Disclaimer:

The information provided herein should never be used as a substitute for professional medical advice, diagnosis or treatment. Always consult your physician or other healthcare professional before changing any treatment options.

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Last updated on December 16, 2018

Categories: Informative

Tags: medical illness, medical problems, nervous system, organs, surgery, tumor

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Sources & references used in this article:

Transsphenoidal hypophysectomy by J Hardy – Journal of neurosurgery, 1971 – thejns.org

Hypophysectomy and a replacement therapy in the rat by PE Smith – American Journal of Anatomy, 1930 – Wiley Online Library

Transantrosphenoidal hypophysectomy by CA HAMBERGER, G Hammer, G Norlen… – Archives of …, 1961 – jamanetwork.com

Hypophysectomy in man by SJ Crowe, H Cushing, J Homans – 1910 – Johns Hopkins Press

Experiences with hypophysectomy in man by R Luft, H Olivecrona, D Ikkos, T Kornerup… – British medical …, 1955 – ncbi.nlm.nih.gov

Pseudo-Hypophysectomy: A Condition Resembling Hypophysectomy Produced by Malnutrition, Two Figures by R Luft, H Olivecrona – Journal of Neurosurgery, 1953 – thejns.org

Effect of adrenalectomy and hypophysectomy upon experimental diabetes in the cat by MG Mulinos, L Pomerantz – The Journal of Nutrition, 1940 – academic.oup.com

The disabilities caused by hypophysectomy and their repair: the tuberal (hypothalamic) syndrome in the rat by CNH Long, FDW Lukens – Proceedings of the Society for …, 1935 – journals.sagepub.com

Hormonal changes following hypophysectomy in humans by PE Smith – Journal of the American Medical Association, 1927 – jamanetwork.com

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