The hormonal effects of pituitary surgery and irradiation: a review of 59 cases

The endocrine function of 59 patients with pituitary tumours who were treated in our unit between 1962 and 1982 is reviewed. There were 20 patients with growth hormone (GH) secreting adenomas, 17 with prolactinomas (1 tumour secreted both GH and prolactin), 14 corticotrophin (ACTH) secreting adenomas and nine non-functioning pituitary adenomas. Patients were treated with pituitary surgery and/or irradiation, with and without the addition of drugs. Patients treated with drugs alone were not included. Following combined surgery, radiotherapy and bromocriptine therapy only two acromegalic patients had persistently raised growth hormone levels and five continued to be hyperprolactinaemic. Pituitary irradiation alone was associated with the development of hypothyroidism in three of eight patients. A delayed but significant fall in free thyroxine index (p < 0.01) was noted in patients receiving 4500 cGy radiotherapy and surgery. Four patients also developed delayed ACTH deficiency at times varying from one to six years after treatment. It is concluded that patients who have received pituitary surgery or irradiation require regular long-term endocrine assessment.