A clinicopathologic analysis of cryohypophysectomy in patients with advanced cancer

Serial sections of the sella turcica were obtained in 18 autopsy specimens of patients with advanced breast and prostatic carcinoma who had undergone extensive endocrine testing before and after cryoablation of the pituitary gland. Cryohypophysectomy, a techinque which requires neither craniotomy nor general anesthesia, resulted in 90 percent or greater destruction of the anterior lobe of the pituitary in 11 cases; destruction was complete in 3 cases. Persistence of human growth hormone following cryohypophysectomy was the most reliable indication of residual anterior pituitary function, but even this was an unreliable index when less than 10 percent of the pituitary gland remained viable. Withdrawal of corticosteroids resulting in an adrenal crisis following operation proved a poor technique to determine the adequacy of pituitary destruction. Length and extent of tumor remission did not seem to be dependent upon the degree of pituitary destruction. Based upon our experience with 60 patients having cryohypophysectomy for advanced carcinoma, CSF rhinorrhea and persistent diabetes insipidus each occurred in 10 percent of the cases.