Podiumsgespräch „Was zeichnet sich an Verbesserungsmöglichkeiten in der Diagnostik und Therapie der Hypophysentumoren ab“

Summary

Remarkable progress in the diagnosis of pituitary tumors with and without hormonal activity has been made by means of direct estimation of different pituitary hormones in plasma. The determination of HGH is not only important in acromegaly but has also become an useful tool to recognize hypopituitary states, as it is now well established the secretion of HGH is diminished at an early stage of hypopituitarism. Also the lack of diurnal rhythm of ACTH secretion exhibits an important feature in recognizing disturbances of the pituitary gland. The application of clomiphen may become helpful in the diagnosis of pituitary hypogonadism at least in male patients. It is to be hoped that the determination of unbound thyroxin and triiodothyronin in plasma will improve the diagnosis of secondary hypothyroidism until reliable methods for the estimation of plasma TSH will be available.

Progress in surgical treatment of pituitary tumors arises from the use of the operation microscope which will enable the surgeon to remove small tumors from the sella turcica without doing damage to the normal pituitary tissue. The implantation of two different isotopes (Yttrium⁹⁰ and Iridium¹⁹²) into the pituitary gland has increased the effectiveness of this therapeutic method. As the application of heavy particles in the treatment of pituitary tumors has been carried out in only a small number of patients in USA and Sweden no conclusions can be drawn up to now with regard to the therapeutic value of this method.

In the field of postoperative substitution therapy of pituitary tumors advances have been made predominantly by using Tegretal and Diabetoral in the treatment of diabetes insipidus. The mechanism of action of these drugs awaits further elucidation.