A hypophysectomy is a surgery done to remove the pituitary gland.
The pituitary gland, also called the hypophysis, is a tiny gland nestled beneath the front of your brain. It controls the hormones produced in other important glands, including the adrenal and thyroid glands.
Hypophysectomy is done for a number of reasons, including:
- removal of tumors around the pituitary gland
- removal of craniopharyngiomas, tumors made of tissue from around the gland
- treatment of Cushing’s syndrome, which happens when your body is exposed to too much of the hormone cortisol
- improving vision by removing extra tissue or masses from around the gland
Only part of the gland may be removed when tumors are removed.
There are several types of hypophysectomy:
- Transsphenoidal hypophysectomy: The pituitary gland is taken out through your nose via the sphenoid sinus, a cavity near the back of your nose. This is often done with the assistance of either a surgical microscope or an endoscopic camera.
- Open craniotomy: The pituitary gland is taken out by lifting it out from under the front of your brain through a small opening in your skull.
- Stereotactic Radiosurgery: Instruments on a surgical helmet are placed inside the skull through tiny openings. The pituitary gland and surrounding tumors or tissues are then destroyed, using radiation to remove specific tissues while preserving the healthy tissue around them. This procedure is mainly used on smaller tumors.
Before the procedure, make sure you’re ready by doing the following:
- Take a few days off work or other normal activities.
- Have someone take you home when you’ve recovered from the procedure.
- Schedule imaging tests with your doctor so that they can get to know the tissues around your pituitary gland.
- Talk to your surgeon about what type of hypophysectomy will work best for you.
- Sign a consent form so that you know all the risks involved in the procedure.
When you get to the hospital, you’ll be admitted into the hospital and asked to change into a hospital gown. Your doctor will then take you to the operating room and give you general anesthesia to keep you asleep during the procedure.
A hypophysectomy procedure depends on the type that you and your surgeon agree upon.
To do a transsphenoidal hypophysectomy, the most common type, your surgeon:
- puts you in a semi-reclining position with your head stabilized so it cannot move
- makes several small cuts under your upper lip and through the front of your sinus cavity
- inserts a speculum to keep your nasal cavity open
- inserts an endoscope to view projected images of your nasal cavity on a screen
- inserts special tools, such as a type of forceps called pituitary rongeurs, to remove the tumor and part or all of the pituitary gland
- uses fat, bone, cartilage, and some surgical materials to reconstruct the area where the tumor and gland were removed
- inserts gauze treated with an antibacterial ointment into the nose to prevent bleeding and infections
- stitches the cuts in the sinus cavity and on the upper lip with sutures
A hypophysectomy takes one to two hours. Some procedures, like stereotaxis, may take 30 minutes or less.
You’ll spend about 2 hours recovering in the post-operative care unit in the hospital. Then, you’ll be taken to a hospital room and rest overnight with an intravenous (IV) fluid line to keep you hydrated while you recover.
While you recover:
- For one to two days, you’ll walk around with the help of a nurse until you’re able to walk on your own again. The amount that you pee will be monitored.
- For the first few days after surgery, you’ll undergo blood tests and vision tests to make sure your vision hasn’t been affected. Blood will likely drain from your nose periodically.
- After leaving the hospital, you’ll return in about six to eight weeks for a follow-up appointment. You’ll meet with your doctor and an endocrinologist to see how your body is responding to possible changes in hormone production. This appointment may include a head scan as well as blood and vision tests.
Until your doctor says it’s okay to do so, avoid doing the following:
- Don’t blow, clean, or stick anything in your nose.
- Don’t bend forward.
- Don’t lift anything heavier than 10 pounds.
- Don’t swim, take a bath, or put your head under water.
- Don’t drive or operate any large machines.
- Don’t return to work or your normal daily activities.
Some conditions that can result from this surgery include:
- Cerebrospinal fluid (CSF) leaks: CSF fluid around your brain and spine leak into your nervous system. This requires treatment with a procedure called a lumbar puncture, which involves inserting a needle into your spine to drain excess fluid.
- Hypopituitarism: Your body doesn’t produce hormones properly. This may need to be treated with hormone replacement therapy (HRT).
- Diabetes insipidus: Your body doesn’t properly control the amount of water in your body.
See your doctor right away if you notice any of the following complications after your procedure:
- frequent nosebleeds
- extreme feelings of thirst
- loss of vision
- clear liquid draining from your nose
- salty taste in the back of your mouth
- peeing more than normal
- headaches that don’t go away with pain medications
- high fever (101° or higher)
- feeling constantly sleepy or exhausted after surgery
- throwing up frequently or having diarrhea
Getting your pituitary gland removed is a major procedure that can affect your body’s ability to produce hormones.
But this surgery can help treat health issues that can otherwise have severe complications.
Plenty of treatments are also available to replace the hormones that your body may not produce enough of anymore.