Herbert Olivecrona

Hypophysectomy in the treatment of malignant tumors

T HE effect of hypophysectomy on the course of certain malignant diseases, especially metastatic cancer of the breast, has been under study in our departments during the past several years. Preliminary results have already been summarized.i-3 In the present report the results obtained so far by us and by other groups are presented. Operative Technic. The technic used was described in detail in 1953.2 In brief, after exposure of the pituitary region by a frontotemporal approach the pituitary stalk is clipped and divided. The diaphragm of the sella is incised and the gland is then mobilized by blunt dissection and removed, usually in pieces, with rongeurs and spoons. After controlling hemorrhage the walls of the sella are cauterized with Zenker’s solution. During the past year sodium hydroxide also has been used as a cauterizing agent. Management of the Patients. The preoperative care of the patients has changed during these years, some patients have been operated upon without any substitution therapy at all. The schedule followed at present consists of the administration of cortisone? in two 100 mg. doses, one on the evening of the day before operation and the other in the morning of the day of operation. Postoperatively, cortisone is given in doses of 50 mg. every four hours during the first twenty-four hours, then in decreasing doses to the maintenance dose of 25 to 50 mg. per day on the eighth to fifteenth day. Administration of parenteral fluids and electrolytes is adjusted to individual needs during the first forty-eight hours. By the third day the patients are usually taking fluid and food by mouth. In the case of patients who have previously