It is the extremely important

It is the extremely important to diagnose this, though and very seldom meeting, a syndrome at its early stages as the hypersecretion and hyperplastic changes in a pituitary body manage to be taken out by means of corresponding therapy, i.e. A thyroxine or sexual steroids. After adenoma development to make there is it it is already impossible, and there can be a necessity for a surgical oncotomy. The syndrome of a family hypopituitarism at ultracet which secretion of a hormone of growth decreases, and, probably is recently described, Gonadotropinums and the augmentation of the sizes of a Turkish saddle [142] is observed. The reason of such augmentation of a saddle without its deformation is unknown, and possibility of development of a tumour is not excluded, as in the described cases of a surgical intervention was not made. TREATMENT To treat patients with nonfunctioning tumours of a pituitary body it is necessary for prevention or restriction of loss of function of a pituitary body and consequences diffusions of these tumours on nearby structures TSNS, for example on an optic chiasm and a hypothalamus. Alternative approaches are operation and an irradiation. Surgical intervention Operations on a pituitary body which as safe and effective actions has developed , serve as a reliable method of treatment of tumours of this organ.
The transface-to-face access usually applied till last decade, remains a choice method at tumours, the cranyopharyngiomas arising out of a Turkish saddle, and primary tumours with appreciable diffusion, especially when they separate from tumours a narrow isthmus. The tumours surrounding an optic nerve, can be removed only at face-to-face access. After working out of ways of treatment by massive doses of glucocorticoids the postoperative mortality earlier bound to manipulations in the field of a hypothalamus, has ceased to be a problem. On modern data, the mortality at transface-to-face operations fluctuates from 1,2 [143] to 10 [144] depending on character of the picked up cases. Necessity of the best access to a forward and bottom part of a pituitary body in which small functioning tumours often settle down, has forced Guiot [145], and then Hardy [146] to return to a transsphenoidal microsurgical method. This method in the beginning developed , has been left because of the complications consisting in efflux from a nose and constantly developing meningitis, resulting in an era to mors of the patient. During colchicine present time transsphenoidal access to a combination with and a microsurgical method is applied in the increasing percent of cases at any tumours of a pituitary body, and the mortality varies from 3 (maximum) almost to zero [146, 147]. it is possible to delete tumours with moderated diffusion and even tumours which demand face-to-face access, often leave double-stagely: after excision parts delete a tumour part. Such approach is especially shown when the intracranial way is interfaced to excessively high risk that it is possible to observe at elderly, almost gone blind because of a long prelum , patients and at patients at whom the tumour extends in a sinus of the basic bone. Contraindications to the transsphenoidal approach are the insufficient pneumatization of a sinus of the basic bone and anatomic anomalies at which the carotid siphon is displaced to an average line. Endocrinologic inspection of patients before operation helps to define volume of a forthcoming surgical resection. If function of peripheric glands at the patient is not broken, a little more conservative operation is shown to keep the rests pituitary body tissues. However if before operation the hypopituitarism there are no reasons to worry concerning conservation of a contained Turkish saddle is established. In practice for maintenance of function of a pituitary body often there is sufficient a narrow stria tissues on edge of a Turkish saddle. Neurosurgeons variously estimate necessity researches before operation. The majority of them consider necessary to make an arteriography and-or a pneumoencephalography for finding-out of anatomy of a surrounding tissue and its potential damage by a tumour whereas some researchers believe, that the sufficient information can be received by means of Kt-scanning. It is expected, that with accumulation of experience frequency of application of invasive methods of preoperative research, at least at tumours of some types, it will be possible to lower. As excision of larger volume of a normal tissue of a pituitary body can be demanded, than it was supposed before operation, it is expedient to spend the operational period under "cover" of steroids even at patients with intact gipofizarno-adrenal system.