Hypophysectomy, or hypophysis, is the surgical removal of the pituitary gland. Surgical methods using new technology have made other approaches possible. The pituitary gland is a small, oval-shaped endocrine gland about the size of a pea located in the center of the brain above the back of the nose. Its major role is to produce hormones that regulate growth and metabolism in the body. Removing this important gland is a drastic step that is usually taken in the case of cancers or tumors that resist other forms of treatment, especially craniopharyngioma tumors. Hypophysectomy may also be performed to treat Cushing's syndrome, a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol, in most cases associated with benign tumors called pituitary adenomas. The goal of the surgery is to remove the pituitary tumor and try to partially preserve the gland. Surgery is a common treatment for pituitary tumors. For patients in whom hypophysectomy has failed or who are not suitable candidates for surgery, radiotherapy is another possible treatment. Radiation therapy uses high-energy x rays to kill cancer cells and shrink tumors. Radiation to the pituitary gland is given over a six-week period, with improvement occurring in 40–50% of adults and up to 80% of children. It may take several months or years before patients feel better from radiation treatment alone. However, the combination of radiation and the drug mitotane (Lysodren) has been shown to help speed recovery. Mitotane suppresses cortisol production and lowers plasma and urine hormone levels. Treatment with mitotane alone can be successful in 30–40% of patients. Other drugs used alone or in combination to control the production of excess cortisol are aminoglutethimide, metyrapone, trilostane, and ketoconazole.
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