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W Selman

Publications and source records attributed to W Selman.

9 recordsLinked to original sources
PubMed1988

Evaluation of the hypothalamic-pituitary-adrenal axis immediately after pituitary adenomectomy: is perioperative steroid therapy necessary?

Patients undergoing pituitary adenomectomy are usually given glucocorticoid therapy, although there are no data to document the need for such therapy. We prospectively studied hypothalamic-pituitary-adrenal axis (HPA) function in 88 consecutive pituitary adenoma patients before and after selective adenomectomy, excluding those with corticotroph adenomas. Preoperatively, 5 patients had adrenal insufficiency (AI); they were treated with glucocorticoids and excluded from the analysis. The remaining 83 patients had normal HPA function preoperatively and were not given glucocorticoids before, during, or immediately after surgery, but were closely monitored, and their serum cortisol levels were measured in the immediate postoperative period. Two patients were clinically suspected to have AI postoperatively and were treated accordingly. The remaining 81 patients had no clinical manifestations of AI and received no glucocorticoid therapy. Their serum cortisol levels in the immediate postoperative period were appropriately elevated. The mean serum cortisol level was 40.5 +/- 11.1 (+/- SD) micrograms/dL (1117 +/- 306 nmol/L) 6 h after surgery; serum cortisol levels decreased gradually thereafter. Morning serum cortisol levels were within the normal range on the fourth, fifth, and sixth days after surgery: day 4, 15.1 +/- 7.0 micrograms/dL (417 +/- 193 nmol/L); day 5, 16.4 +/- 5.6 micrograms/dL (453 +/- 155 nmol/L); and day 6, 16.3 +/- 5.7 micrograms/dL (450 +/- 157 nmol/L). When tested 3 months after surgery, all 81 patients had normal HPA function. We conclude that HPA function is rarely compromised after selective pituitary adenomectomy. Close observation and serum cortisol measurements in the immediate postoperative period can reliably predict the integrity of the HPA after surgery. Routine glucocorticoid therapy is not needed in patients undergoing selective adenomectomy whose preoperative adrenal function is normal.

Adenoma↗
PubMed1987

Value of growth hormone dynamics and somatomedin C (insulin-like growth factor I) levels in predicting the long-term benefit after transsphenoidal surgery for acromegaly.

Transsphenoidal microsurgery has been shown to be effective in the management of human growth hormone (hGH)-secreting pituitary adenomas. We have previously demonstrated the usefulness of hGH dynamic testing (oral glucose tolerance, insulin hypoglycemia, and thyrotropin-releasing hormone stimulation test) in evaluating the completeness of removal of the adenomas. In patients with acromegaly, serum insulin-like growth factor I (IGF-I) levels are known to correlate with the activity of the disease. We studied the dynamics of hGH secretion in 43 patients with hGH-secreting adenomas 2 to 3 months after surgery. In addition, serum IGF-I levels were recently measured in frozen sera obtained from these patients at the time of dynamic testing. Of the 43 patients undergoing surgery, 19 had normal basal hGH levels as well as dynamics (group I). Two additional patients had low or undetectable hGH levels and were hypopituitary (group II). These 21 patients were considered cured and had no evidence for recurrence of their disease during a mean follow-up period of 97 months. Serum IGF-I levels were normal in 19 (group I) and low in the remaining two patients (group II). Nine additional patients had normal basal hGH levels but abnormal dynamics of secretion (group III). Serum IGF-I levels were normal postoperatively in seven of eight patients tested in this group. During the follow-up period in these nine patients (group III), biochemical and clinical recurrence of acromegaly developed in five. The remaining 13 patients had persistent elevation of basal hGH levels, and all samples tested (n = 8) had elevated IGF-I levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromegaly↗
PubMedDate not supplied

Elective EC-IC bypass for unclippable intracranial aneurysms.

Ligation of the carotid artery in the neck has become part of the surgical armamentarium for treating inaccessible or technically difficult intracranial aneurysms. Obliteration of an aneurysm by sacrificing the parent vessel has also been employed for the treatment of unclippable posterior circulation and middle cerebral artery aneurysms. Because parent vessel occlusion is not well tolerated by all individuals, the use of an extracranial-intracranial bypass has been advocated in order to improve the safety of this procedure. The purpose of this report is to detail our methods and results with the use of extracranial-intracranial bypass for the treatment of giant internal carotid and middle cerebral artery aneurysms in 35 patients and review the literature to determine the status of the use of the bypass for other intracranial aneurysms.

Adult↗