Efficacy of transsphenoidal hypophysectomy in treatment of dogs with pituitary-dependent hyperadrenocorticism.
The long-term survival, disease-free fractions, and the complications of hypophysectomy in 150 dogs with pituitary-dependent hyperadrenocorticism (PDH) were examined in a prospective study. Long-term survival and disease-free fractions in relation to pituitary size were analyzed by the Kaplan-Meijer estimate procedure. The 1-, 2-, 3-, and 4-year estimated survival rates were 84% (95% confidence interval [CI], 76-89%), 76% (67-83%), 72% (62-79%), and 68% (55-77%), respectively. Treatment failures included procedure-related mortalities (12 dogs) and incomplete hypophysectomies (9 dogs). The 1-, 2-, 3-, and 4-year estimated relapse-free fractions were 88% (CI: 80-93%), 75% (64-83%), 66% (54-76%), and 58% (45-70%), respectively. Postoperative reduction of tear production (58 eyes in 47 dogs) was often reversible but remained low until death in 11 eyes of 10 dogs. Central diabetes insipidus (CDI) occurred more frequently (62%) in dogs with enlarged pituitaries than in dogs with nonenlarged pituitaries (44%). Survival and disease-free fractions after hypophysectomy were markedly higher in dogs with nonenlarged pituitaries than in dogs with enlarged pituitaries. Transsphenoidal hypophysectomy is an effective treatment for PDH in dogs. The survival and disease-free fractions after hypophysectomy decrease and the incidence of CDI increases with increasing pituitary size. Therefore, early diagnosis of PDH is important and transsphenoidal hypophysectomy is expected to have the best outcome when used as primary treatment for dogs with nonenlarged or moderately enlarged pituitaries.
Hanson
Jeanette M
JM
Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
van 't
Hoofd Martine M
HM
Voorhout
George
G
Teske
Erik
E
Kooistra
Hans S
HS
Meij
Björn P
BP
D000308:Adrenocortical Hyperfunction / Q000401:mortality / Q000601:surgery / Q000662:veterinary*; D000818:Animals; D020790:Diabetes Insipidus, Neurogenic / Q000453:epidemiology / Q000662:veterinary; D018572:Disease-Free Survival; D004283:Dog Diseases / Q000401:mortality / Q000601:surgery*; D004285:Dogs; D005260:Female; D007016:Hypophysectomy / Q000009:adverse effects / Q000379:methods / Q000662:veterinary*; D008297:Male; D010902:Pituitary Gland / Q000000981:diagnostic imaging / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000662:veterinary; D011446:Prospective Studies; D011859:Radiography; D012074:Remission Induction; D016019:Survival Analysis; D013666:Tears / Q000187:drug effects / Q000378:metabolism; D016896:Treatment Outcome