General Surgery

Answer 6 Transphenoidal resection of pituitary adenoma. This patient has Cushing’s syndrome as evidenced by the decreased levels of cortisol on the high-dose dexamethasone test and the presence of a pituitary mass. Because the dysfunction can be attributed to the overproduction of adrenocorticotropin hormone and not to the adrenal glands themselves, adrenalectomy is not an appropriate management strategy. High-dose steroids are used for the diagnosis of a pituitary adenoma; however, steroids are not used to treat them. Pituitary adenomas are typically benign, and therefore chemotherapy is not an appropriate management option. Transphenoidal resection is the treatment of choice for pituitary adenomas. SUGGESTED READINGS 1. Cameron JL, editor. Current surgical therapy. 8th ed. Philadelphia: Elsevier Mosby; 2004. 2. Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston textbook of surgery: the biological basis of modern surgical practice. 17th ed. Philadelphia: Saunders; 2004. Click here to return to the questions

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