In recent years hypophysectomy (Luft and Olivecrona, 1953) and adrenalectomy (which is nearly always combined with ovariectomy) have been used as methods of treating cases of advanced cancer of the breast (Atkins, Falconer, Hayward, MacLean, and Schurr, 1966) and the results of comparative trials suggest that hypophysectomy is slightly the more effective of these two operations (Atkins, Falconer, Hayward, MacLean, Schurr, and Armitage, 1960). As an alternative to hypophysectomy neurosurgeons have sometimes used the operation of pituitary stalk section for relieving such cases and also for treating patients with cancer of the prostate (see Schurr, 1966). In addition pituitary stalk section has been used for patients with advancing diabetic retinopathy (Field, Schepens, Sweet, and Appels, 1962;Cullen, Harris, Munro, and Duncan, 1965;Fager, Rees, and Bradley, 1966). In assessing the merits of this particular operation as a means of depressing pituitary function, it is important to know the extent to which the structure of the gland is altered and its functions impaired. There are few reports in the literature on the effects of stalk section on the human pituitary (Dandy and Goetsch, 1911;Russell, 1956; Daniel, Prichard, and Schurr, 1958;Le Beau and Foncin, 1960;Nicolaidis, 1962; Adams, Daniel, Prichard, and Schurr, 1963), although much information has now been obtained on the effects of the operation on several species of animal (Harris, 1950;Barrnett and Greep, 1951;Greep and Barrnett, 1951;Benoit and Assenmacher, 1953;Campbell and Harris, 1957;Daniel and Prichard, 1958;Holmes, 1961Holmes, , 1962 Laszlo, David, and Kovics, 1962; Adams, Daniel, and Prichard, 1963a, b, c; 1964a, b, c; 1966a, b; Jacobsohn, 1966). We have now had the opportunity of examining the glands of 21 human patients surviving for various periods of time after stalk section and in this paper we report our findings in these pituitary glands.
MATERIAL AND METHODSThe pituitary glands from 21 patients were available for study. In 20 cases the operation was undertaken for the relief of carcinoma of the breast or prostate but in one (case 4 in Table I) the indication was a rapidly advancing diabetic retinopathy. Fourteen of the patients were females and seven were males. The age range was from 36 to 67 years. The pituitary stalk was approached by way of a frontal craniotomy, and in some cases the pituitary stalk was clipped before it was transected at as low a level as was technically possible. In the majority of cases an inert and impermeable barrier or 'plate' (composed usually of dental acrylic resin or tantalum) was placed between the cut ends of the stalk to prevent the re-establishment of the hypothalamo-hypophysial portal circulation.The period of survival after stalk section ranged from 30 hours to 11 months (see Table I). The necropsies on the majority of the cases were undertaken by P.M.D.or J.H.A. but in a few cases the pituitary glands were sent to us, and in these less detailed information is available. At necropsy care was taken to e...