Long-term follow-up of hypothalamic-pituitary function in patients with transsphenoidal pituitary herniation and midfacial anomalies.

OBJECTIVE: We wished to determine whether patients with transsphenoidal pituitary herniation were at risk of developing pituitary failure. DESIGN: We followed up hypothalamic-pituitary function annually in patients with midfacial anomalies and pituitary herniation. PATIENTS: Two patients who had transsphenoidal pituitary herniation and midfacial anomalies were included and the literature was reviewed. RESULTS: Both patients became gonadotrophin, TSH and growth hormone-deficient despite neurosurgical repair. CONCLUSION: We conclude that the early diagnosis and neurosurgical repair of transsphenoidal pituitary herniation may prevent central nervous system infection and rhinorrhoea. Surgical repair may not prevent pituitary failure as was evident in both of our cases. Periodic evaluation of the hypothalamic-pituitary axis is essential to determine whether early hormonal replacement therapy is necessary.