Utilidad de la Hipofisectomía en el alivio del dolor maligno
Resumen
En el cáncer avanzado con múltiples metástasis se produce un dolor sordo, difuso y constante que puede llegar a convertirse en el síntoma más prominente de un 60 a 80o/o de pacientes, agravando el deterioro fisiológico y psicológico producido por la misma enfermedad. Este dolor difícil de tratar puede ser aliviado por la hipofisectomía, que ofrece además la posibilidad de provocar una regresión tumoral en algunos casos. La hipofisectomía transcraneal para el tratamiento del cáncer empezó con Huggins y Bergensal (10), como una lógica extensión de la manipulación hormonal del cáncer de mama y próstata, que se realizaba por gonadectomía y/o adrenalectomía (14), considerándose que así' se suprimiría la fuente de hormonas tróficas que mantenían la actividad metabólica del tumor (34). Pronto se reconoció que se obtenía un alivio del dolor más consistente que la pretendida regresión tumoral, por lo que quedó la acción antiálgica como la indicación más importante de este tratamiento. En años recientes se han desarrollado métodos más seguros y menos cruentos de hipofisectomía lo que ha determinado que sea mayor el número de pacientes que reciban sus beneficios, en especial aquellos con riesgos quirúrgicos elevados o muy debilitados. Por el interés que ofrece la hipofisectomía en el alivio del dolor y en la regresión tumoral consideramos conveniente revisar el tema, así como los posibles mecanismos que puedan explicar estas acciones. (Revista de la Facultad de Ciencias Médicas (Quito), 12: 107, 1987).
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10. Huggins, C., and Bergenstal, D.M.: inhibition of human mammary and prostatic cancers by Adrenalectomy. Cáncer Res. 12. 134, 1952.
11. Jacobi, G.H., Altwein, J.E., Hohenfellner, R.: Adjunct bromocriptine treatment as palliation for prostate cáncer. Scand. J. Urol. Nephrol. (suppl.) 55: 107,1980.
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13. Kenan, P.D.: Accesos quirúrgicos para tumores hipofisarios. Clínicas Obstétricas y Ginecológicas de N.A. pp. 413—423 Interamericana. México, 1980.
14. Kennedy, BJ.: Hormonal therapy of mammary carcinoma. In: The treatment o f Cáncer and allied Diseases. Yol. 4. The Breast, Chest and Esophagus. Edited by G.T. Pack, and I.M. Ariel, Harper N.Y. 1960.
15. Landolt, Á.M., Siegfried, J.: Zur Behandlung maligner metastsierender tumoren mit ter transsphenoidalen Electrocoagulation der Hypophyse. Schweiz Med. Wochenschr. 30:1297, 1970.
16. La Rossa, J.T., Strong,M.S., and Mdby, J.C.: Endocrinologically incomplete, transecthmoidal, transphenoidal hypophysectomy with relief of bone pain in breast cáncer. N. Eng. J. Med. 298:1332,1978.
17. Levin, A.B., Katz, J., Benson, R.C., and Jones, A.G.: Treatment of Pain of diffuse metastatic cáncer by stereotactic chemical hypophysectomy. Long term results and observations of mechanism of action. Neurosurgery 6: 258, 1980.
18. Levin, A.B., Ramírez, L.P., and Katz, J.: The use of sterotaxic chemical hypophysectomy in the treatment of thalamic pain syndrome. J. Neurosurg. 59: 1003,1983.
19. Levin, A.B., Ramírez, L.: Treatment of Cáncer Pain with Hypophysectomy. In. Advances in Pain Research and Therapy. Vol. 7. Edited by C. Benedetti, C. Chapman, and G. Morricca, Raven Press, pp. 631—645. N.Y. 1984.
20. Lipton, S.: Relief of Pain in Clinical Practice. Blackwell Scientific Publications. Oxford, pp. 178-220.1979.
21. Luft, R., and Olivecrona, H.: Experiences with hypophysectomy in man. / . Neurosurg. 10:301, 1953.
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26. Moricca. G.: Neuroádenolysis in the treatment of intractable pain from cáncer. In Persistent Pain, edited by S. Lipton. Gruñe and Stratton. N.Y. pp. 149-173.1977.
27. Moricca. G., Arcuri, E. and Moricca, P.: Neuroadenolysis. In: The Continúing Care o f Terminal Cáncer Pátients, edited by R.G. Twycross and Ventafridda. Pergamon. Oxford, pp. 155—163,1979.
28. Ramírez, L., Levin, A.: Pain Relief after hypophysectomy. Neurosurgery. 14:94, 1984.
29. Rand, R.W., Dashe, AJVI., Paglia, D.E., Conway, L. W. and Salomon, D.E.: Stereotatic Cryohypophysectomy. JAMA. 189:255,1964.
30. Siegfried, J., Kühner, A., Sturm, V.: Neurosurgical treatment cáncer pain. In Pain in the Cáncer Patient.. Springer Verlag. Berlín, pp. 148— 156,1984.
31. Sofroniew, M.V.: Proyections from vasopressin, oxytocin, and neurophysin neurons to neural targets in the at and human. J. Histochem. Cytochem, 28:475,1980.
32. Takeda, F. Uki, J., Fujii, T., Sitani, Y., and Fujita, T.: Pituitary neuroadenolysis to Relief Cáncer Pain: Observations óf spread of Ethanol instilled into the sella turcica and subsequent changes of the Hypothalamopituitary Axis at Autopsy. Neurol. Med. Chir. ( Tokyo). 23: 50, 1983.
33. Tindall, G.T., Ambrose, S. J., Christy, J.H. and Patton, J.M.: Hypophysectomy in the treatment of disseminated carcinoma of the Breast and postata ghuuL South Med. J. 69:579, 1976.
34. West, C.R., Avelanósa, A.M.,Bremer, A. and Yantada. K.: Hypophysectomy for relief of Pain of Disseminated Carcinoma of the prostate. In Advances in Pain Research and Therapy Vol. 2. Edited by J.J. Bonica and V. Ventafridda. Raven Press. N.Y. pp. 393—400,1979.
35. Yanagida, H., Corssen, G., Troubrst, A., Erdmann, N.: Relief of cáncer Pain in Man: alcohol induced Neuroadenolysis, vs. électrical stimulation of the Pituitary gland. Pain. 19:133, 1984.
2. Deshpande, N.: Hormones and Pain: Clinical Management of Pain in Disorders of the Breast. In Advances in Pain Research and Therapy. Vol. 7. Edited by C. Benedetti, C. Chapman and G. Moricca. pp. 593—601. Raven Press. N. York. 1984.
3. Daniel, P.M., and Prichard, M.M.L.: The Human hypothalamus and pituitary stalk after hypophisectomy or pituitary stalk section. Brain. 95:813,1972.
4. De Wied, DHormonal influences on motivation, learning and memory processes. Iíosp. Pract. 11(1): 123,1976.
5. Frante, A.G.: Prolactin Pysiol. Med. 298: 201 1978.
6. Gianasi, G.: Neuroadenolysis of the pituitary of Moricca: an overview of development, mechanisms, technique, and results. In Advances in Pain Reseach and Therapy Vol. 7. Edited by C. Benedetti, C. Chapman and G. Moricca. pp.647—678. Raven Press. N. Y. 1984.
7. Gros, C., Frerebeau, P. Privat, J.M. Benezech, J.: Place of Hypophysectomy in the neurosurgical treatment of pain. Adv. Neusurg. 3: 164,1975.
8. Hardy, J.: Le traitment du cáncer du sein metastasique par l’hypophysectomy. In The neurosurgical treatment of pain. Adv. Neurosurg. 3: 264, 1975.
9. Harvey, H.A., Santean,RJ., Ostdman, J., Samojlik, E., White, S., Lipton, A.: Comparative trial of transphenoidal Hypophysectomy and astrogen with aminogluthetemide in Cáncer. Cáncer 43: 2207,1979.
10. Huggins, C., and Bergenstal, D.M.: inhibition of human mammary and prostatic cancers by Adrenalectomy. Cáncer Res. 12. 134, 1952.
11. Jacobi, G.H., Altwein, J.E., Hohenfellner, R.: Adjunct bromocriptine treatment as palliation for prostate cáncer. Scand. J. Urol. Nephrol. (suppl.) 55: 107,1980.
12. Katz, J. and Levin, A.B.: Treatment of diffuse metastatic cáncer pain by instilation of alcohol into the sella turcica. Anesthesiology, 46: 115, 1977.
13. Kenan, P.D.: Accesos quirúrgicos para tumores hipofisarios. Clínicas Obstétricas y Ginecológicas de N.A. pp. 413—423 Interamericana. México, 1980.
14. Kennedy, BJ.: Hormonal therapy of mammary carcinoma. In: The treatment o f Cáncer and allied Diseases. Yol. 4. The Breast, Chest and Esophagus. Edited by G.T. Pack, and I.M. Ariel, Harper N.Y. 1960.
15. Landolt, Á.M., Siegfried, J.: Zur Behandlung maligner metastsierender tumoren mit ter transsphenoidalen Electrocoagulation der Hypophyse. Schweiz Med. Wochenschr. 30:1297, 1970.
16. La Rossa, J.T., Strong,M.S., and Mdby, J.C.: Endocrinologically incomplete, transecthmoidal, transphenoidal hypophysectomy with relief of bone pain in breast cáncer. N. Eng. J. Med. 298:1332,1978.
17. Levin, A.B., Katz, J., Benson, R.C., and Jones, A.G.: Treatment of Pain of diffuse metastatic cáncer by stereotactic chemical hypophysectomy. Long term results and observations of mechanism of action. Neurosurgery 6: 258, 1980.
18. Levin, A.B., Ramírez, L.P., and Katz, J.: The use of sterotaxic chemical hypophysectomy in the treatment of thalamic pain syndrome. J. Neurosurg. 59: 1003,1983.
19. Levin, A.B., Ramírez, L.: Treatment of Cáncer Pain with Hypophysectomy. In. Advances in Pain Research and Therapy. Vol. 7. Edited by C. Benedetti, C. Chapman, and G. Morricca, Raven Press, pp. 631—645. N.Y. 1984.
20. Lipton, S.: Relief of Pain in Clinical Practice. Blackwell Scientific Publications. Oxford, pp. 178-220.1979.
21. Luft, R., and Olivecrona, H.: Experiences with hypophysectomy in man. / . Neurosurg. 10:301, 1953.
22. Madrid, J.L.: Chemical hypophysectomy. In A d vances in Pain Research and Therapy Vol. 2. Edited by J.J. Bonica and V. Ventafridda. Raven Press. N.Y. pp. 381—391,1979.
23. Miles, J.: Checmical Hypophysectomy. In Adv. in Pain Research and Therapy. Vol. 2. Edited by J.J. Bonica and V. Ventafridda. Raven Press. N.York, pp. 373-380,1979.
24. Milton, J.P.: Precise selection of breast cáncer patients with bone metástasis for endocrine ablation. Surgery. 80:523,1976.
25. Moricca, G.: Neuroádenolysis fór diffuse unbearable^^ cancer Pain. ]n Advances inRain Reseach and Therapy. Vol. 1. Edited by J.J. Bonica and D. Albe Fessard. Raven Press. N.T. pp. 863— 866.1976.
26. Moricca. G.: Neuroádenolysis in the treatment of intractable pain from cáncer. In Persistent Pain, edited by S. Lipton. Gruñe and Stratton. N.Y. pp. 149-173.1977.
27. Moricca. G., Arcuri, E. and Moricca, P.: Neuroadenolysis. In: The Continúing Care o f Terminal Cáncer Pátients, edited by R.G. Twycross and Ventafridda. Pergamon. Oxford, pp. 155—163,1979.
28. Ramírez, L., Levin, A.: Pain Relief after hypophysectomy. Neurosurgery. 14:94, 1984.
29. Rand, R.W., Dashe, AJVI., Paglia, D.E., Conway, L. W. and Salomon, D.E.: Stereotatic Cryohypophysectomy. JAMA. 189:255,1964.
30. Siegfried, J., Kühner, A., Sturm, V.: Neurosurgical treatment cáncer pain. In Pain in the Cáncer Patient.. Springer Verlag. Berlín, pp. 148— 156,1984.
31. Sofroniew, M.V.: Proyections from vasopressin, oxytocin, and neurophysin neurons to neural targets in the at and human. J. Histochem. Cytochem, 28:475,1980.
32. Takeda, F. Uki, J., Fujii, T., Sitani, Y., and Fujita, T.: Pituitary neuroadenolysis to Relief Cáncer Pain: Observations óf spread of Ethanol instilled into the sella turcica and subsequent changes of the Hypothalamopituitary Axis at Autopsy. Neurol. Med. Chir. ( Tokyo). 23: 50, 1983.
33. Tindall, G.T., Ambrose, S. J., Christy, J.H. and Patton, J.M.: Hypophysectomy in the treatment of disseminated carcinoma of the Breast and postata ghuuL South Med. J. 69:579, 1976.
34. West, C.R., Avelanósa, A.M.,Bremer, A. and Yantada. K.: Hypophysectomy for relief of Pain of Disseminated Carcinoma of the prostate. In Advances in Pain Research and Therapy Vol. 2. Edited by J.J. Bonica and V. Ventafridda. Raven Press. N.Y. pp. 393—400,1979.
35. Yanagida, H., Corssen, G., Troubrst, A., Erdmann, N.: Relief of cáncer Pain in Man: alcohol induced Neuroadenolysis, vs. électrical stimulation of the Pituitary gland. Pain. 19:133, 1984.
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Astudillo A. W, Mendinueta A. MDC, Astudillo A. E. Utilidad de la Hipofisectomía en el alivio del dolor maligno. Rev Fac Cien Med (Quito) [Internet]. 16 de junio de 2017 [citado 15 de noviembre de 2024];12(3-4):107-1. Disponible en: https://revistadigital.uce.edu.ec/index.php/CIENCIAS_MEDICAS/article/view/609
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