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Sharifi G, Mohammadi E, Paraandavaji E, Tavangar SM, Dabbagh Ohadi MA, Jafari A, Jahanbakhshi A, Akbari Dilmaghani N, Davoudi Z, Smith TR, Banihashemi G, Azadi M, Hatami N, Zenonos GA, Mohajeri Tehrani M. Empty sella in somatotropic pituitary adenomas; a series of 23 cases. Front Surg 2024; 11:1350032. [PMID: 38500594 PMCID: PMC10944865 DOI: 10.3389/fsurg.2024.1350032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/08/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose We aimed to investigate empty sella syndrome in somatotrophic pituitary adenoma for possible etiology, complications, and treatment options. Method Among over 2,000 skull base masses that have been managed in our center since 2013, we searched for growth hormone-producing adenomas. Clinical, surgical, and imaging data were retrospectively collected from hospital records to check for sella that lacked pituitary tissue on routine imaging. Result In 220 somatotrophic adenomas, 23 patients had an empty sella with surgical and follow-up data. The mean age of the sample was 46 years with the same male-to-female ratio. Five cases had partial empty sella and the rest were complete empty sellas. The most common simultaneous hormonal disturbance was high prolactin levels. Six had adenoma invasion into the clivus or sphenoid sinus and 10 had cavernous sinus intrusion. Peri-operative low-flow and high-flow cerebrospinal fluid (CSF) leaks were encountered in one and two patients, respectively, which were successfully sealed by abdominal fat. The majority of cases required growth hormone replacement therapy while it was controlled without any replacement therapy in nine patients. No pituitary hormonal disturbance occurred after transsphenoidal surgery except for hypothyroidism in one patient. Conclusion An empty sella filled with fluid can be detected frequently in pituitary adenomas, especially in the setting of acromegaly. The pituitary gland may be pushed to the roof of the sella and might be visible as a narrow rim on imaging or may be detected in unusual places out of the sella. The pathophysiology behind such finding originates from soft and hard tissue changes and CSF pressure alternations during abundant growth hormone production.
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Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Loghman Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
- Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Paraandavaji
- Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Tavangar
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali Jafari
- Department of Neurosurgery, Loghman Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
- Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Jahanbakhshi
- Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Akbari Dilmaghani
- Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Davoudi
- Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Timothy R. Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Gelareh Banihashemi
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Azadi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Hatami
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Georgios A. Zenonos
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Mohammadreza Mohajeri Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Urhan E, Hacioglu A, Okcesiz I, Karaca Z, Kara CS, Unluhizarci K. The coexistence of newly diagnosed acromegaly with primary empty sella: More frequent than expected? Growth Horm IGF Res 2023; 68:101521. [PMID: 36427362 DOI: 10.1016/j.ghir.2022.101521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We investigated the coexistence of newly diagnosed acromegaly with primary empty sella (ES), which is considered to be a rare association, and the impact of ES on the laboratory, radiological and prognostic status of acromegaly. DESIGN Acromegaly patients diagnosed and followed-up between 2012 and 2021 were included. Empty sella was defined as the pituitary gland and adenoma filling <50% of the sella turcica on preoperative T1 magnetic resonance imaging (MRI). RESULTS 102 acromegalic patients (45 male, 57 female, 45.5 ± 12.8 (range: 20-70 years) were included and data of a median 3 years (range: 0.5-9 years) were presented. ES was detected in 19 (18.6%) patients and 4 had complete and 15 had partial ES. Although not significant, adenoma size and residual adenoma on MRI on postoperative 3rd month, and disease remission at last control were lower in acromegaly with ES than in acromegaly without ES, while the rate of female gender and remission on postoperative 3rd month were higher. While preoperative serum prolactin and nadir GH responses to OGTT were significantly lower in patients with ES, there was no difference in terms of other pituitary hormones among both groups. CONCLUSION The present study revealed the coexistence of newly diagnosed acromegaly with primary ES at a rate of nearly 20% which is more frequent than expected and this association is not rare. The presence of ES was not associated with any preoperative/postoperative pituitary hormone levels and remission status, except lower preoperative prolactin and nadir GH responses to OGTT.
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Affiliation(s)
- Emre Urhan
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey
| | - Aysa Hacioglu
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey
| | - Izzet Okcesiz
- Department of Radiology, Erciyes University Medical School, Kayseri, Turkey
| | - Zuleyha Karaca
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey
| | - Canan Sehit Kara
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey
| | - Kursad Unluhizarci
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey.
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Daya R, Seedat F, Purbhoo K, Bulbulia S, Bayat Z. Acromegaly with empty sella syndrome. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM210049. [PMID: 34253687 PMCID: PMC8284961 DOI: 10.1530/edm-21-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022] Open
Abstract
SUMMARY Acromegaly is a rare, chronic progressive disorder with characteristic clinical features caused by persistent hypersecretion of growth hormone (GH), mostly from a pituitary adenoma (95%). Occasionally, ectopic production of GH or growth hormone-releasing hormone (GHRH) with resultant GH hypersecretion may lead to acromegaly. Sometimes localizing the source of GH hypersecretion may prove difficult. Rarely, acromegaly has been found in patients with an empty sella (ES) secondary to prior pituitary radiation and/or surgery. However, acromegaly in patients with primary empty sella (PES) is exceeding rarely and has only been described in a few cases. We describe a 47-year-old male who presented with overt features of acromegaly (macroglossia, prognathism, increased hand and feet size). Biochemically, both the serum GH (21.6 μg/L) and insulin-like growth factor 1 (635 μg/L) were elevated. In addition, there was a paradoxical elevation of GH following a 75 g oral glucose load. Pituitary MRI demonstrated an ES. In order to exclude an ectopic source of GH hypersecretion, further biochemical tests and imaging were done, which were unremarkable. Notably, increased uptake in the sella turcica on the 68Gallium DOTATATE PET/CT confirmed the ES as the likely source of GH secretion. As no overt lesion was noted, medical treatment (octreotide acetate) was initiated with a good clinical and biochemical response. At his 3 month follow-up, he reported an improvement in symptoms (fatigue and headache), however he still complained of low libido. Due to a persistently low testosterone level at follow-up, a long-acting testosterone was initiated. His GH level normalised, and IGF-1 has significantly reduced. LEARNING POINTS The commonest cause of acromegaly is due to GH hypersecretion from pituitary adenomas (95%). Acromegaly has rarely been found in patients with ES. It is important to exclude a past history suggestive of pituitary apoplexy. Extra-pituitary source of GH such as ectopic production of GHRH with resultant GH hypersecretion needs to be excluded. In such cases, since there is no resectable mass, medical therapy is the primary treatment option.
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Affiliation(s)
- Reyna Daya
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Helen Joseph Hospital, Rossmore, Johannesburg, South Africa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Faheem Seedat
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Helen Joseph Hospital, Rossmore, Johannesburg, South Africa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Khushica Purbhoo
- Department of Nuclear Medicine and Molecular Imaging, Chris Hani Baragwanath Academic Hospital and Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Saajidah Bulbulia
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Helen Joseph Hospital, Rossmore, Johannesburg, South Africa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Zaheer Bayat
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Helen Joseph Hospital, Rossmore, Johannesburg, South Africa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Sharavii VB, Shnayder NA, Sharavii LK, Petrova MM, Nasyrova RF. Empty Sella Prevalence: Step By Step. RUSSIAN OPEN MEDICAL JOURNAL 2021. [DOI: 10.15275/rusomj.2021.0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
An empty sella (ES), also known as an empty sella turcica (empty pituitary fossa) is defined as an intrasellar herniation of subarachnoid space within the sella which leads to flattening of the pituitary gland towards the posteroinferior wall. Purpose — to analyze studies of ES prevalence in the world. Methods — We carried out a systematic search in both Russian and English databases (E-library, PubMed, GoogleScholar, OxfordPress, ClinicalKeys) using keywords “empty sella”, “empty sella turcica”, “empty pituitary fossa”, “prevalence” and their combinations. The period of search: 2000-2020. It is also worth noting that earlier publications of historical interest were included in the review. Results — We have analyzed 23 studies. They can be roughly devided into two groups: the first group – screening studies of ES, the second group – targeted studies of ES.
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Affiliation(s)
- Victoria B. Sharavii
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Natalya A. Shnayder
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint-Petersburg; V.F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Lada K. Sharavii
- Public healthcare institution of Republic of Tuva Republican children’s hospital, Kyzyl, Russia
| | - Marina M. Petrova
- V.F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Regina F. Nasyrova
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint-Petersburg, Russia; Kazan Federal University, Kazan, Russia
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Halloul I, Abdelkerim AB, Saad G, Slim A, Hasni Y, Othman WB, Kacem M, Chaieb M, Maaroufi A, Ach K. Association of an empty sella and grave´s disease in a patient with acromegaly: a case report. Pan Afr Med J 2021; 38:394. [PMID: 34381538 PMCID: PMC8325439 DOI: 10.11604/pamj.2021.38.394.25034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 11/11/2022] Open
Abstract
Acromegaly is, in most cases, caused by growth hormone secreting pituitary adenomas. Those patients often develop different pathologies of the thyroid gland, however, the occurrence of Grave´s disease is quite a rare situation. We report a case of a 64-year-old female patient who presented with signs of hyperthyroidism and imbalance of her diabetes mellitus. On physical examination, she had facial features of acromegaly. Biochemical testing confirmed the suspicion of acromegaly and Grave´s disease, with an elevated insulin-like growth factor-1 and a suppressed thyroid stimulation hormone (TSH) with positive TSH-receptor antibodies. A pituitary Magnetic Resonance Imaging (MRI) was performed, revealing a macro-adenoma and an empty sella. The patient successfully underwent a transsphenoidal surgery and obtained a remission of her hyperthyroidism under anti-thyroid drugs.
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Affiliation(s)
- Imen Halloul
- Endocrinology and Diabetes Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Asma Ben Abdelkerim
- Endocrinology and Diabetes Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Ghada Saad
- Endocrinology and Diabetes Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Ahlem Slim
- Endocrinology and Diabetes Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Yosra Hasni
- Endocrinology and Diabetes Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Wafa Ben Othman
- Endocrinology and Diabetes Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Maha Kacem
- Endocrinology and Diabetes Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Molka Chaieb
- Endocrinology and Diabetes Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Amel Maaroufi
- Endocrinology and Diabetes Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Koussay Ach
- Endocrinology and Diabetes Department, Farhat Hached University Hospital, Sousse, Tunisia
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de Pablos-Velasco P, Venegas EM, Álvarez Escolá C, Fajardo C, de Miguel P, González N, Bernabéu I, Valdés N, Paja M, Díez JJ, Biagetti B. Diagnosis, treatment and follow-up of patients with acromegaly in a clinical practice setting in Spain: the ACROPRAXIS program Delphi survey. Pituitary 2020; 23:129-139. [PMID: 31823249 PMCID: PMC7066268 DOI: 10.1007/s11102-019-01012-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The ACROPRAXIS program aims to describe the management of acromegaly in Spain and provide guidance. METHODS Ninety-three endocrinologists were organized into 13 panels to discuss the practical issues in managing acromegaly. Based on the key learnings, an online Delphi survey with 62 statements was performed, so those statements achieving consensus could be used as guidance. Statements were rated on a 9-point scale (9, full agreement; consensus > 66.6% of response in the same tertile). RESULTS Ninety-two endocrinologists (98.8%) answered two rounds of the survey (mean age 47.6 years; 59.8% women; median 18.5 years of experience). Consensus was achieved for 49 (79%) statements. DIAGNOSIS The levels of insulin-like growth factor I (IGFI) is the preferred screening test. If IGFI levels 1-1.3 ULN, the test is repeated and growth hormone (GH) after oral glucose tolerance test (OGTT) is assessed. A pituitary magnetic resonance is performed after biochemical diagnosis. TREATMENT Surgery is the first treatment choice for patients with microadenoma or macroadenoma with/without optical pathway compression. Pre-surgical somatostatin analogues (SSA) are indicated when surgery is delayed and/or to reduce anaesthesia-associated risks. After unsuccessful surgery, reintervention is performed if the residual tumor is resectable, while if non-resectable, SSA are administered. Follow-up First biochemical and clinical controls are performed 1-3 months after surgery. Disease remission is considered if random GH levels are < 1 µg/L or OGTT is < 1 or ≤ 0.4 µg/L, depending on the assay's sensitivity. CONCLUSION Current clinical management for acromegaly is homogeneous across Spain and generally follows clinical guidelines.
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Affiliation(s)
- Pedro de Pablos-Velasco
- Endocrinology Service, Hospital Universitario de Gran Canaria Dr. Negrín, C/Barranco de la Ballena, s/n, 35010, Las Palmas de Gran Canaria, Spain.
| | - Eva María Venegas
- Endocrinology Service, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Carmen Fajardo
- Endocrinology Service, Hospital Universitario de La Ribera, Valencia, Spain
| | - Paz de Miguel
- Endocrinology Service, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Natividad González
- Endocrinology Service, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Ignacio Bernabéu
- Endocrinology Service, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Nuria Valdés
- Endocrinology Service, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Miguel Paja
- Endocrinology Service, Hospital Universitario de Basurto, Bilbao, Spain
| | - Juan José Díez
- Endocrinology Service, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Betina Biagetti
- Endocrinology Service, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
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Bier G, Hempel JM, Grimm F, Ernemann U, Bender B, Honegger J. Quantification of specific growth patterns and frequency of the empty sella phenomenon in growth hormone-secreting pituitary adenomas. Eur J Radiol 2018; 104:79-86. [PMID: 29857870 DOI: 10.1016/j.ejrad.2018.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/22/2018] [Accepted: 05/07/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess and quantify the prevalence and co-occurence of a sellar floor lowering and empty sella phenomenon in patients with GH (growth hormone)-secreting pituitary adenoma. METHODS A total number of 159 acromegalic patients were included in this study, as well as two control groups (150 patients with non-GH-secreting adenomas and 50 patients without pituitary adenomas). Magnetic resonance images of all patients were evaluated for presence of an empty sella, downward and lateral tumor extension, and maximum superoinferior diameter of the mass. Additionally, these values were correlated with growth hormone and IGF-1 levels. RESULTS The empty sella phenomenon was detected significantly more often in patients with a GH-secreting adenoma with a prevalence of 22% vs. 5.3% in non-GH-secreting adenomas (p < 0.001) or 8% in the healthy control group (p = .036). Moreover, GH-secreting adenomas presented with a significant rate of downward tumor extension (74.8% vs. 35.5%; p < 0.001), whose extent correlated inversely but weakly with the GH hormone level (r = - 0.17; p = .036). It was also found that a decreased superoinferior diameter and higher ratio of intrasellar to suprasellar extension are predictive quantitative values for the presence of a GH-secreting adenoma (area under curve, 0.712). CONCLUSIONS GH-secreting pituitary adenomas are frequently associated with an empty sella phenomenon. Moreover, GH-secreting adenomas are frequently accompanied by an enhanced, quantitatively measurable impression of the sellar floor. Hypothetically, this is caused by tumor-induced local bone remodeling processes.
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Affiliation(s)
- Georg Bier
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, D-72076 Tuebingen, Germany.
| | - Johann-Martin Hempel
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, D-72076 Tuebingen, Germany
| | - Florian Grimm
- Department of Neurosurgery, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, D-72076 Tuebingen, Germany
| | - Ulrike Ernemann
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, D-72076 Tuebingen, Germany
| | - Benjamin Bender
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, D-72076 Tuebingen, Germany
| | - Juergen Honegger
- Department of Neurosurgery, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, D-72076 Tuebingen, Germany
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8
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Wang Q, Guo X, Gao L, Wang Z, Deng K, Lian W, Wang R, Zhu H, Xing B. Surgical Outcome of Growth Hormone–Secreting Pituitary Adenoma with Empty Sella Using a New Classification. World Neurosurg 2017. [DOI: 10.1016/j.wneu.2017.06.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sasagawa Y, Hayashi Y, Tachibana O, Oishi M, Fukui I, Iizuka H, Nakada M. Clinical characteristics of acromegalic patients with empty sella and their outcomes following transsphenoidal surgery. Pituitary 2017; 20:403-408. [PMID: 28233140 DOI: 10.1007/s11102-017-0798-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyze the clinical characteristics of acromegalic patients with empty sella (ES, herniation of the subarachnoid space within the sella turcica) and the impact of ES on transsphenoidal surgery in such patients. METHODS Seventy-eight patients, newly diagnosed with acromegaly who underwent transsphenoidal surgery were included. ES was defined as the pituitary gland and adenoma occupying less than 50% of the sella turcica on midsagittal magnetic resonance (MR) imaging. RESULTS Twelve patients (15.4%), predominantly female (10 women, p = .047), had ES in preoperative MR imaging. ES patients had smaller mean tumor diameter (6.3 mm) than non-ES patients (11.2 mm, p = .001). In preoperative MR imaging, occult adenoma was found in three (25%) ES and three (4.5%) non-ES patients (p = .044). Intraoperative cerebrospinal fluid (CSF) leakage was more frequent in the ES patients than in the non-ES patients (58.3 vs. 25.8%, p = .024). This led to an increased rate of sellar floor reconstruction using abdominal fat and/or postoperative lumber drainage in the ES patients (ES: 41.7 vs. non-ES: 16.7%, p = .063). Endocrinological remission after surgery was more frequent in the non-ES patients (72.7%) than in the ES patients (58.3%) (p = .248). CONCLUSIONS Co-existence of acromegaly with ES is not rare, and is associated with occult adenoma, intra/postoperative CSF leakage, and a worse endocrinological outcome after transsphenoidal surgery; although, the underlying mechanism remains unclear.
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Affiliation(s)
- Yasuo Sasagawa
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Osamu Tachibana
- Department of Neurosurgery, Kanazawa Medical University, KanazawaIshikawa, Japan
| | - Masahiro Oishi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Issei Fukui
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hideaki Iizuka
- Department of Neurosurgery, Kanazawa Medical University, KanazawaIshikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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Tohti M, Li J, Tang C, Wen G, Abdujilil A, Yizim P, Ma C. Serum AGR2 as a useful biomarker for pituitary adenomas. Clin Neurol Neurosurg 2017; 154:19-22. [PMID: 28092730 DOI: 10.1016/j.clineuro.2017.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/12/2016] [Accepted: 01/07/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aims to evaluate whether the serum Anterior Gradient-2 (AGR2) can be used as a potential biomarker screening in the diagnosis of Pituitary adenomas(PAs). PATIENTS AND METHODS The serum AGR2 protein levels were preoperatively measured in 163 PA patients, 43 patients with other sellar lesions excluding PAs, 7 patients with prostate cancer as a positive control and 20 normal people(10 female and 10 male) using Enzyme-Linked ImmunoSorbent Assay (ELISA). Differences in the serum AGR2 level between different groups were analyzed for statistical significance with a Mann-Whitney U test. RESULTS The data showed that serum AGR2 level was significantly higher in the serum of PA patients (250.10±79.14ng/ml) than the patients with other sellar lesions (220.84±79.62ng/ml, P=0.017) and normal people (163.67±50.38ng/ml, P <0.001). Receiver operating characteristic (ROC) curve analysis was used. The detected area under the curve (AUC) was 0.835. The calculated optimal cut-off point for AGR2 level in serum samples was 158.63ng/ml (Youden index=0.564). The sensitivity was 91.4% and the specificity was 65.0%. Despite the variety of PA clinical features, the serum level of AGR2 are definite in PAs, although there may be a difference between male or female patients. CONCLUSION Our data suggests AGR2 as a potential biomarker for the diagnosis of PAs.
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Affiliation(s)
- Mamatemin Tohti
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China; Department of Neurosurgery, The People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Urumqi, 830001, China
| | - Junyang Li
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Chao Tang
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Guodao Wen
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China
| | - Abdukeyum Abdujilil
- Department of Neurosurgery, The People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Urumqi, 830001, China
| | - Parhat Yizim
- Department of Neurosurgery, The People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Urumqi, 830001, China
| | - Chiyuan Ma
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China.
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11
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Tajudeen BA, Kuan EC, Adappa ND, Han JK, Chandra RK, Palmer JN, Kennedy DW, Wang MB, Suh JD. Ectopic Pituitary Adenomas Presenting as Sphenoid or Clival Lesions: Case Series and Management Recommendations. J Neurol Surg B Skull Base 2016; 78:120-124. [PMID: 28321374 DOI: 10.1055/s-0036-1592081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022] Open
Abstract
Background An ectopic pituitary adenoma presenting as a clival or sphenoid mass is a rare clinical occurrence that may mislead the clinician and result in unnecessary interventions or potential medicolegal consequences. Here, we present one of the largest multi-institutional case series and review the literature with an emphasis on radiological findings and critical preoperative workup. Methods Retrospective chart review. Results Nine patients were identified with ectopic pituitary adenomas of the sphenoid or clivus. There were four females and five males. Median age was 60 years old (range, 36-73 years). The most common presenting symptom was headache (56%). Five (56%) patients presented with a mass arising from the clivus while four (44%) presented with a mass in the sphenoid. Six (67%) patients demonstrated biochemical evidence of hypersecretion on full endocrinology panel. All masses showed evidence of enhancement with gadolinium with a propensity for adjacent bone involvement. Lesions also had a predilection for growth toward the cavernous sinus, carotid artery, or sellar floor. Surgical intervention was performed in eight patients (89%). In eight patients (89%), tumors demonstrated immunoreactivity to prolactin. Conclusions Pituitary adenomas can rarely present as an isolated sphenoid or clival mass. Lesions displayed similar magnetic resonance imaging findings with an erosive growth pattern toward the sellar floor, cavernous sinus, or adjacent carotid artery. Patients with clival or parasellar lesions with comparable features should have a preoperative workup which includes prolactin level and alert the physician to consider an ectopic pituitary adenoma in the differential to prevent unnecessary surgery and potential complications.
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Affiliation(s)
- Bobby A Tajudeen
- Department of Otorhinolarygology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Edward C Kuan
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Nithin D Adappa
- Department of Otorhinolarygology-Head and Neck Surgery, The University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Joseph K Han
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, United States
| | - Rakesh K Chandra
- Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - James N Palmer
- Department of Otorhinolarygology-Head and Neck Surgery, The University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - David W Kennedy
- Department of Otorhinolarygology-Head and Neck Surgery, The University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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12
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Zubeldia-Brenner L, Roselli CE, Recabarren SE, Gonzalez Deniselle MC, Lara HE. Developmental and Functional Effects of Steroid Hormones on the Neuroendocrine Axis and Spinal Cord. J Neuroendocrinol 2016; 28:10.1111/jne.12401. [PMID: 27262161 PMCID: PMC4956521 DOI: 10.1111/jne.12401] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 12/13/2022]
Abstract
This review highlights the principal effects of steroid hormones at central and peripheral levels in the neuroendocrine axis. The data discussed highlight the principal role of oestrogens and testosterone in hormonal programming in relation to sexual orientation, reproductive and metabolic programming, and the neuroendocrine mechanism involved in the development of polycystic ovary syndrome phenotype. Moreover, consistent with the wide range of processes in which steroid hormones take part, we discuss the protective effects of progesterone on neurodegenerative disease and the signalling mechanism involved in the genesis of oestrogen-induced pituitary prolactinomas.
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Affiliation(s)
- L Zubeldia-Brenner
- Instituto de Biología y Medicina Experimental-CONICET, Buenos Aires, Argentina
| | - C E Roselli
- Department of Physiology and Pharmacology, Oregon Health and Science University Portland, Portland, OR, USA
| | - S E Recabarren
- Laboratory of Animal Physiology and Endocrinology, Faculty of Veterinary Sciences, University of Concepcion, Chillán, Chile
| | - M C Gonzalez Deniselle
- Instituto de Biología y Medicina Experimental-CONICET, Buenos Aires, Argentina
- Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - H E Lara
- Laboratory of Neurobiochemistry Department of Biochemistry and Molecular Biology, Faculty of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile
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13
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Su H, Zhou J, Bao YQ, Mo YF, Zhang WT, Zhao JG, Ma XJ, Jia WP. Primary empty sella associated with pituitary adenoma diagnosed by inferior petrosal sinus blood sampling. Chin Med J (Engl) 2015; 128:567-8. [PMID: 25673467 PMCID: PMC4836268 DOI: 10.4103/0366-6999.151123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
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