1
|
Yuan S, Lin Y, Zhao Y, Du M, Dong S, Chen Y, Wei H. Pineal cysts may promote pubertal development in girls with central precocious puberty: a single-center study from China. Front Endocrinol (Lausanne) 2024; 15:1323947. [PMID: 38405141 PMCID: PMC10885350 DOI: 10.3389/fendo.2024.1323947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Pineal cysts have long been considered a benign intracranial variation. However, in our clinical practice, it has been observed that some children with central precocious puberty (CPP) who have pineal cysts experience rapid progression in adolescent development. In recent years, there has been a significant increase in the prevalence of CPP in girls, leading to more diagnoses of CPP among children with pineal cysts. Despite this, there is no consensus regarding whether pineal cysts contribute to CPP as one of its organic factors. This study aimed to analyze the clinical characteristics of pineal cysts in children with CPP and explore the potential effects of pineal cysts on puberty development. Methods This single-center study retrospectively analyzed clinical data from girls aged 3 to 10 years who underwent head/pituitary magnetic resonance imaging at the Children's Hospital Affiliated to Zhengzhou University between 2019 and 2022. The study categorized the detection rates of pineal cysts based on systematic disease classification and compared the rates of cyst detection between girls diagnosed with CPP and those without CPP. Subsequently, CPP-diagnosed girls with pineal cysts were examined. Among CPP-diagnosed girls meeting the study's criteria, those with pineal cysts formed the 'cyst group,' while those without cysts were matched in a 1:1 ratio based on age and body mass index to form the 'non-cyst group.' Comparative analyses were conducted to assess the clinical characteristics between these two groups. CPP-diagnosed girls with cysts were further subdivided into three groups according to cyst size (≤5 mm, 5.1-9.9 mm, and ≥10 mm) to investigate potential differences in clinical characteristics among these subgroups. The study involved an analysis of clinical data from girls diagnosed with CPP and included imaging follow-ups to explore the progression of pineal cysts over time. Results Among the 23,245 girls who underwent head/pituitary magnetic resonance imaging scans, the detection rate of pineal cysts was 3.6% (837/23,245), with most cases being associated with endocrine diseases. The detection rate of pineal cysts in CPP patients was 6.4% (262/4099), which was significantly higher than the 3.0% (575/19,146) in patients without CPP. In comparison to the non-cyst group, the cyst group exhibited statistically significant increases in estradiol levels, peak luteinizing hormone (LH) levels, peak LH/follicle-stimulating hormone (FSH) ratios, uterine body length, and cervix length (P < 0.001). As cyst size increased, there were significant rises in LH peak, peak LH/FSH ratio, uterine body length, and cervical length (P < 0.01). Estradiol levels and left ovarian volume also showed an increasing trend (P < 0.05). Among girls who underwent follow-up imaging, 26.3% (5/19) exhibited an increase in cyst size. Conclusion Pineal cysts are relatively common in children with CPP. They may affect the pubertal development process, with larger cysts correlating to faster pubertal development. Therefore, the authors hypothesize that pineal cysts may trigger CPP in some cases, especially when the cysts are larger than 5 mm in size, as indicated by our data.
Collapse
Affiliation(s)
- Shuxian Yuan
- Department of Endocrinology and Inborn Error of Metabolism, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Tianjian Laboratory of Advanced Biological Sciences, Zhengzhou, China
| | - Yifan Lin
- Department of Endocrinology and Inborn Error of Metabolism, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Tianjian Laboratory of Advanced Biological Sciences, Zhengzhou, China
| | - Yixuan Zhao
- Department of Endocrinology and Inborn Error of Metabolism, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Tianjian Laboratory of Advanced Biological Sciences, Zhengzhou, China
| | - Mengmeng Du
- Department of Endocrinology and Inborn Error of Metabolism, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Tianjian Laboratory of Advanced Biological Sciences, Zhengzhou, China
| | - Shijie Dong
- Department of Imaging and Nuclear Medicine, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Yongxing Chen
- Department of Endocrinology and Inborn Error of Metabolism, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Tianjian Laboratory of Advanced Biological Sciences, Zhengzhou, China
| | - Haiyan Wei
- Department of Endocrinology and Inborn Error of Metabolism, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Tianjian Laboratory of Advanced Biological Sciences, Zhengzhou, China
| |
Collapse
|
2
|
Gheban BA, Colosi HA, Gheban-Roșca IA, Georgiu C, Gheban D, Crișan D, Crișan M. Digital histological morphometry of the human pineal gland in a postmortem study, with endocrine and neurological clinical implications. Anat Histol Embryol 2023; 52:12-20. [PMID: 35762404 DOI: 10.1111/ahe.12828] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 01/19/2023]
Abstract
The pineal gland is a small-sized, photo neuroendocrine organ in the midline of the brain that synthesises and secretes melatonin and serotonin. Chords and islands of pinealocytes constitute the secretory parenchyma, while glial tissue and calcifications represent degenerative changes. This study examined human postmortem pineal glands to microscopically assess morphological changes possibly associated with clinical data, by using digital techniques. A retrospective autopsy study has been performed on 72 paediatric and adult autopsy cases. The glands have been processed for histological analysis and immunohistochemical staining with synaptophysin (SYN), neuron-specific enolase (NSE), and neurofilament (NF). Slides were digitally scanned. Morphometric data were obtained using CaseViewer and ImageJ. The comorbidities used for correlation with morphometric data were obesity, type 2 diabetes, adrenal gland adenoma, goitre, chronic pancreatitis, arterial hypertension, and mixed dementia. Thirty-three females and 39 males were included in the study. Increased secretory parenchyma was found in patients with chronic pancreatitis, arterial hypertension, and adrenal gland adenoma. Reduced activity was found in patients with type 2 diabetes, obesity, advanced pineal calcification, mixed dementia, and old age. There were no changes associated with goitre, cachexia, or Willis's polygon atherosclerosis. No significant differences between gender were found. The activity of the pineal gland can be assessed by quantitative immunohistochemistry of neuroendocrine and structural pinealocyte markers and observation of glial tissue and calcifications. There is a need for further research to evaluate the clinical impact of these morphological changes on the neuroendocrine systems, with clinical implications in endocrinology, neurology, and even psychiatry. Digital techniques offer a more exact analysis of histological data.
Collapse
Affiliation(s)
- Bogdan-Alexandru Gheban
- Dept. of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency Clinical County Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Horațiu Alexandru Colosi
- Dept. of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana-Andreea Gheban-Roșca
- Dept. of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Carmen Georgiu
- Dept. of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency Clinical County Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Dan Gheban
- Dept. of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Children's Emergency Clinical Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Doinița Crișan
- Dept. of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency Clinical County Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Maria Crișan
- Emergency Clinical County Hospital Cluj-Napoca, Cluj-Napoca, Romania.,Dept. of Histology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
3
|
Lu D, Liu J, MacKinnon AD, Tozer DJ, Markus HS. Prevalence and Risk Factors of Cerebral Microbleeds: Analysis From the UK Biobank. Neurology 2021; 97:e1493-e1502. [PMID: 34408070 DOI: 10.1212/wnl.0000000000012673] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 08/05/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the prevalence of and risk factors for cerebral microbleeds (CMBs) at different locations in a large healthy community population. METHODS A total of 8,159 participants from the UK Biobank with MRI scans suitable for CMB analysis were included. Brain susceptibility-weighted imaging data were acquired on 2 identical 3.0T scanners. The Microbleed Anatomical Rating Scale was used to identify definite CMBs. Generalized linear models were used to determine independent associations with all CMBs and lobar, deep, and infratentorial CMBs. RESULTS The mean age at scan was 62.1 ± 7.4 years. One or more definite CMBs were detected in 572 (7.0%) participants. Of those with CMBs, 439 (76.7%) had lobar CMBs, 103 (18.0%) had deep CMBs, and 83 (14.5%) had infratentorial CMBs. Age was an independent risk factor for CMBs in all locations. APOE4 and male sex were positively associated and higher body mass index was negatively associated with lobar CMBs. Hypertension, smoking, and alcohol consumption were associated with deep CMBs, but not with lobar CMBs. Only age was associated with infratentorial CMBs. The associations were unchanged after controlling for white matter hyperintensity lesion volume as a marker of small vessel disease severity. DISCUSSION In this large population-based study, CMB prevalence detected using a low sensitivity and high specificity system was 7%. There were distinct risk factor profiles for CMBs in lobar and deep locations consistent with different underlying pathophysiologic processes. TRIAL REGISTRATION INFORMATION Clinical Trial registration number: UK Biobank application number 19463.
Collapse
Affiliation(s)
- Dongwei Lu
- From the Stroke Research Group, Department of Clinical Neurosciences (D.L., J.L., D.J.T., H.S.M.), University of Cambridge, UK; Department of Neurology (D.L.), Zhongnan Hospital, Wuhan University; Department of Neurology (J.L.), West China Hospital, Sichuan University, China; and Department of Neuroradiology (A.D.M.), Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Junfeng Liu
- From the Stroke Research Group, Department of Clinical Neurosciences (D.L., J.L., D.J.T., H.S.M.), University of Cambridge, UK; Department of Neurology (D.L.), Zhongnan Hospital, Wuhan University; Department of Neurology (J.L.), West China Hospital, Sichuan University, China; and Department of Neuroradiology (A.D.M.), Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrew D MacKinnon
- From the Stroke Research Group, Department of Clinical Neurosciences (D.L., J.L., D.J.T., H.S.M.), University of Cambridge, UK; Department of Neurology (D.L.), Zhongnan Hospital, Wuhan University; Department of Neurology (J.L.), West China Hospital, Sichuan University, China; and Department of Neuroradiology (A.D.M.), Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Daniel J Tozer
- From the Stroke Research Group, Department of Clinical Neurosciences (D.L., J.L., D.J.T., H.S.M.), University of Cambridge, UK; Department of Neurology (D.L.), Zhongnan Hospital, Wuhan University; Department of Neurology (J.L.), West China Hospital, Sichuan University, China; and Department of Neuroradiology (A.D.M.), Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Hugh S Markus
- From the Stroke Research Group, Department of Clinical Neurosciences (D.L., J.L., D.J.T., H.S.M.), University of Cambridge, UK; Department of Neurology (D.L.), Zhongnan Hospital, Wuhan University; Department of Neurology (J.L.), West China Hospital, Sichuan University, China; and Department of Neuroradiology (A.D.M.), Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
4
|
Himes BT, Bhargav AG, Brown DA, Kaufmann TJ, Bancos I, Van Gompel JJ. Does pituitary compression/empty sella syndrome contribute to MRI-negative Cushing's disease? A single-institution experience. Neurosurg Focus 2021; 48:E3. [PMID: 32480375 DOI: 10.3171/2020.3.focus2084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cushing's disease arises from functioning adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas. These tumors can be very small and evade detection by MRI. Empty sella syndrome is a phenomenon by which an arachnoid outpouching of CSF into the sella leads to compression of the pituitary, likely due to intracranial hypertension (a common issue in Cushing's disease), further leading to difficulty in visualizing the pituitary gland that may contribute to difficulty in finding a tumor on MRI, so-called MRI-negative Cushing's disease. The authors sought to examine the association between empty sella syndrome and MRI-negative Cushing's disease. METHODS A single-institution database of Cushing's disease cases from 2000 to 2017 was reviewed, and 197 cases were included in the analysis. One hundred eighty patients had a tissue diagnosis of Cushing's disease and 17 had remission with surgery, but no definitive tissue diagnosis was obtained. Macroadenomas (tumors > 1 cm) were excluded. The degree of empty sella syndrome was graded on the degree of CSF visualized in the sella on midline sagittal T1-weighted MRI. RESULTS Of the 197 cases identified, 40 (20%) presented with MRI-negative disease, and empty sella syndrome was present in 49 cases (25%). MRI-negative disease was found in 18 (37%) of 49 empty sella cases versus 22 (15%) of 148 cases without empty sella syndrome present. Empty sella syndrome was significantly associated with MRI-negative disease (OR 3.32, 95% CI 1.61-6.74, p = 0.0018). Decreased thickness of the pituitary gland was also associated with MRI-negative disease (mean thickness 5.6 vs 6.8 mm, p = 0.0002). CONCLUSIONS Empty sella syndrome is associated with an increased rate of MRI-negative Cushing's disease. Pituitary compression causing a relative reduction in the volume of the pituitary for imaging is a plausible cause for not detecting the tumor mass with MRI.
Collapse
Affiliation(s)
| | - Adip G Bhargav
- 2Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | | | | | | | | |
Collapse
|
5
|
Gheban BA, Rosca IA, Crisan M. The morphological and functional characteristics of the pineal gland. Med Pharm Rep 2019; 92:226-234. [PMID: 31460502 PMCID: PMC6709953 DOI: 10.15386/mpr-1235] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/20/2019] [Accepted: 02/03/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction The pineal gland is a photo-neuro-endocrine organ situated inside the brain, that secretes serotonin, melatonin and N,N-dymethyltriptamine. This narrative review will address the latest information gathered on this function of the gland as well as the unknown roles it may have. The different histological and pathological findings of the pineal gland have demonstrated a role in clinical manifestations of numerous endocrine, neurological and psychiatric pathologies. Materials For this narrative review we used the NCBI website database PubMed. The search terms were “Pineal Gland” AND/OR “histology, melatonin, DMT, pathology”. Total number of articles included were 86. Results We have reviewed physiological information of melatonin and DMT, anatomical, histological and histopathological information on the pineal gland and its role in endocrine, neurological and psychiatric pathology. Conclusion The role of melatonin in immunity and its potential therapeutic effects show promising potential for further research. DMT seems to have a role in psychiatric pathology and potential therapeutic effects. Proper tumoral screening and diagnostic protocol are required.
Collapse
Affiliation(s)
- Bogdan Alexandru Gheban
- Morphological Sciences Department, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Ioana Andreea Rosca
- Radiotherapy Department, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Maria Crisan
- Histology and Dermatology Department, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| |
Collapse
|
6
|
Grajauskas LA, Siu W, Medvedev G, Guo H, D’Arcy RC, Song X. MRI-based evaluation of structural degeneration in the ageing brain: Pathophysiology and assessment. Ageing Res Rev 2019; 49:67-82. [PMID: 30472216 DOI: 10.1016/j.arr.2018.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 11/08/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022]
Abstract
Advances in MRI technology have significantly contributed to our ability to understand the process of brain ageing, allowing us to track and assess changes that occur during normal ageing and neurological conditions. This paper focuses on reviewing structural changes of the ageing brain that are commonly seen using MRI, summarizing the pathophysiology, prevalence, and neuroanatomical distribution of changes including atrophy, lacunes, white matter lesions, and dilated perivascular spaces. We also review the clinically accessible methodology for assessing these MRI-based changes, covering visual rating scales, as well computer-aided and fully automated methods. Subsequently, we consider novel assessment methods designed to evaluate changes across the whole brain, and finally discuss new directions in this field of research.
Collapse
|
7
|
Gokce E, Beyhan M. Evaluation of pineal cysts with magnetic resonance imaging. World J Radiol 2018; 10:65-77. [PMID: 30079153 PMCID: PMC6068724 DOI: 10.4329/wjr.v10.i7.65] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/29/2018] [Accepted: 05/23/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate radiological imaging findings of patients who had been found to have pineal cyst (PC) in brain magnetic resonance imaging (MRI).
METHODS A total of 9546 patients who had brain MRI examination in March 2010-January 2018 period were studied. Fifty-six patients (44 female and 12 male) found to have PC were evaluated. Eighteen of the patients had had follow-up examinations of 2-94 mo (mean 30.50 ± 28.83). PC dimensions and volume, radiological imaging features (signal intensities, contours, internal septation-loculation and contrast-enhancement features) and natural history in cases who had been followed-up were evaluated by two radiologists.
RESULTS Of 9546 patients, 5555 were female (58.2%) and 3991 male (41.8%). Age range was 1-99 (mean 43.18 ± 20.94). PC frequency was calculated to be 0.58%. Forty-four of the 56 patients (78.57%) with PC were female and 12 male (21.43%), and their age range was 5-61 (mean 31.26 ± 12.73). Thirty-five of the PCs were typical (62.50%) and 21 (37.50%) were atypical. No significant difference was found between initial and final imaging sizes of PCs which were monitored by follow-up examinations (P > 0.05).
CONCLUSION PCs are cysts which do not show clear size and natural changes and are more frequently observed in females and in adult ages. Most of them are isointense with cerebrospinal fluid on T1 and T2A weighted images, hyperintense compared to cerebrospinal fluid on fluid-attenuated inversion recovery; sequence and smoothly contoured. Their typical forms have peripheral rim and multilocular ones may have septal contrast-enhancement.
Collapse
Affiliation(s)
- Erkan Gokce
- Department of Radiology, Gaziosmanpaşa University, School of Medicine, Tokat 60100, Turkey
| | - Murat Beyhan
- Department of Radiology, Tokat State Hospital, Tokat 60100, Turkey
| |
Collapse
|