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Meij BP, van Stee LL. Transsphenoidal Surgery for Pituitary Tumors. Vet Clin North Am Small Anim Pract 2024:S0195-5616(24)00063-9. [PMID: 39227253 DOI: 10.1016/j.cvsm.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Transsphenoidal surgery for the treatment of pituitary masses in cats and dogs has become a more established treatment over the last 2 decades. Although expert centers and surgeons that provide this service remain limited, the patient population presented for pituitary surgery increases with wider availability of advanced imaging, together with more challenging cases. In this review, the current state of hypophysectomy is described with future challenges and opportunities.
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Affiliation(s)
- Björn P Meij
- Small Animal Surgery, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht 3584CM, The Netherlands
| | - Lucinda L van Stee
- Small Animal Surgery, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht 3584CM, The Netherlands.
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Cho H, Choi M, Yoo S, Jeong M, Park SA. Case report: Unilateral papilledema in a dog with a large suprasellar mass and suspected intracranial hypertension: insights from funduscopy, optical coherence tomography, and magnetic resonance imaging. Front Vet Sci 2024; 11:1372802. [PMID: 38933701 PMCID: PMC11202079 DOI: 10.3389/fvets.2024.1372802] [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: 01/18/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
A spayed, 8-year-old female Poodle, weighing 5.7 kg, was presented with the chief complaint of vision impairment. Vision assessment, including pupillary light reflexes, menace response, dazzle reflex, and maze navigation in photopic and scotopic circumstances, revealed a negative response in both eyes except for positive direct pupillary light reflex in the right eye and positive consensual pupillary light reflex from the right eye to the left eye. Systemic evaluation, including neurologic status, blood profile, and thoracic radiographs, did not reveal any abnormalities. Complete ophthalmic examinations, ocular ultrasonography, and electroretinography did not identify a cause of blindness. Upon funduscopy, the left eye exhibited an increased optic disk diameter, blurred optic disk borders, and loss of the physiologic pit, as well as an increase in vascular tortuosity. In the right eye, there were multifocal depigmented areas in the non-tapetal fundus and several pigmented spots surrounded by a region of dull tapetal reflection in the tapetal fundus. The optical coherence tomography revealed severe anterior deformation of the optic nerve head and Bruch's membrane in the peripapillary region of the left eye. Magnetic resonance imaging revealed an irregular, broad-based suprasellar mass, with features suggestive of intracranial hypertension, including dorsal displacement of third ventricles, a rightward shift of the falx cerebri, trans-tentorial herniation, perilesional edema, flattening/protrusion of the posterior sclera, and lager optic nerve sheath diameter in left side than right side. This is the first comprehensive report that describes unilateral papilledema in a dog with a brain tumor, using advanced ophthalmic and neuro-imaging modalities.
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Affiliation(s)
- Heejong Cho
- Yoolim Animal Eye Clinic, Seoul, Republic of Korea
- Bon Animal Medical Center, Suwon, Republic of Korea
| | - Mihyun Choi
- Bon Animal Medical Center, Suwon, Republic of Korea
| | - Sukjong Yoo
- Yoolim Animal Eye Clinic, Seoul, Republic of Korea
| | - Manbok Jeong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Shin Ae Park
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
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Steele MME, Lawson JS, Scudder C, Watson AH, Ho NTZ, Yaffy D, Batchelor D, Fenn J. Transsphenoidal hypophysectomy for the treatment of hypersomatotropism secondary to a pituitary somatotroph adenoma in a dog. J Vet Intern Med 2024; 38:351-357. [PMID: 37916616 PMCID: PMC10800194 DOI: 10.1111/jvim.16929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
Pituitary-dependent hypersomatotropism is rarely diagnosed in dogs and surgical treatment is not reported. A 6-year-10-month male neutered Patterdale Terrier presented with polyuria, polydipsia, progressive pharyngeal stertor, excessive hair growth and widened facial features and paws. Serum insulin-like growth factor-1 concentration via radioimmunoassay was consistent with hypersomatotropism (1783 ng/mL). A pituitary mass was identified on magnetic resonance and computed tomography imaging. Six weeks later, glucosuria, starved hyperglycemia and serum fructosamine above the reference range (467.6 μmol/L, RI 177-314) were documented, consistent with diabetes mellitus. Transsphenoidal hypophysectomy was performed under general anesthesia without complications. Pituitary histopathology identified an acidophil neoplasm, with positive immunostaining for growth hormone. Postoperatively, there was rapid resolution of clinical, biochemical and morphologic changes of hypersomatotropism with persistence of diabetes mellitus. This case demonstrates successful resolution of hypersomatotropism with ongoing diabetes mellitus in a dog after surgical treatment by transsphenoidal hypophysectomy.
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Affiliation(s)
| | - Jack S. Lawson
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - Christopher Scudder
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - Alice H. Watson
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - Nicola T. Z. Ho
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - Dylan Yaffy
- Department of Pathobiology and Population SciencesRoyal Veterinary CollegeHatfieldUK
| | - Daniel Batchelor
- Department of Small Animal Clinical SciencesUniversity of LiverpoolNestonUK
| | - Joe Fenn
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
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Chen S, Young MG, Bush WW, Shores A, Levine C. Detailed anatomic description of the lateral, transzygomatic approach to the middle fossa and rostral brainstem and its use in three dogs. Vet Surg 2023; 52:1180-1190. [PMID: 37104695 DOI: 10.1111/vsu.13959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/14/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To describe a craniectomy using a lateral, transzygomatic approach to the middle fossa and rostral brainstem, and to report clinical outcomes and complications in three dogs. ANIMALS Two cadaver dogs and three client-owned dogs. Two of the client-owned dogs with middle fossa lesions, and one with a rostral brainstem lesion. METHODS Two cadavers were used to describe the lateral, transzygomatic surgical approach to the middle fossa and rostral brainstem. The medical records of three dogs undergoing this surgical approach were reviewed for data on signalment, preoperative and postoperative neurological status, diagnostic imaging, surgical technique, complications, and outcome. RESULTS Indications for this surgical approach included incisional biopsy (n = 1) and debulking surgery for brain lesions (n = 2). Definitive diagnoses were achieved in two cases, and tumor volume reduction in all cases. Two of the three dogs developed postoperative facial nerve paralysis ipsilateral to the surgical site, which resolved within 2 and 12 weeks after surgery. CONCLUSION The lateral, transzygomatic approach provided useful access to ventrally located cerebral/skull base lesions in dogs without major complications.
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Affiliation(s)
- Sandy Chen
- Bush Veterinary Neurology Service, Springfield, Virginia, USA
| | - Martin G Young
- Bush Veterinary Neurology Service, Richmond, Virginia, USA
| | - William W Bush
- Bush Veterinary Neurology Service, Springfield, Virginia, USA
| | - Andy Shores
- Mississippi State University CVM and Veterinary Specialty Center, Starkville, Mississippi, USA
| | - Chris Levine
- Levine Veterinary Neurology, Bradenton, Florida, USA
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Costanza D, Coluccia P, Auletta L, Castiello E, Navas L, Greco A, Meomartino L. Computed Tomographic Assessment of Pituitary Gland Dimensions in Domestic Short-Haired Cats. Animals (Basel) 2023; 13:1935. [PMID: 37370445 DOI: 10.3390/ani13121935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/27/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
The detection of subtle changes in the pituitary dimensions has relevant clinical implications. In cats, a few studies have established the cut-off values of the pituitary gland's dimensions using small and inhomogeneous samples. The aims of this study were: to determine by computed tomography (CT) the pituitary linear dimensions and the pituitary-to-brain (P:B) ratio in a sample of domestic short-haired (DSH) cats; to assess the effects of sex, age, and weight on pituitary dimensions; and to evaluate the inter- and intra-observer agreement for such measurements. All skull CTs of DSH cats performed over four years using a multidetector CT and a standardized protocol were retrospectively reviewed. The exclusion criteria were: clinical, laboratory, or CT alterations of the pituitary gland, brain diseases, fractures of the neurocranium, and diabetes. The pituitary dimensions and brain area were assessed by two different observers using multiplanar reconstructions and automated segmentation tools. Fifty-one cats were included in the final sample. The intraclass correlation coefficients for intra- and inter-observer reliability were good/excellent, and moderate/good, respectively. No differences between sexes were detected, and negligible correlations were found between age and weight. According to this study, a pituitary gland with a height > 4 mm or a P:B ratio > 0.49 mm should be considered enlarged.
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Affiliation(s)
- Dario Costanza
- Interdepartmental Center of Veterinary Radiology, University of Napoli "Federico II", Via Federico Delpino 1, 80137 Napoli, Italy
| | - Pierpaolo Coluccia
- Interdepartmental Center of Veterinary Radiology, University of Napoli "Federico II", Via Federico Delpino 1, 80137 Napoli, Italy
| | - Luigi Auletta
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milano, Via dell'Università 6, 26900 Lodi, Italy
| | - Erica Castiello
- Interdepartmental Center of Veterinary Radiology, University of Napoli "Federico II", Via Federico Delpino 1, 80137 Napoli, Italy
| | - Luigi Navas
- Department of Veterinary Medicine and Animal Production, University of Napoli "Federico II", Via Federico Delpino 1, 80137 Napoli, Italy
| | - Adelaide Greco
- Interdepartmental Center of Veterinary Radiology, University of Napoli "Federico II", Via Federico Delpino 1, 80137 Napoli, Italy
| | - Leonardo Meomartino
- Interdepartmental Center of Veterinary Radiology, University of Napoli "Federico II", Via Federico Delpino 1, 80137 Napoli, Italy
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Woelfel CW, Mariani CL, Nolan MW, Keenihan EK, Topulos SP, Early PJ, Muñana KR, Musulin SE, Olby NJ. Presumed pituitary apoplexy in 26 dogs: Clinical findings, treatments, and outcomes. J Vet Intern Med 2023; 37:1119-1128. [PMID: 37084035 DOI: 10.1111/jvim.16703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/24/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Pituitary apoplexy refers to hemorrhage or infarction within the pituitary gland resulting in acute neurological abnormalities. This condition is poorly described in dogs. OBJECTIVES To document presenting complaints, examination findings, endocrinopathies, magnetic resonance imaging (MRI), treatments, and outcomes of dogs with pituitary apoplexy. ANIMALS Twenty-six client-owned dogs with acute onset of neurological dysfunction. METHODS Retrospective case series. Dogs were diagnosed with pituitary apoplexy if MRI or histopathology documented an intrasellar or suprasellar mass with evidence of hemorrhage or infarction in conjunction with acute neurological dysfunction. Clinical information was obtained from medical records and imaging reports. RESULTS Common presenting complaints included altered mentation (16/26, 62%) and gastrointestinal dysfunction (14/26, 54%). Gait or posture changes (22/26, 85%), mentation changes (18/26, 69%), cranial neuropathies (17/26, 65%), cervical or head hyperpathia (12/26, 46%), and hyperthermia (8/26, 31%) were the most frequent exam findings. Ten dogs (38%) lacked evidence of an endocrinopathy before presentation. Common MRI findings included T1-weighted hypo- to isointensity of the hemorrhagic lesion (21/25, 84%), peripheral enhancement of the pituitary mass lesion (15/25, 60%), brain herniation (14/25, 56%), and obstructive hydrocephalus (13/25, 52%). Fifteen dogs (58%) survived to hospital discharge. Seven of these dogs received medical management alone (median survival 143 days; range, 7-641 days) and 8 received medications and radiation therapy (median survival 973 days; range, 41-1719 days). CONCLUSIONS AND CLINICAL IMPORTANCE Dogs with pituitary apoplexy present with a variety of acute signs of neurological disease and inconsistent endocrine dysfunction. Dogs that survive to discharge can have a favorable outcome.
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Affiliation(s)
- Christian W Woelfel
- Veterinary Hospital, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Christopher L Mariani
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
- Comparative Neuroimmunology and Neuro-Oncology Laboratory, North Carolina State University, Raleigh, North Carolina, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Michael W Nolan
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Erin K Keenihan
- Veterinary Hospital, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Sophia P Topulos
- Veterinary Hospital, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Peter J Early
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Karen R Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Sarah E Musulin
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
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Hyde BR, Martin LG, Chen AV, Guess SC, Carrera-Justiz S, Bruyette D, Owen TJ. Clinical characteristics and outcome in 15 dogs treated with transsphenoidal hypophysectomy for nonfunctional sellar masses. Vet Surg 2023; 52:69-80. [PMID: 36416123 PMCID: PMC10100401 DOI: 10.1111/vsu.13917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/22/2022] [Accepted: 10/30/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To characterize the clinical features, neurological examination findings, diagnostic imaging results, histopathological findings, and outcome following transsphenoidal hypophysectomy (TSH) in dogs with nonfunctional sellar masses (NFSM). STUDY DESIGN Multi-institutional retrospective study. METHODS Medical records of dogs that underwent TSH for a NFSM were reviewed for clinical signs, physical and neurological examination findings, diagnostic imaging results, endocrine testing, surgery reports, and outcome. Magnetic resonance (MR) imaging was rereviewed, and tumors were classified using the previously described system according to pituitary tumor extension and vascular involvement. Owners of dogs that survived to discharge were contacted. RESULTS The majority of dogs presented for mentation change (12/15). The mean pituitary to brain ratio (P/B ratio) was 1.05 (0.6-1.4). Eight dogs had a tumor imaging classification of 5B. Eleven dogs were diagnosed with a nonfunctional pituitary adenoma (NFPA). Perioperative mortality was 33% (5/15). The median survival for all dogs was 232 days (0-1658). When dogs that did not survive to discharge were excluded, the median survival time was 708 days. Seven of 10 dogs that survived the perioperative period received adjunctive therapy. Owner assessment of outcome was excellent (6/7) to good (1/7). CONCLUSION The common presenting complaint for dogs with large NFSM causing mass effect was mentation changes. Dogs with NFPA that survived to discharge and received adjunctive therapy had good to excellent outcomes. CLINICAL SIGNIFICANCE Transsphenoidal debulking with adjunctive therapy can be considered for the treatment of NFSM causing clinical signs of mass effect in dogs. Successful long-term outcomes are possible.
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Affiliation(s)
- Brittany R Hyde
- Department of Veterinary Clinical Sciences and Veterinary Teaching Hospital, Washington State University, Pullman, Washington, USA
| | - Linda G Martin
- Department of Veterinary Clinical Sciences and Veterinary Teaching Hospital, Washington State University, Pullman, Washington, USA
| | - Annie V Chen
- Department of Veterinary Clinical Sciences and Veterinary Teaching Hospital, Washington State University, Pullman, Washington, USA
| | - Sarah C Guess
- Department of Veterinary Clinical Sciences and Veterinary Teaching Hospital, Washington State University, Pullman, Washington, USA
| | | | - David Bruyette
- VCA West Los Angeles Animal Hospital, Los Angeles, California, USA
| | - Tina J Owen
- Department of Veterinary Clinical Sciences and Veterinary Teaching Hospital, Washington State University, Pullman, Washington, USA
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Escauriaza L, Fenn J, McCue J, Roper D, Vandenberghe H, Nye G, Oxley B, Granger N. A 3-Dimensional Printed Patient-Specific Surgical Guide to Facilitate Transsphenoidal Hypophysectomy in Dogs. Front Vet Sci 2022; 9:930856. [PMID: 35795781 PMCID: PMC9251581 DOI: 10.3389/fvets.2022.930856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Hypophysectomy in dogs is a difficult surgery that requires specific learning and training. We aimed to evaluate the accuracy of a 3-dimensional printed patient-specific surgical guide to facilitate choosing the entry point in the basisphenoid bone before approaching the sella turcica during transsphenoidal hypophysectomy in dogs. Methods Two canine cadavers and 8 dogs undergoing transsphenoidal hypophysectomy for Cushing's disease treatment, involving design and fabrication of a 3-dimensional printed guide. The ideal entry point in the basisphenoid bone outer cortical layer was determined in each dog pre-operatively; its anatomical location was described with a set of measurements then compared to post-operative computed tomography measures describing the location of the outer cortical window created in the basisphenoid bone. Results Several guide designs were proposed, and a consensus reached based on surgeons' experience performing hypophysectomy. The device chosen could be applied to the size and shape of skulls encountered in this case series. The pre-planned measurements were comparable to post-operative measurement (there was also no statistical difference), with median of differences <0.1 mm, which we judged as clinically acceptable. Clinical Significance Hypophysectomy in dogs is a challenging procedure that has a learning curve and needs to be performed by specialist neurosurgeons. We propose that a low-profile 3-dimensional printed surgical guide can aid the specialist neurosurgeon to locate the burring site of the outer cortical layer of the basisphenoid bone at a pre-defined location and with good accuracy. It does not alleviate the need to understand the anatomy of the region and to know how to create a slot within the basisphenoid bone, which remains essential to enter the sella turcica. This device could help specialist veterinary neurosurgeons wishing to be trained to perform hypophysectomy.
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Affiliation(s)
- Leticia Escauriaza
- Neurology Department, Bristol Veterinary Specialists at Highcroft, CVS Referrals, Bristol, United Kingdom
| | - Joe Fenn
- Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - John McCue
- Animal Medical Centre, New York, NY, United States
| | - Darren Roper
- Neurology Department, Bristol Veterinary Specialists at Highcroft, CVS Referrals, Bristol, United Kingdom
| | - Helene Vandenberghe
- Neurology Department, Bristol Veterinary Specialists at Highcroft, CVS Referrals, Bristol, United Kingdom
| | - George Nye
- Neurology Department, Bristol Veterinary Specialists at Highcroft, CVS Referrals, Bristol, United Kingdom
| | | | - Nicolas Granger
- Neurology Department, Bristol Veterinary Specialists at Highcroft, CVS Referrals, Bristol, United Kingdom
- *Correspondence: Nicolas Granger
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Rodriguez P, Guzman DSM, Robertson J, La Porte AD, Hawkins MG, Paul-Murphy JR, Hansen KS. Stereotactic Radiation Treatment of a Pituitary Mass in a Rabbit (Oryctolagus cuniculus). J Exot Pet Med 2022. [DOI: 10.1053/j.jepm.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Roh Y, Kim D, Jeong S, Lee H. Evaluation of the accuracy of three-dimensionally printed patient-specific guides for transsphenoidal hypophysectomy in small-breed dogs. Am J Vet Res 2022; 83:465-472. [PMID: 35175933 DOI: 10.2460/ajvr.21.09.0154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the accuracy of transsphenoidal hypophysectomy using 3-D printed patient-specific guides (3D-PSGs) in small-breed dogs. ANIMALS Heads obtained from the cadavers of 19 small-breed dogs (ex vivo portion of study) and 3 healthy adult (3 to 4 years) purpose-bred Beagles with a median body weight of 9.2 kg. PROCEDURES In the ex vivo study, CT images of the cadavers were collected. The position, width, and length of the pituitary fossa and the pilot hole (insertion angle and place) were measured. Using PSGs, 19 pilot holes were made for the pituitary gland fossa, and CT was performed to assess the position accuracy. In the in vivo study, 3 surgical windows from the pilot holes were made using PSGs. Repeated CT and MRI were performed to evaluate the safeness and effectiveness of PSGs, followed by necropsy. RESULTS In the ex vivo study, the median (interquartile range) difference between the pre- and postoperative insertion angles was 2° (0° to 3.5°) and the median deviation of the pilot hole was 0.46 mm (0 to 1.58 mm). In the in vivo study, the surrounding structures were not damaged, and favorable outcomes were evident in terms of the shape, size, and position of the surgical window. CLINICAL RELEVANCE 3D-PSGs provided a safe and effective surgical window for transsphenoidal hypophysectomy. Our findings emphasized the applicability of PSGs in brain surgery, in terms of accuracy and effectiveness.
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Del Magno S, van Rijn S, Azzariti S, Valtolina C, L' Ami J, Meij BP. Plasma sodium and potassium concentrations after hypophysectomy in dogs with corticotroph adenomas. J Vet Intern Med 2021; 36:39-48. [PMID: 34914137 PMCID: PMC8783358 DOI: 10.1111/jvim.16337] [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: 04/02/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Electrolyte abnormalities, especially hypernatremia, are frequent complications after transsphenoidal hypophysectomy in dogs with pituitary‐dependent hypercortisolism. Objectives To describe electrolyte abnormalities after transsphenoidal hypophysectomy and to investigate possible associations between postoperative hypernatremia and clinical and surgical variables as well as with postoperative outcome. Animals One hundred and twenty‐seven client‐owned dogs. Methods Dogs with pituitary corticotroph adenomas that underwent transsphenoidal hypophysectomy were retrospectively included. Plasma sodium and potassium concentrations were measured −2, +2, +8, +24, and +48 hours from hypophysectomy. Clinical (breed, age, body weight, skull type, urinary cortisol/creatinine ratio, percentage of suppression to dexamethasone) and surgical variables (duration of anesthesia and surgery, pituitary dimensions) were compared to the development of hypernatremia. Results Postoperative hypernatremia developed in 46.5% (57/127) of dogs and hyponatremia in 6.3% (8/127). Plasma sodium concentration increased after surgery and peaked at 8 hours after surgery, normalizing after 24 to 48 hours. Plasma potassium concentration increased without exceeding the reference limit. No significant associations were found between clinical and surgical variables and hypernatremia, or between hypernatremia and postoperative death, long‐term survival or recurrence. Surgery time was significantly longer in dogs that developed persistent diabetes insipidus (P = .02) and persistent diabetes insipidus occurred more frequently in dogs with enlarged pituitary glands (P = .01). Conclusion and Clinical Importance Hypernatremia remains a frequent postoperative complication after transsphenoidal hypophysectomy but did not appear to have an impact on postoperative outcome. No predisposing factor to postoperative hypernatremia was identified. Variations in plasma potassium concentrations do not seem to influence postoperative outcome.
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Affiliation(s)
- Sara Del Magno
- Department of Veterinary Medical Sciences, School of Agriculture and Veterinary Medicine, University of Bologna, Ozzano dell'Emilia, Italy
| | - Sarah van Rijn
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Stefano Azzariti
- Department of Clinical Sciences and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Chiara Valtolina
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jiske L' Ami
- IVC Evidensia Nederland, Vleuten, The Netherlands
| | - Björn P Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Morsink NC, Klaassen NJM, Meij BP, Kirpensteijn J, Grinwis GCM, Schaafsma IA, Hesselink JW, Nijsen JFW, van Nimwegen SA. Case Report: Radioactive Holmium-166 Microspheres for the Intratumoral Treatment of a Canine Pituitary Tumor. Front Vet Sci 2021; 8:748247. [PMID: 34805338 PMCID: PMC8600255 DOI: 10.3389/fvets.2021.748247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In this case study, a client-owned dog with a large pituitary tumor was experimentally treated by intratumoral injection of radioactive holmium-166 microspheres (166HoMS), named 166Ho microbrachytherapy. To our knowledge, this is the first intracranial intratumoral treatment through needle injection of radioactive microspheres. Materials and Methods: A 10-year-old Jack Russell Terrier was referred to the Clinic for Companion Animal Health (Faculty of Veterinary Medicine, Utrecht University, The Netherlands) with behavioral changes, restlessness, stiff gait, and compulsive circling. MRI and CT showed a pituitary tumor with basisphenoid bone invasion and marked mass effect. The tumor measured 8.8 cm3 with a pituitary height-to-brain area (P/B) ratio of 1.86 cm-1 [pituitary height (cm) ×10/brain area (cm2)]. To reduce tumor volume and neurological signs, 166HoMS were administered in the tumor center by transsphenoidal CT-guided needle injections. Results: Two manual CT-guided injections were performed containing 0.6 ml of 166HoMS suspension in total. A total of 1097 MBq was delivered, resulting in a calculated average tumor dose of 1866 Gy. At 138 days after treatment, the tumor volume measured 5.3 cm3 with a P/B ratio of 1.41 cm-1, revealing a total tumor volume reduction of 40%. Debulking surgery was performed five months after 166HoMS treatment due to recurrent neurological signs. The patient was euthanized two weeks later at request of the owners. Histopathological analysis indicated a pituitary adenoma at time of treatment, with more malignant characteristics during debulking surgery. Conclusion: The 40% tumor volume reduction without evident severe periprocedural side effects demonstrated the feasibility of intracranial intratumoral 166HoMS treatment in this single dog.
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Affiliation(s)
- Nino Chiron Morsink
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Nienke Johanna Maria Klaassen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Björn Petrus Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jolle Kirpensteijn
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | | | - Irene Afra Schaafsma
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jan Willem Hesselink
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Johannes Frank Wilhelmus Nijsen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Quirem Medical, Deventer, Netherlands
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13
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Miller MA, Piotrowski SL, Donovan TA, Scott-Moncrieff JC, Owen TJ, McCue JP, DuSold DM, Ramos-Vara JA, Weng HY, Chen AV, Martin LG, Bruyette DS. Feline Pituitary Adenomas: Correlation of Histologic and Immunohistochemical Characteristics With Clinical Findings and Case Outcome. Vet Pathol 2021; 58:266-275. [PMID: 33280571 PMCID: PMC10722206 DOI: 10.1177/0300985820978309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pituitary glands from 141 feline autopsy cases were reviewed histologically. Adenoma and hyperplasia were the most common lesions at 13 cases each. Pituitary adenoma was more likely than hyperplasia to be associated with clinical evidence of endocrinopathy or an intracranial mass (P < .001). A histochemical and immunohistochemical panel was applied to 44 autopsy- or hypophysectomy-derived pituitary adenomas in 43 cats from 2 diagnostic laboratories. Adenomas were differentiated from hyperplasia by the presence of disrupted reticulin fibers. One cat had a double (somatotroph and melanotroph) adenoma. Twenty somatotroph adenomas consisted of periodic acid-Schiff (PAS)-negative acidophils that expressed growth hormone; 16/20 had hypersomatotropism; 17/20 had diabetes mellitus. Eleven melanotroph adenomas consisted of PAS-positive basophils or chromophobes that expressed melanocyte-stimulating and adrenocorticotrophic hormones; 5/11 had hypercortisolism; 6/11 had diabetes mellitus. Eleven gonadotroph adenomas consisted of PAS-negative chromophobes that expressed follicle-stimulating and/or luteinizing hormones. Two thyrotroph adenomas consisted of PAS-negative basophils or chromophobes that expressed thyroid-stimulating hormone. Pituitary-dependent disease was not recognized in cats with gonadotroph or thyrotroph adenomas. The Ki-67 proliferation index in hypophysectomy specimens was lower in somatotroph than in melanotroph adenomas. Fourteen cats with hypophysectomy-treated somatotroph or melanotroph adenoma had an 899-day median survival time versus 173 days in 17 nonsurgical cases. After adjusting for age, adenoma size and type, hypophysectomized cats had an overall better survival time than nonsurgical cases (P = .029). The study results underscore the value of hypophysectomy and trophic hormone immunohistochemistry in the treatment and classification of feline pituitary adenomas.
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Affiliation(s)
| | - Stacey L. Piotrowski
- Purdue University, West Lafayette, IN, USA
- Comparative Biomedical Scientist Training Program, National Institutes of Health, Bethesda, MD, USA
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14
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Rivenburg R, Owen TJ, Martin LG, Chen AV. Pituitary Surgery: Changing the Paradigm in Veterinary Medicine in the United States. J Am Anim Hosp Assoc 2021; 57:73-80. [PMID: 33450023 DOI: 10.5326/jaaha-ms-7009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2020] [Indexed: 11/11/2022]
Abstract
Medical management is currently the most common treatment for pituitary-dependent hyperadrenocorticism and hypersomatotropism/acromegaly in veterinary medicine. Medical management does not provide a cure for either disease process, and rarely is pituitary imaging a part of initial diagnostics. Early pituitary imaging in animals with clinically functional pituitary tumors provides a baseline assessment, allows monitoring of tumor changes, and permits radiation and surgical planning. Surgery is the only treatment for pituitary tumors that has curative intent and allows for a definitive diagnosis. Surgical removal of pituitary tumors via transsphenoidal hypophysectomy is an effective treatment for clinical pituitary tumors in patients exhibiting endocrine abnormalities associated with pituitary-dependent hyperadrenocorticism and hypersomatotropism. Surgery, however, is rarely pursued until patients have failed medical management, and often not until they are showing neurologic signs, making surgical success challenging. It is well documented that dogs surgically treated when the pituitary mass is small have a lower mortality, a lower recurrence rate, and a longer survival than those with larger pituitary masses. Providing owners with the option of early pituitary imaging in addition to medical, surgical, and radiation treatment options should be the standard of care for animals diagnosed with pituitary-dependent hyperadrenocorticism or hypersomatotropism.
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15
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Fleeman L, Gostelow R. Updates in Feline Diabetes Mellitus and Hypersomatotropism. Vet Clin North Am Small Anim Pract 2020; 50:1085-1105. [PMID: 32680669 DOI: 10.1016/j.cvsm.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Flash glucose monitoring is a novel, noninvasive monitoring technique that is increasingly used in the management of small animal diabetes. This article provides guidance on the use of flash glucose monitoring in cats and demonstrates how this technique can be used in a range of feline diabetic cases, including those where management is proving challenging. Other aspects of complicated feline diabetic care are also discussed, including management of the sick diabetic cat, potassium depletion myopathy, and treatment options for cats with hypersomatotropism-associated diabetes mellitus. The use of insulin glargine 300 U/ml as a promising new long-acting insulin for diabetic cats is also discussed.
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Affiliation(s)
- Linda Fleeman
- Animal Diabetes Australia, 9-11 Miles Street, Mulgrave, Victoria 3170, Australia
| | - Ruth Gostelow
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, UK.
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16
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Li X, Su S, Zhao H, Li Y, Xu X, Gao Y, Sun D, Yang Z, Jin W, Ke C. Virus Injection to the Pituitary via Transsphenoidal Approach and the Innervation of Anterior and Posterior Pituitary of Rat. Front Endocrinol (Lausanne) 2020; 11:546350. [PMID: 33343506 PMCID: PMC7746818 DOI: 10.3389/fendo.2020.546350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
The theory holds that the anterior pituitary in mammals receives humoral regulation. Previous studies have reported that the pars distalis of the anterior pituitary of several mammalian species contains substance P-, calcitonin gene-related peptide (CGRP)-, and galanin-like immunoreactive nerve fibers, but the origins of these nerve fibers are unclear. Removal of the pituitary gland, also called hypophysectomy, involves methods that access the pituitary gland via the transauricular or parapharyngeal pathways. However, these methods are not applicable for viral tracer injection to investigate the innervation of the anterior pituitary. The transauricular technique leads to inaccuracies in locating the pituitary gland, while the parapharyngeal approach causes high mortality in animals. Here, we introduce a protocol that accesses the pituitary gland in the rat via the transsphenoidal pathway. This method imitates surgical manipulations such as endotracheal intubation and sphenoid bone drilling, which involve the use of custom-made devices. Using the transsphenoidal pathway greatly improves the survival rate of rats because no additional dissection of blood vessels and nerves is required. Moreover, the pituitary gland can be viewed clearly and directly during the operation, making it possible to accurately inject pseudorabies virus (PRV) 152-expressing enhanced green fluorescent protein (EGFP) into the anterior or posterior pituitary, respectively. After injecting PRV 152 into the anterior pituitary, we found no evidence of direct innervation of the anterior pituitary in the rat brain. However, PRV 152 injection into the posterior pituitary revealed retrograde transneuronal cell bodies in many brain areas, including the CA1 field of the hippocampus, the basolateral amygdaloid nucleus, posterior part (BLP), the arcuate hypothalamic nucleus (Arc), the dorsal portion of the dorsomedial hypothalamic nucleus (DMD), the suprachiasmatic nucleus (SCh), and the subfornical organ (SFO). In the present study, we provide a description of a possible model of hypophysectomy or pituitary injection, and identify brain regions involved in regulating the rat pituitary gland using transneuronal retrograde cell body labeling with PRV.
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Affiliation(s)
- Xiaohui Li
- Institute of Anesthesiology and Pain (IAP), Department of Anesthesiology, Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Shanchun Su
- Institute of Anesthesiology and Pain (IAP), Department of Anesthesiology, Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Haiwen Zhao
- Institute of Anesthesiology and Pain (IAP), Department of Anesthesiology, Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yang Li
- Institute of Anesthesiology and Pain (IAP), Department of Anesthesiology, Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Xueqin Xu
- Institute of Anesthesiology and Pain (IAP), Department of Anesthesiology, Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yan Gao
- Institute of Anesthesiology and Pain (IAP), Department of Anesthesiology, Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Dongsheng Sun
- Institute of Anesthesiology and Pain (IAP), Department of Anesthesiology, Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Zeyong Yang
- Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Weilin Jin
- Institute of Nano Biomedicine and Engineering, Department of Instrument Science and Engineering, Key Lab. for Thin Film and Microfabrication Technology of Ministry of Education, School of Electronic Information and Electronic Engineering, Shanghai JiaoTong University, Shanghai, China
| | - Changbin Ke
- Institute of Anesthesiology and Pain (IAP), Department of Anesthesiology, Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- *Correspondence: Changbin Ke,
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17
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Lehner L, Garamvölgyi R, Jakab C, Kerekes Z, Czeibert K. A Recurrent Suprapituitary Ependymal Cyst Managed by Endoscopy-Assisted Transsphenoidal Surgery in a Canine: A Case Report. Front Vet Sci 2019; 6:112. [PMID: 31041316 PMCID: PMC6476904 DOI: 10.3389/fvets.2019.00112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/25/2019] [Indexed: 11/13/2022] Open
Abstract
A 9-years-old spayed female mixed-breed dog was referred for the evaluation of intermittent head tremors, obtundation, long-standing blindness, and a tendency to seek confined spaces. The dog lost its vision 6 months before the current presentation. A menace response was absent on ophthalmological examination. Neurological examination did not show any abnormalities. A cyst measuring 16 × 18 × 14 mm was observed above the pituitary gland on magnetic resonance imaging. It extended toward the frontal area and compressed the optic chiasm and hypothalamic regions. A minimum preoperative database, including the findings of other required blood tests, was prepared. No abnormal laboratory findings were observed. Endoscopy-assisted transsphenoidal hypophysectomy was performed to remove the pituitary gland, drain the cyst, and partially excise the cyst wall. Normal pituitary gland tissue was observed on histopathology, and the mass was found to have a neuroendocrine or ependymal origin on cytology. Strict post-operative laboratory tests were performed at 1-h intervals for 24 h. An empty sella turcica region, and a collapsed and empty cyst wall was observed on follow-up magnetic resonance imaging. After 3 days of observation, the dog was discharged with a prescription of substitution therapy. However, the dog presented with the same signs and symptoms 73 days after the surgery. Cyst recurrence was apparent on magnetic resonance imaging. The owner requested euthanasia, and an ependymal cyst was observed on necropsy. To the best of our knowledge, we present the first case of an intra- and suprasellar ependymal cyst, and its surgical management in a canine. The findings from this case suggest that endoscopic transsphenoidal drainage and hypophysectomy could be a good surgical approach in cases where involvement of the pituitary gland is confirmed or strongly suspected on the basis of cytological and imaging findings.
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Affiliation(s)
- László Lehner
- Felicavet Veterinary Clinic and Hospital, Budapest, Hungary
| | - Rita Garamvölgyi
- Medicopus Nonprofit, Ltd., "Kaposi Mór" Teaching Hospital of Somogy County, Kaposvár, Hungary
| | | | - Zoltán Kerekes
- VetScan Small Animal Diagnostic, Ltd., Budapest, Hungary
| | - Kálmán Czeibert
- Department of Ethology, Institute of Biology, "Eötvös Loránd" University, Budapest, Hungary
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18
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Del Magno S, Fracassi F, Grinwis GCM, Mandrioli L, Gandini G, Rossi F, Sirri R, Pisoni L, Tryfonidou MA, Meij BP. Sequential Treatment of a Large Pituitary Corticotroph Neoplasm and Associated Neurological Signs in a Dog. J Am Anim Hosp Assoc 2019; 55:e55202. [PMID: 30776261 DOI: 10.5326/jaaha-ms-6831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
No standardized treatment guidelines are reported in veterinary medicine for dogs with large pituitary corticotroph neoplasms causing neurological signs, and such dogs usually have a short overall survival. When these dogs undergo pituitary surgery and the tumor regrows there are few reports of subsequent treatments. A 7 yr old male Maltese diagnosed with pituitary-dependent hypercortisolism developed seizures in conjunction with a large pituitary corticotroph adenoma and underwent transsphenoidal hypophysectomy. After 3 yr of clinical remission, hypercortisolism recurred, and trilostane therapy was initiated. One year later, the dog developed new neurological signs and computed tomography revealed regrowth of a large pituitary mass that was then treated with radiation therapy. The dog lived disease-free for 3 more yr. At postmortem examination, a more aggressive pituitary neoplasm than the one examined at the time of surgery was found, which is suggestive of malignant transformation into a carcinoma despite the absence of convincing metastasis.
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Affiliation(s)
- Sara Del Magno
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Federico Fracassi
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Guy C M Grinwis
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Luciana Mandrioli
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Gualtiero Gandini
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Federica Rossi
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Rubina Sirri
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Luciano Pisoni
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Marianna A Tryfonidou
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
| | - Björn P Meij
- From the Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy (S.D.M., F.F., L.M., G.G., R.S. L.P.); Department of Pathobiology (G.C.M.G.) and Department of Clinical Sciences of Companion Animals (M.A.T., B.P.M.), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy (F.R.)
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