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Park SS, Kang H, Kim YH, Kim JH. Different tumor growth pattern of clinically nonfunctioning pituitary neuroendocrine tumor according to sex and age: a longitudinal study. J Endocrinol Invest 2024; 47:1911-1921. [PMID: 38310625 PMCID: PMC11266204 DOI: 10.1007/s40618-024-02303-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024]
Abstract
PURPOSE Asymptomatic patients with clinically non-functional pituitary neuroendocrine tumors (CNF-PitNETs) are usually followed up. However, the natural course of CNF-PitNETs according to sex and age remains unclear. Therefore, this study assessed growth patterns of CNF-PitNETs according to sex and age. METHODS In this longitudinal study, we enrolled 431 consecutive patients with CNF-PitNETs who were treated at Seoul National University Hospital from 1997 to 2021. The patients underwent hormone function testing and visual field testing, and were subsequently followed up with imaging over a median duration of 66 months. RESULTS The median age of the patients was 53.0 years, and 37.1% (n = 160) were men. Men were older and harbored more macroadenomas than women. The annual tumor volume change was higher in men than in women (0.21 vs. 0.04 cm3/year, P < 0.001). The estimated cutoff value of age for significant tumor growth was 51 years. In men, the annual tumor volume change was similar across all age groups. In women, those aged ≤ 50 years showed significantly lower annual tumor volume change than those aged > 50 years (0.01, 0.11, and 0.17 cm3/year, P = 0.001). When comparing sexes within the same age group, the annual tumor volume changes was significantly lower for women than for men, only in patients aged ≤ 50 years (0.01 vs. 0.15 cm3/year, P < 0.001). CONCLUSIONS Among patients with CNF-PitNET, tumor growth was slower in women aged ≤ 50 years than in men and women aged > 50. These findings may guide the customization of surveillance strategies for CNF-PitNETs according to sex and age.
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Affiliation(s)
- S S Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Dae-hak ro, Seoul, 03080, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Pituitary Center, Seoul National University Hospital, Seoul, Korea
| | - H Kang
- Pituitary Center, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Dae-hak ro, Seoul, 03080, Korea
| | - Y H Kim
- Pituitary Center, Seoul National University Hospital, Seoul, Korea.
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Dae-hak ro, Seoul, 03080, Korea.
| | - J H Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Dae-hak ro, Seoul, 03080, Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
- Pituitary Center, Seoul National University Hospital, Seoul, Korea.
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Endocrinological aspects of pituitary adenoma surgery in Europe. Sci Rep 2022; 12:6529. [PMID: 35444169 PMCID: PMC9021226 DOI: 10.1038/s41598-022-10300-1] [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: 08/14/2021] [Accepted: 04/04/2022] [Indexed: 12/03/2022] Open
Abstract
Hormone-secreting adenomas are treated in many neurosurgical centers within Europe. The goal of the survey is to understand variance in practice management of pituitary tumors amongst neurosurgical centers. A list of departments performing pituitary surgery was created. The survey consisted of 58 questions. This study focuses on neurosurgical care of hormone-secreting adenomas. For analysis, the departments were divided into four subgroups: academic/non-academic, high-volume/low-volume, “mainly endoscopic/mainly microscopic practice” and geographical regions. Data from 254 departments from 34 countries were obtained. Most centers surgically treat 1–5 hormone-secreting adenomas per year. In prolactinomas this is the case in 194 centers, (76.4%), in GH-secreting adenomas: 133 centers, (52.4%), ACTH-secreting adenomas: 172 centers, (69.8%). Surgery as a primary treatment of prolactinomas is considered in 64 centers (25.2%). In 47 centers (18.8%), GH-secreting microadenomas are often treated pharmacologically first. Debulking surgery for an invasive GH-secreting adenoma in which hormonal remission is not a realistic goal of the surgery and the patient has no visual deficit surgery is always or mostly indicated in 156 centers (62.9%). Routine postoperative hydrocortisone replacement therapy is administered in 147 centers (58.6%). Our survey shows that in most centers, few hormone-secreting adenomas are treated per year. In about 25% of the centers, prolactinoma surgery may be regarded as first-line treatment; in about 20% of the centers, medical treatment is the first-line treatment for GH-secreting adenomas. Pretreatment for ACTH-secreting adenomas is routinely used in 21% of centers. This survey may serve as plea for neurosurgical care centralization of hormone-secreting adenomas.
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Májovský M, Grotenhuis A, Foroglou N, Zenga F, Froehlich S, Ringel F, Sampron N, Thomas N, Komarc M, Netuka D. What is the current clinical practice in pituitary adenoma surgery in Europe? European Pituitary Adenoma Surgery Survey (EU-PASS) results-technical part. Neurosurg Rev 2021; 45:831-841. [PMID: 34337683 DOI: 10.1007/s10143-021-01614-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
Pituitary adenoma surgery has evolved rapidly in recent decades, changing clinical practice markedly and raising new challenges. There is no current consensus or guidelines for perioperative care that includes possible complication management. This study aims to determine current practice across European neurosurgical centres. We created a list of eligible departments performing pituitary adenoma surgery based on cooperation with EANS, national neurosurgical societies, and personal communication with local neurosurgeons. We contacted the chairpersons from each department and asked them (or another responsible neurosurgeon) to fill out the survey. The survey consisted of 58 questions. For further analysis, departments were divided into subgroups: "academic"/ "non-academic centre", "high-volume"/"low-volume", "mainly endoscopic"/ "mainly microscopic"/ "mixed practise", and by geographical regions. Data from 254 departments from 34 countries were obtained. The average time to complete the survey was 18 min. Notably, the endoscopic approach is the predominant surgical approach in Europe, used in 56.8% of the centres. In routine cases without intraoperative cerebrospinal fluid leak, high-volume centres are less pedantic with sellar closure when compared with low-volume centres (p < 0.001). On the other hand, when a postoperative cerebrospinal fluid leak occurs, high-volume centres are more active and indicate early reoperation (p = 0.013). Less than 15% of the participating centres perform early postoperative MRI scans. Marked variation was noted among different groups of respondents and some contentious issues are discussed. Such information can encourage useful debate about the reasons for the variations seen and perhaps help develop standardised protocols to improve patient outcomes. A future research focus is to compare European results with other regions.
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Affiliation(s)
- Martin Májovský
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
| | - Andre Grotenhuis
- Neurosurgery Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nicolas Foroglou
- 1St Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Francesco Zenga
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | | | - Florian Ringel
- Department of Neurosurgery, Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Nicolas Sampron
- Neurosurgery Department, University Hospital Donostia, San Sebastian, Spain
| | - Nick Thomas
- Department of Neurosurgery, King's College, London, UK
| | - Martin Komarc
- Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
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Chibbaro S, Signorelli F, Milani D, Cebula H, Scibilia A, Bozzi MT, Messina R, Zaed I, Todeschi J, Ollivier I, Mallereau CH, Dannhoff G, Romano A, Cammarota F, Servadei F, Pop R, Baloglu S, Lasio GB, Luca F, Goichot B, Proust F, Ganau M. Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience. Cancers (Basel) 2021; 13:cancers13143603. [PMID: 34298816 PMCID: PMC8304085 DOI: 10.3390/cancers13143603] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/22/2021] [Accepted: 07/10/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Giant pituitary adenomas are highly invasive tumors whose treatment is challenging. Surgery is their management mainstay. However, there is no consensus about the type of approach. Open transcranial, microscopic, and endoscopic trans-sphenoidal approaches have all been employed, alone or in combination. Extended endoscopic endonasal techniques may represent a versatile and safe one-stage approach. Our research aimed at evaluating prospectively their applicability, effectiveness, and safety in a multicenter series, to acquire further evidence toward its use in the treatment of those challenging lesions. Ninety-six patients were recruited and followed-up for 52.4 months on average. Most of them (81.2%) presented with visual deficits and >50% had various degrees of adenohypophysis insufficiency. Resection of at least 75% of initial volume was achieved in all cases, with 98.7% visual improvement, >50% endocrine deficit recovery and a permanent complication rate of 4.2%, indicating extended endoscopic endonasal approaches as a valuable treatment option. Abstract Purpose: To evaluate factors influencing clinical and radiological outcome of extended endoscopic endonasal transtuberculum/transplanum approach (EEA-TTP) for giant pituitary adenomas (GPAs). Methods: We recruited prospectively all consecutive GPAs patients undergoing EEA-TTP between 2015 and 2019 in 5 neurosurgical centers. Preoperative clinical and radiologic features, visual and hormonal outcomes, extent of resection (EoR), complications and recurrence rates were recorded and analyzed. Results: Of 1169 patients treated for pituitary adenoma, 96 (8.2%) had GPAs. Seventy-eight (81.2%) patients had visual impairment, 12 (12.5%) had headaches, 3 (3.1%) had drowsiness due to hydrocephalus, and 53 (55.2%) had anterior pituitary insufficiency. EoR was gross or near-total in 46 (47.9%) and subtotal in 50 (52.1%) patients. Incomplete resection was associated with lateral suprasellar, intraventricular and/or cavernous sinus extension and with firm/fibrous consistence. At the last follow-up, all but one patient (77, 98.7%) with visual deficits improved. Headache improved in 8 (88.9%) and anterior pituitary function recovered in 27 (50.9%) patients. Recurrence rate was 16.7%, with 32 months mean recurrence-free survival. Conclusions: EEA-TTP is a valid option for GPAs and seems to provide better outcomes, lower rate of complications and higher EoR compared to one- or multi-stage microscopic, non-extended endoscopic transsphenoidal, and transcranial resections.
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Affiliation(s)
- Salvatore Chibbaro
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Francesco Signorelli
- Neurosurgery Unit, Department of Basic Medical Sciences, Neurosciences, Sense Organs, University “Aldo Moro”, 70124 Bari, Italy;
- Correspondence: ; Tel.: +39-0805592900
| | - Davide Milani
- Neurosurgery Unit, Humanitas Research Hospital, 20089 Milano, Italy; (D.M.); (F.S.); (G.B.L.)
| | - Helene Cebula
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Antonino Scibilia
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Maria Teresa Bozzi
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Raffaella Messina
- Neurosurgery Unit, Department of Basic Medical Sciences, Neurosciences, Sense Organs, University “Aldo Moro”, 70124 Bari, Italy;
| | - Ismail Zaed
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
- Neurosurgery Unit, Humanitas Research Hospital, 20089 Milano, Italy; (D.M.); (F.S.); (G.B.L.)
| | - Julien Todeschi
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Irene Ollivier
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Charles Henry Mallereau
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Guillaume Dannhoff
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Antonio Romano
- Neurosurgery Department, Parma and Reggio Emilia Hospital, University of Parma, 43126 Parma, Italy;
| | - Francesco Cammarota
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Franco Servadei
- Neurosurgery Unit, Humanitas Research Hospital, 20089 Milano, Italy; (D.M.); (F.S.); (G.B.L.)
| | - Raoul Pop
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Seyyid Baloglu
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Giovanni Battista Lasio
- Neurosurgery Unit, Humanitas Research Hospital, 20089 Milano, Italy; (D.M.); (F.S.); (G.B.L.)
| | - Florina Luca
- Endocrinology Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (F.L.); (B.G.)
| | - Bernard Goichot
- Endocrinology Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (F.L.); (B.G.)
| | - Francois Proust
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
| | - Mario Ganau
- Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France; (S.C.); (H.C.); (A.S.); (M.T.B.); (I.Z.); (J.T.); (I.O.); (C.H.M.); (G.D.); (F.C.); (R.P.); (S.B.); (F.P.); (M.G.)
- Neurosurgery Department, Oxford University Hospital, Oxford OX3 9DU, UK
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Chen W, Wang M, Duan C, Yao S, Jiao H, Wang Z, Hu B, Mao Z, Zhu Y, Wang H. Prediction of the Recurrence of Non-Functioning Pituitary Adenomas Using Preoperative Supra-Intra Sellar Volume and Tumor-Carotid Distance. Front Endocrinol (Lausanne) 2021; 12:748997. [PMID: 34659129 PMCID: PMC8515129 DOI: 10.3389/fendo.2021.748997] [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: 07/28/2021] [Accepted: 09/14/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Currently, it is difficult to estimate the possibility of recurrence of nonfunctioning pituitary adenomas (NFPAs). Markers such as Ki-67 or transcription factors rely on postoperative pathology, while few indices can be used for preoperative prediction. Therefore, we aimed to investigate the predictive effectiveness of supra-intrasellar volume and tumor-carotid distance based on measurements derived from preoperative magnetic resonance imaging (MRI) data. METHOD Ninety-eight cases of NFPAs were evaluated, along with their clinical characteristics and MRI features. Four radiologic indices were analyzed, including intrasellar tumor volume, suprasellar tumor volume, maximum horizontal tumor diameter, and intercarotid distance. The ratio of supra-intrasellar volume and ratio of tumor-carotid distance were measured using 3D Slicer software, and the sum of two ratios was defined as the V-D value. The correlation between recurrence and multiple factors was analyzed using univariate and multivariate logistic regression and Kaplan-Meier analysis, and ROC curves were used to estimate the prognostic performance of radiologic measurements in NFPAs. RESULT The supra-intrasellar volume ratio, tumor-carotid distance ratio and V-D value were significantly correlated with the recurrence of NFPAs. The predictive importance of the V-D value reached 84.5%, with a sensitivity of 83.7% and specificity of 67.3%. The cutoff limit of the V-D value was 1.53, and patients with V-D values higher than 1.53 tended to relapse much earlier. CONCLUSION The V-D value has predictive importance for the recurrence of NFPAs preoperatively. Patients with higher V-D values will undergo recurrence earlier and should be given greater consideration in terms of surgery and follow-up time.
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Affiliation(s)
- Wenli Chen
- Center for Pituitary Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mengqi Wang
- Center for Pituitary Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chengbin Duan
- Center for Pituitary Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shun Yao
- Center for Pituitary Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haosen Jiao
- Center for Pituitary Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zongming Wang
- Center for Pituitary Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Hu
- Center for Pituitary Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhigang Mao
- Center for Pituitary Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yonghong Zhu
- Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Haijun Wang, ; Yonghong Zhu,
| | - Haijun Wang
- Center for Pituitary Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Haijun Wang, ; Yonghong Zhu,
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