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Mo C, Li M, Li Y, Liu Y, Zhao R, Wang H, Hu J, Guo W. A Simple Scoring System for Predicting the Risk of Delayed Hyponatremia After Endoscopic Transsphenoidal Surgery for Pituitary Adenomas. World Neurosurg 2024; 187:e35-e41. [PMID: 38531471 DOI: 10.1016/j.wneu.2024.03.073] [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: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND To identify high-risk patients for delayed postoperative hyponatremia (DPH) early, we constructed a simple and effective scoring system. METHODS We retrospectively analyzed 141 consecutive patients who underwent endoscopic transsphenoidal surgery from January 2019 to December 2022. Patients were divided into DPH group and nondelayed postoperative hyponatremia group based on whether hyponatremia occurred after the third postoperative day. Multivariable logistic regression analysis was conducted to determine the predictive factors of DPH, and a simple scoring system was constructed based on these predictors. RESULTS Among 141 patients, 36 (25.5%) developed DPH. Multivariable logistic regression analysis showed that age ≥48 years (odds ratio [OR], 3.74; 95% confidence interval [CI], 1.14-12.21; P = 0.029), Knosp grade ≥3 (OR, 5.17; 95% CI, 1.20-22.27; P = 0.027), postoperative hypokalemia within three days (OR, 3.13; 95% CI, 1.05-9.33; P = 0.040), a difference in blood sodium levels between the first and second day after surgery ≥1 mEq/L (OR, 3.65; 95% CI, 1.05-12.77; P = 0.043), and postoperative diabetes insipidus (OR, 3.57; 95% CI, 1.16-10.96; P = 0.026) were independent predictors of DPH. CONCLUSIONS This scoring system for predicting DPH has an area under the receiver operating characteristic curve of 0.856 (95% CI, 0.787-0.925), indicating moderate to good predictive value for DPH in our cohort, but further prospective external validation is needed.
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Affiliation(s)
- Changhong Mo
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
| | - Maoxiang Li
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
| | - Yangyang Li
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
| | - Yi Liu
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
| | - Ruijing Zhao
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
| | - Hao Wang
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China; Department of Neurosurgery, Shenzhen People's Hospital, Shenzhen, Guangdong, China; Guangdong Engineering Technological Research Center for Nervous Anatomy and Related Clinical Applications, Shenzhen, Guangdong, China
| | - Jiliang Hu
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China; Department of Neurosurgery, Shenzhen People's Hospital, Shenzhen, Guangdong, China; Guangdong Engineering Technological Research Center for Nervous Anatomy and Related Clinical Applications, Shenzhen, Guangdong, China
| | - Wei Guo
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China; Department of Neurosurgery, Shenzhen People's Hospital, Shenzhen, Guangdong, China; Guangdong Engineering Technological Research Center for Nervous Anatomy and Related Clinical Applications, Shenzhen, Guangdong, China.
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Filchenko I, Korostovtseva L, Bochkarev M, Tsoy U, Sviryaev Y. Cardiovascular remodeling in active and controlled acromegaly: association with sleep-disordered breathing. Sleep Breath 2023; 27:2305-2314. [PMID: 37148385 DOI: 10.1007/s11325-023-02838-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE We hypothesized that an unfavorable cardiovascular profile in acromegaly is associated with sleep-disordered breathing (SDB), while acromegaly control improves both respiratory sleep characteristics and the cardiovascular profile. METHODS The patients underwent the assessment of breathing during sleep and cardiovascular profile assessment at the start of the study including arterial stiffness, blood pressure, echocardiography, nocturnal heart rate variability (HRV). The assessment was repeated in patients with acromegaly at 1 year after transsphenoidal adenectomy (TSA). RESULTS A total of 47 patients with acromegaly and 55 control subjects were enrolled. At one year after TSA, 22 patients with acromegaly were reassessed. Multiple linear regression analysis with adjustment for age, sex and body mass index (BMI) showed the associations of insulin growth-like factor 1 (IGF-1) with obstructive apnea index (OAI: β=0.035/h, p<0.001), but not with cardiovascular parameters, in patients with acromegaly. The analysis of combined acromegaly and control dataset with adjustment for age, sex and BMI showed the association the presence of acromegaly with diastolic blood pressure (DBP; β=17.99 mmHg, p<0.001), ejection fraction (EF; β=6.23%, p=0.009), left heart remodeling (left ventricle posterior wall: β=0.81 mm, p=0.045) and the association of the presence of SDB (apnea-hypopnea index≥15/h) with left ventricular function (EF: -4.12%, p=0.040; end systolic volume: 10.12 ml, p=0.004). Control of acromegaly was accompanied by the decrease in OAI (5.9 [0.8, 14.5]/h and 1.7 [0.2, 5.1]/h, p=0.004) and nocturnal heart rate (66.1 [59.2, 69.8] bpm and 61.7 [54.0, 67.2] bpm, p=0.025) and by the increase in blood pressure (DBP: 78.0 [70.3, 86.0] mm Hg and 80.0 [80.0, 90.0] mm Hg, p=0.012). CONCLUSION The comorbidities of acromegaly, including sleep-disordered breathing, appear to have a long-term effect on cardiovascular remodeling in active acromegaly. Future studies should investigate the applicability of the treatment of SDB for the reduction of cardiovascular risk in acromegaly.
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Affiliation(s)
- Irina Filchenko
- Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341.
| | - Lyudmila Korostovtseva
- Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341
| | - Mikhail Bochkarev
- Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341
| | - Uliana Tsoy
- Almazov National Medical Research Center, Laboratory of Endocrinology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341
| | - Yuri Sviryaev
- Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341
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Hussein IH, Mansour AA, Jameel NA. Comparing MRI volume measurement techniques for pituitary macroadenoma: Investigating volume reduction and its relationship with biochemical control. J Med Life 2023; 16:998-1006. [PMID: 37900080 PMCID: PMC10600678 DOI: 10.25122/jml-2022-0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 02/28/2023] [Indexed: 10/31/2023] Open
Abstract
Pituitary adenomas are one of the most common types of primary intracranial tumors. Measuring pituitary adenoma volume is fundamental for effective management. This study aimed to assess the reliability of the ellipsoid method in comparison with the perimeter method for measuring pituitary macroadenoma volume. In addition, we investigated the correlation between adenoma size reduction and biochemical control in functioning adenomas. This was a retrospective cross-sectional cohort study including 113 patients with pituitary macroadenomas. MRI was obtained for volume measurement by ellipsoid and perimeter methods using two types of DICOM viewer software. Both ellipsoid and perimeter methods exhibit positive, strong, and significant correlations in pituitary macroadenomas in pre-treatment and post-treatment volume (Spearman correlation coefficient 0.95, p-value <0.0001). There was no significant difference in the mean post-treatment pituitary adenoma volume measurements utilizing the ellipsoid and the perimeter methods in different treatment modalities. There were significant differences in the pre-treatment volume measurements between the two methods, both in NFPA and prolactinoma. No correlation was found between volume variability measured by ellipsoid and perimeter methods and the degree of hormonal control in functioning pituitary adenomas. Both the ellipsoid and perimetric methods can be utilized for pituitary adenoma volume measurements as they demonstrate a strong and positive correlation. However, it is important to note that the ellipsoid method tends to result in overestimated tumor volume. There was no correlation between the adenoma size reduction and the degree of biochemical response in functioning adenomas.
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Affiliation(s)
- Ibrahim Hani Hussein
- Department of Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC), Basrah, Iraq
| | - Abbas Ali Mansour
- Department of Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC), Basrah, Iraq
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De Alcubierre D, Puliani G, Cozzolino A, Hasenmajer V, Minnetti M, Sada V, Martines V, Zaccagnino A, Ruggeri AG, Pofi R, Sbardella E, Venneri MA. Pituitary adenoma consistency affects postoperative hormone function: a retrospective study. BMC Endocr Disord 2023; 23:92. [PMID: 37101307 PMCID: PMC10131333 DOI: 10.1186/s12902-023-01334-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/05/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Tumor consistency recently emerged as a key factor in surgical planning for pituitary adenomas, but its impact on postoperative endocrine function is still unclear. Our study aimed to evaluate the impact of tumor consistency on the development of postoperative pituitary deficiencies. METHODS Single-center, retrospective analysis of consecutive pituitary surgeries performed between January 2017 and January 2021 at Policlinico Umberto I in Rome. All patients underwent radiological and biochemical evaluations at baseline, and hormone assessments 3 and 6 months after pituitary surgery. Postoperative MRI studies were used to determine resection rates following surgery. Data on tumor consistency, macroscopic appearance, neurosurgical approach, and intraoperative complications were collected. RESULTS Fifty patients [24 women, mean age 57 ± 13 years, median tumor volume 4800 mm3 [95% CI 620-8828], were included. Greater tumor volume (χ2 = 14.621, p = 0.006) and male sex (χ2 = 12.178, p < 0.001) were associated with worse preoperative endocrine function. All patients underwent transsphenoidal adenomectomy. Fibrous consistency was observed in 10% of patients and was associated with a Ki-67 greater than 3% (χ2 = 8.154, p = 0.04), greater risk of developing postoperative hormone deficiencies (χ2 = 4.485, p = 0.05, OR = 8.571; 95% CI: 0.876-83.908), and lower resection rates (χ2 = 8.148, p = 0.004; OR 1.385, 95% CI; 1.040-1.844). Similarly, worse resection rates were observed in tumors with suprasellar extension (χ2 = 5.048, p = 0.02; OR = 6.000, 95% CI; 1.129-31.880) and CSI (χ2 = 4.000, p = 0.04; OR = 3.857, 95% CI; 0.997-14.916). CONCLUSIONS Tumor consistency might provide useful information about postoperative pituitary function, likely due to its impact on surgical procedures. Further prospective studies with larger cohorts are needed to confirm our preliminary findings.
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Affiliation(s)
- Dario De Alcubierre
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulia Puliani
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Cozzolino
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Valeria Hasenmajer
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marianna Minnetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Valentina Sada
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Antonella Zaccagnino
- Department of Neurology and Psychiatry-Neurosurgery Unit, Sapienza University of Rome, Rome, Italy
| | - Andrea Gennaro Ruggeri
- Department of Neurology and Psychiatry-Neurosurgery Unit, Sapienza University of Rome, Rome, Italy
| | - Riccardo Pofi
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, UK
| | - Emilia Sbardella
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
| | - Mary Anna Venneri
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
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Lehrich BM, Birkenbeuel JL, Roman K, Mahmoodi A, Goshtasbi K, Sahyouni R, Hsu FP, Kuan EC. Treatment selection towards active surveillance over definitive treatment for pituitary adenomas is influenced by sociodemographic factors. Clin Neurol Neurosurg 2022; 222:107455. [DOI: 10.1016/j.clineuro.2022.107455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/11/2022] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
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Muacevic A, Adler JR, Gelinne A, Quig N, Thorp B, Zanation A, Ewend M, Sasaki-Adams D, Quinsey C. Disparities in Postoperative Endocrine Outcomes After Endoscopic-Assisted Transsphenoidal Pituitary Adenoma Resection. Cureus 2022; 14:e31934. [PMID: 36582567 PMCID: PMC9794913 DOI: 10.7759/cureus.31934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives Socioeconomic factors can influence morbidity in patients with pituitary adenoma. This study aims to identify associations between socioeconomic factors and postoperative outcomes in patients with pituitary adenomas. Methods A retrospective medical chart review was conducted on adult patients who underwent resection of purely sellar nonfunctional and functional pituitary adenomas between May 1, 2014, and May 31, 2020, at the University of North Carolina Medical Center. The main outcome measures included the incidence of postoperative diabetes insipidus (PDI), postoperative hyponatremia (PHN), and postoperative hypopituitarism (PHP). Outcome measures were analyzed using univariate and multivariate analyses against preoperative tumor volume as well as socioeconomic and demographic factors (self-identified race/ethnicity, age, gender, address assessed by the Area Deprivation Index (ADI), and insurance status). Results On univariate analysis, patients of Hispanic race/ethnicity and patients living in more disadvantaged neighborhoods had an increased incidence of postoperative diabetes insipidus. Patients who experienced PDI were significantly younger on average in both univariate and multivariate analyses. When analyzed further, patients of Hispanic race/ethnicity were significantly younger and more likely to be uninsured compared to their respective racial/ethnic counterparts. No significant correlations were found for PHN or PHP. Conclusions Patients of Hispanic race/ethnicity and patients living in more disadvantaged neighborhoods were more likely to experience PDI. This finding, when combined with findings regarding age and insurance status, suggests complex disparities in medical care that are confirmed or corroborated by prior literature. These results may enhance clinicians' management of patients from disadvantaged socioeconomic backgrounds through increased awareness of disparities and the provision of resources for assistance.
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Fajardo-Montañana C, Villar R, Gómez-Ansón B, Brea B, Mosqueira AJ, Molla E, Enseñat J, Riesgo P, Cardona-Arboniés J, Hernando O. Recommendations for the diagnosis and radiological follow-up of pituitary neuroendocrine tumours. ENDOCRINOL DIAB NUTR 2022; 69:744-761. [PMID: 36428207 DOI: 10.1016/j.endien.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/01/2021] [Indexed: 06/16/2023]
Abstract
Pituitary neuroendocrine tumours (PitNETs) constitute a heterogeneous group of tumours with a gradually increasing incidence, partly accounted for by more sensitive imaging techniques and more extensive experience in neuroradiology in this regard. Although most PitNETs are indolent, some exhibit aggressive behaviour, and recurrence may be seen after surgical removal. The changes introduced in the WHO classification in 2017 and terminological debates in relation to neuroendocrine tumours warrant an update of the guidelines for the diagnosis, preoperative and postoperative management, and follow-up of response to treatment of PitNETs. This multidisciplinary document, an initiative of the Neuroendocrinology area of the Sociedad Española de Endocrinología y Nutrición [Spanish Society of Endocrinology and Nutrition] (SEEN), focuses on neuroimaging studies for the diagnosis, prognosis and follow-up of PitNETs. The basic requirements and elements that should be covered by magnetic resonance imaging are described, and a minimum radiology report to aid clinicians in treatment decision-making is proposed. This work supplements the consensus between the Neuroendocrinology area of the SEEN and the Sociedad Española de Anatomía Patológica [Spanish Society of Pathology] (SEAP) for the pathological study of PitNETs.
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Affiliation(s)
| | - Rocío Villar
- Departamento de Endocrinología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Beatriz Gómez-Ansón
- Neurorradiología, Departamento de Radiodiagnóstico, Hospital Universitari Sant Pau, Barcelona, Spain
| | - Beatriz Brea
- Departamento de Radiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Antonio Jesús Mosqueira
- Departamento de Radiología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Enrique Molla
- Departamento de Radiología, Hospital Universitario de la Ribera, Alcira, Valencia, Spain
| | - Joaquín Enseñat
- Departamento de Neurocirugía, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pedro Riesgo
- Departamento de Neurocirugía, Hospital Universitario de la Ribera, Alcira, Valencia, Spain
| | - Jorge Cardona-Arboniés
- Departamento de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Ovidio Hernando
- Departamento de Oncología Radioterápica, Centro Integral Oncológico Clara Campal, Madrid, Spain
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Kim M, Kim H, Park J, Park S, Kim YH, Kim S, Lee J, Lebel M. Thin-Slice Pituitary MRI with Deep Learning-Based Reconstruction for Preoperative Prediction of Cavernous Sinus Invasion by Pituitary Adenoma: A Prospective Study. AJNR Am J Neuroradiol 2022; 43:280-285. [PMID: 34992127 PMCID: PMC8985667 DOI: 10.3174/ajnr.a7387] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Accurate radiologic prediction of cavernous sinus invasion by pituitary adenoma remains challenging. We aimed to assess whether 1-mm-slice-thickness MRI with deep learning-based reconstruction can better predict cavernous sinus invasion by pituitary adenoma preoperatively and to estimate the depth of invasion and degree of contact in relation to the carotid artery, compared with 3-mm-slice-thickness MRI. MATERIALS AND METHODS This single-institution, prospective study included 67 consecutive patients (mean age, 53 [SD, 12] years; 28 women), between January and August 2020, who underwent a combined contrast-enhanced T1-weighted imaging protocol of 1-mm-slice-thickness MRI + deep learning-based reconstruction and 3-mm-slice-thickness MRI. An expert neuroradiologist who was blinded to the imaging protocol determined cavernous sinus invasion using the modified Knosp classification on 1-mm-slice-thickness MRI + deep learning-based reconstruction and 3-mm-slice-thickness MRI, respectively. Reference standards were established by the consensus of radiologic, intraoperative, pathologic, and laboratory findings. The primary end point was the diagnostic performance of each imaging protocol, and the secondary end points included depth of invasion and degree of contact in relation to the carotid artery. RESULTS The diagnostic performance of 1-mm-slice-thickness MRI + deep learning-based reconstruction (area under the curve, 0.79; 95% CI, 0.69 - 0.89) in predicting cavernous sinus invasion by pituitary adenoma was higher than that of 3-mm-slice-thickness MRI (area under the curve, 0.61; 95% CI, 0.52-0.70; P < .001). One-millimeter-slice-thickness MRI + deep learning-based reconstruction demonstrated greater depth of invasion by pituitary adenomas from the medial intercarotid line than 3-mm-slice-thickness MRI (4.07 versus 3.12 mm, P < .001). A higher proportion of cases were in a greater degree of contact with the intracavernous ICA with 1-mm-slice-thickness MRI + deep learning-based reconstruction than with 3-mm-slice-thickness MRI (total encasement, 37.3% versus 13.4%, P < .001; >270°, 38.8% versus 16.4%, P < .001). CONCLUSIONS Compared with 3-mm-slice-thickness MRI, 1-mm-slice-thickness MRI + deep learning-based reconstruction showed a higher diagnostic performance in preoperatively predicting cavernous sinus invasion by pituitary adenomas and demonstrated a greater depth and degree of contact in relation to the carotid artery.
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Affiliation(s)
- M. Kim
- From the Department of Radiology and Research Institute of Radiology (M.K., H.S.K., J.E.P., S.J.K.)
| | - H.S. Kim
- From the Department of Radiology and Research Institute of Radiology (M.K., H.S.K., J.E.P., S.J.K.)
| | - J.E. Park
- From the Department of Radiology and Research Institute of Radiology (M.K., H.S.K., J.E.P., S.J.K.)
| | - S.Y. Park
- Departments of Clinical Epidemiology and Biostatistics (S.Y.P.)
| | - Y.-H. Kim
- Neurosurgery (Y.-H.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - S.J. Kim
- From the Department of Radiology and Research Institute of Radiology (M.K., H.S.K., J.E.P., S.J.K.)
| | - J. Lee
- GE Healthcare (J.L.), Seoul, Korea
| | - M.R. Lebel
- GE Healthcare (M.R.L.), Calgary, Alberta, Canada,Department of Radiology (M.R.L.), University of Calgary, Calgary, Alberta, Canada
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Palpan Flores A, Sáez Alegre M, Vivancos Sanchez C, Pérez AZ, Pérez-López C. Volumetric Resection and Complications in Nonfunctioning Pituitary Adenoma by Fully Endoscopic Transsphenoidal Approach along 15 Years of Single-Center Experience. J Neurol Surg B Skull Base 2021; 84:8-16. [PMID: 36743717 PMCID: PMC9897901 DOI: 10.1055/s-0041-1741017] [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: 12/30/2020] [Accepted: 11/12/2021] [Indexed: 02/07/2023] Open
Abstract
Objective The aim of this study was to evaluate the rate of complications and the extent of resection (EOR) of nonfunctioning pituitary adenomas by endoscopic endonasal approach (EEA) in a 15-year learning curve. Methods A total of 100 patients operated by the same surgical team were divided chronologically into two, three, and four groups, comparing differences in EOR measured by a semiautomatic software (Smartbrush, Brainlab), rate of immediate postoperative complications, and the visual and hormonal status at 6 months. Results There were no significant differences over the years in rates of postoperative complications and in visual status at 6 months. A significant linear correlation between the EOR and the number of surgeries (rho = 0.259, p = 0.007) was found. The analysis was performed in three groups because of the remarkable differences among them; the EOR were: 87.2% (early group), 93.03% (intermediate group), and 95.1% (late group) ( p = 0.019). Gross total resection was achieved in 30.3, 51.5, and 64%, respectively ( p = 0.017); also, the rate of reoperation and the worsening of at least one new hormonal axis were worse in the early group. Consequently, the early group had a higher risk of incomplete resection compared with the late group (odds ratio: 4.2; 95% confidence interval: 1.5-11.7). The three groups were not different in demographic and volume tumor variables preoperatively. Conclusions The first 33 interventions were associated with a lower EOR, a high volume of residual tumor, a high reoperation rate, and a higher rate of hormonal dysfunction. We did not find differences in terms of postoperative complications and the visual status at 6-month follow-up.
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Affiliation(s)
- Alexis Palpan Flores
- Department of Neurosurgery, La Paz University Hospital, Madrid, Spain,Address for correspondence Alexis Palpan Flores, MD Department of Neurosurgery, La Paz University Hospitalc/ Avda. de La Castellana 261, 28046 MadridSpain
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Fajardo-Montañana C, Villar R, Gómez-Ansón B, Brea B, Mosqueira AJ, Molla E, Enseñat J, Riesgo P, Cardona-Arboniés J, Hernando O. Recomendaciones sobre el diagnóstico y seguimiento radiológico de los tumores neuroendocrinos hipofisarios. ENDOCRINOL DIAB NUTR 2021. [DOI: 10.1016/j.endinu.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shu X, Zhou Y, Li F, Zhou T, Meng X, Wang F, Zhang Z, Pu J, Xu B. Three-Dimensional Semantic Segmentation of Pituitary Adenomas Based on the Deep Learning Framework-nnU-Net: A Clinical Perspective. MICROMACHINES 2021; 12:1473. [PMID: 34945322 PMCID: PMC8703586 DOI: 10.3390/mi12121473] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
This study developed and evaluated nnU-Net models for three-dimensional semantic segmentation of pituitary adenomas (PAs) from contrast-enhanced T1 (T1ce) images, with aims to train a deep learning-based model cost-effectively and apply it to clinical practice. METHODS This study was conducted in two phases. In phase one, two models were trained with nnUNet using distinct PA datasets. Model 1 was trained with 208 PAs in total, and model 2 was trained with 109 primary nonfunctional pituitary adenomas (NFPA). In phase two, the performances of the two models were investigated according to the Dice similarity coefficient (DSC) in the leave-out test dataset. RESULTS Both models performed well (DSC > 0.8) for PAs with volumes > 1000 mm3, but unsatisfactorily (DSC < 0.5) for PAs < 1000 mm3. CONCLUSIONS Both nnU-Net models showed good segmentation performance for PAs > 1000 mm3 (75% of the dataset) and limited performance for PAs < 1000 mm3 (25% of the dataset). Model 2 trained with fewer samples was more cost-effective. We propose to combine the use of model-based segmentation for PA > 1000 mm3 and manual segmentation for PA < 1000 mm3 in clinical practice at the current stage.
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Affiliation(s)
- Xujun Shu
- Medical School of Chinese PLA, Beijing 100853, China;
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
| | - Yijie Zhou
- School of Computer Science, Fudan University, Shanghai 200433, China;
| | - Fangye Li
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
| | - Tao Zhou
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
| | - Xianghui Meng
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
| | - Fuyu Wang
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
| | - Zhizhong Zhang
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
| | - Jian Pu
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai 200433, China
| | - Bainan Xu
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
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12
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Oh H, Cheun H, Kim YJ, Yoon HK, Kang H, Lee HC, Park HP, Kim JH, Kim YH. Cephalocaudal tumor diameter is a predictor of diabetes insipidus after endoscopic transsphenoidal surgery for non-functioning pituitary adenoma. Pituitary 2021; 24:303-311. [PMID: 33191457 DOI: 10.1007/s11102-020-01108-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Diabetes insipidus (DI) develops commonly after endoscopic transsphenoidal surgery (ETS). We retrospectively investigated the incidence, onset, duration and predictors of DI after ETS in patients with non-functioning pituitary adenoma (NFPA). METHODS A total of 168 patients who underwent ETS to remove NFPAs were included. Various perioperative data on demographics, comorbidities, previous treatments, perioperative hormone deficiencies, tumor characteristics, surgery, anesthesia, intraoperative fluid balance, perioperative laboratory findings, postoperative complications, readmission and hospital length of stay were collected and analyzed. Patients were diagnosed with DI and treated with desmopressin when they showed urine output > 5 mL/kg/hr with a serum sodium concentration > 145 mmol/L or an increase ≥ 3 mmol/L in serum sodium concentration between two consecutive tests after surgery. DI was considered permanent when desmopressin was prescribed for > 6 months after surgery. RESULTS Seventy-seven (45.8%) patients experienced postoperative DI and 10 (6.0%) patients suffered from permanent DI. The median onset of DI and the median duration of transient DI were postoperative day 1 and 5 days, respectively. In multivariable logistic regression analysis, cephalocaudal tumor diameter (odds ratio [95% confidence interval] 2.59 [1.05-6.36], P = 0.038) was related to postoperative DI. In receiver operating characteristic analysis, its area under the curve was 0.68 (95% confidence interval 0.59-0.76, P < 0.001). Its optimal cutoff value that maximized the sum of sensitivity and specificity for postoperative DI was 2.7 cm. CONCLUSIONS Postoperative DI was observed in 45.8% of patients undergoing ETS to remove NFPAs. A large cephalocaudal tumor diameter was predictive of postoperative DI in such patients.
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Affiliation(s)
- Hyongmin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyeon Cheun
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yoon Jung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, 03080, Korea
- Pituitary Center, Seoul National University Hospital, Seoul, 03080, Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Pituitary Center, Seoul National University Hospital, Seoul, 03080, Korea.
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13
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Filchenko I, Korostovtseva L, Bochkarev M, Boyarinova M, Alieva A, Rotar O, Sviryaev Y, Tsoi U, Grineva E. Pulse wave velocity is decreased in acromegaly compared to non-acromegaly study participants with similar cardiovascular risk profile. Growth Horm IGF Res 2021; 57-58:101395. [PMID: 33962370 DOI: 10.1016/j.ghir.2021.101395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/06/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Acromegaly patients were reported to have an increased arterial stiffness that could contribute to the frequent cardiovascular complications in this population. The chronic excess of GH and IGF-1 may lead to arterial stiffening via different mechanisms, including hypertension, impaired glucose tolerance and dyslipidemia, however, it is not known whether the activation of GH/IGF-1 axis might influence arterial stiffening independently of cardiovascular risk factors. The objective of this prospective case-control study was to compare arterial stiffness assessed with pulse-wave velocity (PWV) in acromegaly versus non-acromegaly group with similar cardiovascular risk profile. DESIGN This prospective case-control study included 27 patients with active acromegaly, who underwent the assessment of clinical, physiological, biochemical parameters and the evaluation of PWV with applanation tonometry. We used "The epidemiology of cardiovascular disease in different regions of the Russian Federation" study database (n = 522) to establish a non-acromegaly control group with similar cardiovascular risk profile (n = 54). Non-acromegaly control participants underwent the same assessment as acromegaly patients except for the measurement of serum GH and IGF-1 levels. We compared PWV in acromegaly patients to the general non-acromegaly cohort and its subset, matched with acromegaly patients for cardiovascular risk factors. We also investigated the associations of PWV with clinical, physiological and biochemical parameters in acromegaly and non-acromegaly group using correlation and regression analysis with adjustment for age and sex. RESULTS Acromegaly patients had lower PWV (6.70 (5.75-7.65) m/s) compared to unmatched non-acromegaly control cohort (7.50 (6.70-8.57) m/s, p = 0.01) and to the non-acromegaly control group matched for cardiovascular risk factors (7.45 (6.73-8.60), p < 0.01). In non-acromegaly control group PWV was associated with BMI (ρ = 0.40, p < 0.01; β = 0.09, p < 0.01), obesity (r = 0.46, p < 0.01; β = 1.36, p < 0.01), systolic blood pressure (ρ = 0.60, p < 0.01; β = 0.05, p < 0.01), diastolic blood pressure (ρ = 0.62, p < 0.01; β = 0.07, p < 0.01), triglycerides (ρ = 0.55, p < 0.01; β = 0.58, p = 0.04), glucose (ρ = 0.54, p < 0.01; β = 0.70, p < 0.01) and diabetes (r = 0.40, p < 0.01; β = 1.10, p = 0.03), while in acromegaly group PWV was associated with IGF-1 expressed in mcg/ml (ρ = -0.49, p ≤0.01; β = -0.002, p ≤0.01) and in percentage of the upper limit of the normal (ρ = -0.47, p = 0.01; β = -0.005, p ≤0.01) as well as with diuretics treatment (β = -1.17, p = 0.03). CONCLUSIONS PWV is decreased in acromegaly patients compared to non-acromegaly control participants with similar cardiovascular risk profile. Future studies need to explore the role of GH/IGF-1 axis in the regulation of arterial wall properties and the reliability of PWV as a prognostic marker of cardiovascular complications in acromegaly.
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Affiliation(s)
- Irina Filchenko
- I. M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Prospekt Toreza 44, St. Petersburg 194223, Russia.
| | - Lyudmila Korostovtseva
- Almazov National Medical Research Centre, Ulica Akkuratova 2, St. Petersburg 197341, Russia
| | - Mikhail Bochkarev
- Almazov National Medical Research Centre, Ulica Akkuratova 2, St. Petersburg 197341, Russia
| | - Maria Boyarinova
- Almazov National Medical Research Centre, Ulica Akkuratova 2, St. Petersburg 197341, Russia
| | - Asiyat Alieva
- Almazov National Medical Research Centre, Ulica Akkuratova 2, St. Petersburg 197341, Russia
| | - Oxana Rotar
- Almazov National Medical Research Centre, Ulica Akkuratova 2, St. Petersburg 197341, Russia
| | - Yuri Sviryaev
- I. M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Prospekt Toreza 44, St. Petersburg 194223, Russia; Almazov National Medical Research Centre, Ulica Akkuratova 2, St. Petersburg 197341, Russia
| | - Uliana Tsoi
- Almazov National Medical Research Centre, Ulica Akkuratova 2, St. Petersburg 197341, Russia
| | - Elena Grineva
- Almazov National Medical Research Centre, Ulica Akkuratova 2, St. Petersburg 197341, Russia
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14
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Van Laethem D, Michotte A, Cools W, Velkeniers B, Unuane D, Andreescu CE, Bravenboer B. Hyperprolactinemia in Acromegaly is Related to Prolactin Secretion by Somatolactotroph Tumours. Horm Metab Res 2020; 52:647-653. [PMID: 32757187 DOI: 10.1055/a-1207-1132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study is to assess differences in patient characteristics, tumour characteristics and hormone levels between acromegalic patients with and without hyperprolactinemia. 44 patients of the University Hospital of Brussels, Belgium with acromegaly who were diagnosed between January 2007 and July 2018 were included in this study. Nineteen patients were classified in the hyperprolactinemia group and 25 patients were classified in the normoprolactinemia group. No significant differences between acromegalic patients with and without hyperprolactinemia were found in age at diagnosis, gender, presence of hyperprolactinemia symptoms, insulin-like growth factor 1, growth hormone and testosterone levels, tumour volume, tumour invasiveness, immunohistochemistry of growth hormone and prolactin, Ki-67 index and mitotic index. However, for a cut-off of 10% of prolactin-positive cells, there was a trend towards a higher percentage of prolactin-positive tumours in hyperprolactinemia patients (p=0.054) and higher mean prolactin level in case of positive prolactin immunostaining (p=0.007)). In our study there were no differences in characteristics between acromegaly patients with hyper- and normoprolactinemia. An association between the serum prolactin level and the positivity of prolactin immunohistochemistry of the adenoma tissue was found. The absence of a difference in tumour volume between patients with hyper- and normoprolactinemia suggests that the hyperprolactinemia is likely to be caused by the co-secretion of growth hormone and prolactin by the tumour. Finally, for the first time, the cut-off of 10% of prolactin cells was validated for the diagnosis of somatolactotroph tumours in acromegaly.
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Affiliation(s)
| | - Alex Michotte
- Department of Pathology (Neuropathology), Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Wilfried Cools
- Statistics, Vrije Universiteit Brussel, Brussel, Belgium
| | | | - David Unuane
- Endocrinology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - C E Andreescu
- Endocrinology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Bert Bravenboer
- Endocrinology, Universitair Ziekenhuis Brussel, Brussel, Belgium
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15
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Boertien TM, Drent ML, Booij J, Majoie CBLM, Stokkel MPM, Hoogmoed J, Pereira A, Biermasz NR, Simsek S, Groote Veldman R, Tanck MWT, Fliers E, Bisschop PH. The GALANT trial: study protocol of a randomised placebo-controlled trial in patients with a 68Ga -DOTATATE PET-positive, clinically non-functioning pituitary macroadenoma on the effect of lan reotide on t umour size. BMJ Open 2020; 10:e038250. [PMID: 32792446 PMCID: PMC7430490 DOI: 10.1136/bmjopen-2020-038250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION At present, there is no approved medical treatment option for patients with non-functioning pituitary adenoma. A number of open-label studies suggest that treatment with somatostatin analogues may prevent tumour progression. In vivo somatostatin receptor imaging using 68Ga-DOTATATE PET (PET, positron emission tomography) could help in preselecting patients potentially responsive to treatment. Our aim is to investigate the effect of the somatostatin analogue lanreotide as compared with placebo on tumour size in patients with a 68Ga-DOTATATE PET-positive non-functioning pituitary macroadenoma (NFMA). METHODS AND ANALYSIS The GALANT study is a multicentre, randomised, double-blind, placebo-controlled trial in adult patients with a suprasellar extending NFMA. Included patients undergo a 68Ga-DOTATATE PET/CT of the head and tracer uptake is assessed after coregistration with pituitary MRI. Forty-four patients with a 68Ga-DOTATATE PET-positive NFMA are randomised in a 1:1 ratio between lanreotide 120 mg or placebo, both administered as subcutaneous injections every 28 days for 72 weeks. The primary outcome is the change in cranio-caudal tumour diameter on pituitary MRI after treatment. Secondary outcomes are change in tumour volume, time to tumour progression, change in quality of life and number of adverse events. Final results are expected in the second half of 2021. ETHICS AND DISSEMINATION The study protocol has been approved by the Medical Research Ethics Committee of the Academic Medical Centre (AMC) of the Amsterdam University Medical Centres and by the Dutch competent authority. It is an investigator-initiated study with financial support by Ipsen Farmaceutica BV. The AMC, as sponsor, remains owner of all data. Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NL5136 (Netherlands Trial Register); pre-recruitment.
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Affiliation(s)
- Tessel M Boertien
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Madeleine L Drent
- Department of Internal Medicine, Section of Endocrinology, Amsterdam UMC, location VUMC, VU University, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel P M Stokkel
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jantien Hoogmoed
- Department of Neurosurgery, Neurosurgical Centre Amsterdam, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Alberto Pereira
- Department of Medicine, Division of Endocrinology, and Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Centre, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, and Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Centre, Leiden, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Section of Endocrinology, Amsterdam UMC, location VUMC, VU University, Amsterdam, The Netherlands
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Michael W T Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter H Bisschop
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
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16
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Hwang JY, Aum DJ, Chicoine MR, Dacey RG, Osbun JW, Rich KM, Zipfel GJ, Klatt-Cromwell CN, McJunkin JL, Pipkorn P, Schneider JS, Silverstein JM, Kim AH. Axis-specific analysis and predictors of endocrine recovery and deficits for non-functioning pituitary adenomas undergoing endoscopic transsphenoidal surgery. Pituitary 2020; 23:389-399. [PMID: 32388803 DOI: 10.1007/s11102-020-01045-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Endoscopic transsphenoidal surgery (ETSS) is a well-established treatment for patients with nonfunctioning pituitary adenomas (NFPAs). Data on the rates of pituitary dysfunction and recovery in a large cohort of NFPA patients undergoing ETSS and the predictors of endocrine function before and after ETSS are scarce. This study is purposed to analyze the comprehensive changes in hormonal function and identify factors that predict recovery or worsening of hormonal axes following ETSS for NFPA. METHODS A retrospective review of 601 consecutive patients who underwent ETSS between 2010 and 2018 at one institution was performed. Recovery or development of new hypopituitarism was analyzed in 209 NFPA patients who underwent ETSS. RESULTS Patients with preoperative endocrine deficits (59.8%) in one or more pituitary axes had larger tumor volumes (P = 0.001) than those without preoperative deficits. Recovery of preoperative pituitary deficit occurred in all four axes, with overall mean recovery of 29.7%. The cortisol axis showed the highest recovery whereas the thyroid axis showed the lowest, with 1-year cumulative recovery rates of 44.3% and 6.1%, respectively. Postoperative hypopituitarism occurred overall in 17.2%, most frequently in the thyroid axis (24.3%, 27/111) and least frequently in the cortisol axis (9.7%, 16/165). Axis-specific predictors of post-operative recovery and deficiency were identified. CONCLUSIONS Dynamic alterations in pituitary hormones were observed in a proportion of patients following ETSS in NFPA patients. Postoperative endocrine vulnerability, recovery, and factors that predicted recovery or loss of endocrine function depended on the hormonal system, necessitating an axis-specific surveillance strategy postoperatively.
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Affiliation(s)
- Jenie Y Hwang
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Diane J Aum
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael R Chicoine
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ralph G Dacey
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua W Osbun
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Keith M Rich
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory J Zipfel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Cristine N Klatt-Cromwell
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jonathan L McJunkin
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - John S Schneider
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie M Silverstein
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, MO, USA
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
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17
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Pofi R, Gunatilake S, Macgregor V, Shine B, Joseph R, Grossman AB, Isidori AM, Cudlip S, Jafar-Mohammadi B, Tomlinson JW, Pal A. Recovery of the Hypothalamo-Pituitary-Adrenal Axis After Transsphenoidal Adenomectomy for Non-ACTH-Secreting Macroadenomas. J Clin Endocrinol Metab 2019; 104:5316-5324. [PMID: 31225871 DOI: 10.1210/jc.2019-00406] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/17/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Secondary adrenal insufficiency is a potential complication of transsphenoidal adenomectomy (TSA). Most centers test recovery of the hypothalamo-pituitary-adrenal (HPA) axis after TSA, but, to our knowledge, there are no data predicting likelihood of recovery or the frequency of later recovery of HPA function. OBJECTIVE To assess timing and predictors of HPA axis recovery after TSA. DESIGN Single-center, retrospective analysis of consecutive pituitary surgeries performed between February 2015 and September 2018. PATIENTS Patients (N = 109) with short Synacthen test (SST) data before and at sequential time points after TSA. MAIN OUTCOME MEASURES Recovery of HPA axis function at 6 weeks, and 3, 6, and 9 to12 months after TSA. RESULTS Preoperative SST indicated adrenal insufficiency in 21.1% Among these patients, 34.8% recovered by 6 weeks after TSA. Among the 65.2% (n = 15) remaining, 13.3% and 20% recovered at 3 months and 9 to 12 months, respectively. Of the 29% of patients with adrenal insufficiency at the 6-week SST, 16%, 12%, and 6% subsequently recovered at 3, 6, and 9 to 12 months, respectively. Preoperative SST 30-minute cortisol, postoperative day 8 cortisol, and 6-week postoperative SST baseline cortisol levels above or below 430 nmol/L [15.5 μg/dL; AUC ROC, 0.86]; 160 nmol/L (5.8 μg/dL; AUC ROC, 0.75); and 180 nmol/L (6.5 μg/dL; AUC ROC, 0.88), were identified as cutoffs for predicting 6-week HPA recovery. No patients with all three cutoffs below the threshold recovered within 12 months after TSA, whereas 92% with all cutoffs above the threshold recovered HPA function within 6 weeks (OR, 12.200; 95% CI, 5.268 to 28.255). CONCLUSION HPA axis recovery can occur as late as 9 to 12 months after TSA, demonstrating the need for periodic reassessment of patients who initially have SST-determined adrenal insufficiency after TSA. Pre- and postoperative SST values can guide which patients are likely to recover function and potentially avoid unnecessary lifelong glucocorticoid replacement.
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Affiliation(s)
- Riccardo Pofi
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, United Kingdom
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals National Health Servce Foundation Trust, Oxford, United Kingdom
| | - Sonali Gunatilake
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Victoria Macgregor
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Brian Shine
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Robin Joseph
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals National Health Servce Foundation Trust, Oxford, United Kingdom
| | - Ashley B Grossman
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Simon Cudlip
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Bahram Jafar-Mohammadi
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Jeremy W Tomlinson
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Aparna Pal
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, United Kingdom
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18
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Tampourlou M, Karapanou O, Vassiliadi DA, Tsagarakis S. Medical therapy for non-functioning pituitary tumors-a critical approach. Hormones (Athens) 2019; 18:117-126. [PMID: 30368687 DOI: 10.1007/s42000-018-0070-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 10/01/2018] [Indexed: 01/12/2023]
Abstract
Non-functioning pituitary adenomas (NFPAs) are the second most common variant of pituitary tumors. When symptomatic, primary therapy is surgery. Recurrence rates are high. Since many NFPAs express dopamine and somatostatin receptors, medical therapy has been used after surgery in order to prevent recurrence. So far, dopamine agonists have been more widely tested with some promise when introduced immediately after surgery but with less efficacy when introduced later upon tumor regrowth. Currently, the role of medical therapy to prevent tumor regrowth in NFPAs is limited by imprecisions as to final outcome and uncertainties concerning on patient selection, dosing, duration, and side effects.
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Affiliation(s)
- Metaxia Tampourlou
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece.
| | - Olga Karapanou
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Dimitra A Vassiliadi
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Stylianos Tsagarakis
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
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19
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Fibrous Pituitary Macroadenomas: Predictive Role of Preoperative Radiologic Investigations for Proper Surgical Planning in a Cohort of 66 Patients. World Neurosurg 2019; 121:e449-e457. [DOI: 10.1016/j.wneu.2018.09.137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 11/19/2022]
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20
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Niu J, Zhang S, Ma S, Diao J, Zhou W, Tian J, Zang Y, Jia W. Preoperative prediction of cavernous sinus invasion by pituitary adenomas using a radiomics method based on magnetic resonance images. Eur Radiol 2018; 29:1625-1634. [PMID: 30255254 PMCID: PMC6510860 DOI: 10.1007/s00330-018-5725-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/20/2018] [Accepted: 08/17/2018] [Indexed: 12/31/2022]
Abstract
Objectives To predict cavernous sinus (CS) invasion by pituitary adenomas (PAs) pre-operatively using a radiomics method based on contrast-enhanced T1 (CE-T1) and T2-weighted magnetic resonance (MR) imaging. Methods A total of 194 patients with Knosp grade two and three PAs (training set: n = 97; test set: n = 97) were enrolled in this retrospective study. From CE-T1 and T2 MR images, 2553 quantitative imaging features were extracted. To select the most informative features, least absolute shrinkage and selection operator (LASSO) was performed. Subsequently, a linear support vector machine (SVM) was used to fit the predictive model. Furthermore, a nomogram was constructed by incorporating clinico-radiological risk factors and radiomics signature, and the clinical usefulness of the nomogram was validated using decision curve analysis (DCA). Results Three imaging features were selected in the training set, based on which the radiomics model yielded area under the curve (AUC) values of 0.852 and 0.826 for the training and test sets. The nomogram based on the radiomics signature and the clinico-radiological risk factors yielded an AUC of 0.899 in the training set and 0.871 in the test set. Conclusions The nomogram developed in this study might aid neurosurgeons in the pre-operative prediction of CS invasion by Knosp grade two and three PAs, which might contribute to creating surgical strategies. Key Points • Pre-operative diagnosis of CS invasion by PAs might affect creating surgical strategies • MRI might help for diagnosis of CS invasion by PAs before surgery • Radiomics might improve the CS invasion detection by MR images. Electronic supplementary material The online version of this article (10.1007/s00330-018-5725-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jianxing Niu
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Shuaitong Zhang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China.,University of Chinese Academy of Sciences, Beijing, 100080, China
| | - Shunchang Ma
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jinfu Diao
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Wenjianlong Zhou
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China.,University of Chinese Academy of Sciences, Beijing, 100080, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Yali Zang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China. .,University of Chinese Academy of Sciences, Beijing, 100080, China.
| | - Wang Jia
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
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Lin YJ, Chen KT, Lee CC, Toh CH, Wu TWE, Huang YC, Hsu PW, Lu YJ, Chuang CC, Chen PY, Wei KC. Anterior Skull Base Tumor Resection by Transciliary Supraorbital Keyhole Craniotomy: A Single Institutional Experience. World Neurosurg 2018; 111:e863-e870. [DOI: 10.1016/j.wneu.2017.12.177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/26/2017] [Accepted: 12/30/2017] [Indexed: 10/18/2022]
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22
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Gao M, Zhu B, Li P, Zhang G, Chen K, Lv H, Ma R, Zhang L, Fan Y, Kang X. Influence of the IGFBP3-202A/C Gene Polymorphism on Clinical Features and Surgery Outcome in Acromegalic Patients. Front Endocrinol (Lausanne) 2018; 9:751. [PMID: 30619084 PMCID: PMC6297192 DOI: 10.3389/fendo.2018.00751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022] Open
Abstract
Purpose: Excess growth hormone (GH) secretion in acromegaly patients results in increased levels of IGF-1 expression, which causes the clinical manifestations of acromegaly. IGF-1 levels are attenuated by IGFBP3, and a polymorphism in the promoter of IGFBP3 is known to affect the circulating level of IGFBP3 protein. The aim of the study was to evaluate the association of the IGFBP3 gene polymorphism with clinical features and surgery outcomes in acromegaly. We also investigate the difference in IGFBP3 polymorphism between acromegaly and general population. Methods: The study included 102 acromegalic patients and 142 sex- and age-matched healthy controls. The genotyping of IGFBP3 was carried out using the MassARRAY method. Patients were followed up for 4-12 months to estimate the neurosurgical effects. Clinical data were obtained from the medical records. Results: The CC genotype, which is associated with decreased IGFBP3 levels, was less common in acromegaly patients than among the healthy controls; although, this correlation was not significant (P = 0.056). There was no association of the IGFBP3 gene polymorphism with glucose, lipid, phosphorus, blood urea nitrogen, creatinine or uric acid levels. Additionally, there was no association between tumor size, texture, or hemorrhage/cyst, except there was a trend that more patients with the C allele (P = 0.054) needed additional treatment post-operation than did patients carrying the A allele (OR 1.985, 95% CI 0.983-4.008). Moreover, higher IGF-1 values after treatment were observed in patients carrying the C allele (P = 0.012 and P = 0.014 according to the additive model and dominant model, respectively). Conclusion: Polymorphisms in IGFBP3 may not influence metabolic parameters or pituitary tumor characteristics in acromegalic patients, but they may be associated with the hormone levels and surgery effects.
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Affiliation(s)
- Ming Gao
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents and Clinical Research, Beijing, China
| | - Bin Zhu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ping Li
- Department of Endocrinology, Yuncheng Central Hospital, Shanxi Medical University, Yuncheng, China
| | - Guojun Zhang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents and Clinical Research, Beijing, China
| | - Kelin Chen
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents and Clinical Research, Beijing, China
| | - Hong Lv
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents and Clinical Research, Beijing, China
| | - Ruimin Ma
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents and Clinical Research, Beijing, China
| | - Limin Zhang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents and Clinical Research, Beijing, China
| | - Yubo Fan
- Lab of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xixiong Kang
- Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents and Clinical Research, Beijing, China
- Lab of Biological Science and Medical Engineering, Beihang University, Beijing, China
- *Correspondence: Xixiong Kang
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