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Fan Y, Guo S, Tao C, Fang H, Mou A, Feng M, Wu Z. Noninvasive radiomics approach predicts dopamine agonists treatment response in patients with prolactinoma: a multicenter study. Acad Radiol 2024:S1076-6332(24)00672-X. [PMID: 39332989 DOI: 10.1016/j.acra.2024.09.023] [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: 07/28/2024] [Revised: 09/05/2024] [Accepted: 09/06/2024] [Indexed: 09/29/2024]
Abstract
RATIONALE AND OBJECTIVES The first-line treatment for prolactinoma is drug therapy with dopamine agonists (DAs). However, some patients with resistance to DA treatment should prioritize surgical treatment. Therefore, it is crucial to accurately identify the drug treatment response of prolactinoma before treatment. The present study was performed to determine the DA treatment response of prolactinoma using a clinical radiomic model that incorporated radiomic and clinical features before treatment. MATERIALS AND METHODS In total, 255 patients diagnosed with prolactinoma were retrospectively divided to training and validation sets. An elastic net algorithm was used to screen the radiomic features, and a fusion radiomic model was established. A clinical radiomic model was then constructed to integrate the fusion radiomic model and the most important clinical features through multivariate logistic regression analysis for individual prediction. The calibration, discrimination, and clinical applicability of the established models were evaluated. 60 patients with prolactinoma from other centers were used to validate the performance of the constructed model. RESULTS The fusion radiomic model was constructed from three significant radiomic features, and the area under the curve in the training set and validation set was 0.930 and 0.910, respectively. The clinical radiomic model was constructed using the radiomic model and three clinical features. The model exhibited good recognition and calibration abilities as evidenced by its area under the curve of 0.96, 0.92, and 0.92 in the training, validation, and external multicenter validation set, respectively. Analysis of the decision curve showed that the fusion radiomic model and clinical radiomic model had good clinical application value for DA treatment response prediction in patients with prolactinoma. CONCLUSION Our clinical radiomic model demonstrated high sensitivity and excellent performance in predicting DA treatment response in prolactinoma. This model holds promise for the noninvasive development of individualized diagnosis and treatment strategies for patients with prolactinoma.
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Affiliation(s)
- Yanghua Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing, China
| | - Shuaiwei Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuming Tao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hua Fang
- Department of Neurosurgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Anna Mou
- Department of Radiology, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Sherin RP, Vietor NO, Usman A, Hoang TD, Shakir MK. REVIEW ARTICLE: CARDIOVASCULAR DISORDERS ASSOCIATED WITH ACROMEGALY: An Update. Endocr Pract 2024:S1530-891X(24)00689-X. [PMID: 39332498 DOI: 10.1016/j.eprac.2024.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 09/15/2024] [Accepted: 09/16/2024] [Indexed: 09/29/2024]
Abstract
The most common causes of increased cardiovascular mortality in acromegaly are due to cardiac arrhythmias and sudden cardiac death. Acromegalic cardiomyopathy, is defined as concentric biventricular hypertrophy and diastolic dysfunction when other cardiac diseases like hypertension, diabetes mellitus, and arrhythmias related cardiac disorders have been excluded. This also contributes to significant morbidity and mortality in these patients. The main risk factors contributing to the development of cardiomyopathy include advancing age, disease duration and body mass index (BMI). The duration of GH excess rather than the degree of hormone elevation is more closely associated with the development of biventricular enlargement, diastolic dysfunction, heart failure, and valvular disease. Additionally, other cardiovascular disorders such as coronary artery disease, arrhythmias, valvular heart diseases, systemic hypertension, atherosclerosis, and rarely congestive cardiac failure are also involved in the shortened life span of these patients especially if poorly controlled. Biochemical control of acromegaly with the recently available multimodal treatment along with better management of cardiovascular co-morbidities has improved the morbidity and mortality rates of patients with acromegaly. However, with the recent advances in the treatment of acromegaly neoplastic causes presently remain as the main leading cause of death in these patients.
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Affiliation(s)
- Rinsha Pv Sherin
- Department of Endocrinology, Diabetes & Metabolism, Walter Reed National Military Medical Center, Bethesda, MD
| | - Nicole O Vietor
- Department of Endocrinology, Diabetes & Metabolism, Walter Reed National Military Medical Center, Bethesda, MD
| | - Aqueel Usman
- Department of Endocrinology, Diabetes & Metabolism, Walter Reed National Military Medical Center, Bethesda, MD
| | - Thanh D Hoang
- Department of Endocrinology, Diabetes & Metabolism, Walter Reed National Military Medical Center, Bethesda, MD.
| | - Mohamed Km Shakir
- Department of Endocrinology, Diabetes & Metabolism, Walter Reed National Military Medical Center, Bethesda, MD
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Bioletto F, Sibilla M, Gasco V, Ghigo E, Grottoli S. Excess mortality in patients with non-functioning pituitary adenoma: a systematic review and meta-analysis. J Endocrinol Invest 2024; 47:2143-2155. [PMID: 38503992 PMCID: PMC11369010 DOI: 10.1007/s40618-024-02356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Patients with non-functioning pituitary adenoma (NFPA) often present with a variety of clinical manifestations and comorbidities, mainly determined by the local mass effect of the tumor and by hypopituitarism. Whether this has an impact on overall mortality, however, is still unclear. METHODS PubMed/Medline, EMBASE, and Cochrane Library databases were systematically searched until May 2023 for studies reporting data either about standardized mortality ratios (SMRs) or about predictors of mortality in patients with NFPA. Effect sizes were pooled through a random-effect model. This systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO, #CRD42023417782). RESULTS Eleven studies were eligible for inclusion in the systematic review; among these, five studies reported data on SMRs, with a total follow-up time of approximately 130,000 person-years. Patients with NFPA showed an increased mortality risk compared to the general population (SMR = 1.57 [95%CI: 1.20-1.99], p < 0.01). Age and sex appeared to act as effect modifiers, with a trend towards higher SMRs in females (SMR = 1.57 [95%CI: 0.91-2.41], p = 0.10) than in males (SMR = 1.00 [95%CI: 0.89-1.11], p = 0.97), and in patients diagnosed at age 40 years or younger (SMR = 3.19 [95%CI: 2.50-3.97], p < 0.01) compared to those with later onset of the disease (SMR = 1.26 [95%CI: 0.93-1.65], p = 0.13). The trend towards excess mortality was similar in patients with normal (SMR = 1.22 [95%CI: 0.94-1.53], p = 0.13) or deficient (SMR = 1.26 [95%CI: 0.82-1.79], p = 0.27) pituitary function. CONCLUSIONS Excess mortality is observed in patients with NFPA, regardless of pituitary function, especially in women and in patients with a younger age at diagnosis.
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Affiliation(s)
- F Bioletto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy.
| | - M Sibilla
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - V Gasco
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - E Ghigo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - S Grottoli
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
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Ravnik J, Rowbottom H, Snyderman CH, Gardner PA, Šmigoc T, Glavan M, Kšela U, Kljaić N, Lanišnik B. The Impact of Surgical Telementoring on Reducing the Complication Rate in Endoscopic Endonasal Surgery of the Skull Base. Diagnostics (Basel) 2024; 14:1874. [PMID: 39272659 PMCID: PMC11393863 DOI: 10.3390/diagnostics14171874] [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: 06/29/2024] [Revised: 07/31/2024] [Accepted: 08/23/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Pituitary adenomas represent the most common pituitary disorder, with an estimated prevalence as high as 20%, and they can manifest with hormone hypersecretion or deficiency, neurological symptoms from mass effect, or incidental findings on imaging. Transsphenoidal surgery, performed either microscopically or endoscopically, allows for a better extent of resection while minimising the associated risk in comparison to the transcranial approach. Endoscopy allows for better visualisation and improvement in tumour resection with an improved working angle and less nasal morbidity, making it likely to become the preferred surgical treatment for pituitary neoplasms. The learning curve can be aided by telementoring. METHODS We retrospectively analysed the clinical records of 94 patients who underwent an endoscopic endonasal resection of a pituitary neoplasm between the years 2011 and 2023 at Maribor University Medical Centre in Slovenia. Remote surgical telementoring over 3 years assisted with the learning curve. RESULTS The proportion of complication-free patients significantly increased over the observed period (60% vs. 79%). A gradual but insignificant increase in the percentage of patients with improved endocrine function was observed. Patients' vision improved significantly over the observed period. By gaining experience, the extent of gross total tumour resection increased insignificantly (67% vs. 79%). CONCLUSIONS Telementoring for the endoscopic endonasal approach to pituitary neoplasms enables low-volume centres to achieve efficiency, decreasing rates of postoperative complications and increasing the extent of tumour resection.
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Affiliation(s)
- Janez Ravnik
- Department of Neurosurgery, Maribor University Medical Centre, 2000 Maribor, Slovenia
| | - Hojka Rowbottom
- Department of Neurosurgery, Maribor University Medical Centre, 2000 Maribor, Slovenia
| | - Carl H Snyderman
- Departments of Otolaryngology and Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Tomaž Šmigoc
- Department of Neurosurgery, Maribor University Medical Centre, 2000 Maribor, Slovenia
| | - Matic Glavan
- Department of Otorhinolaryngology, Head and Neck Surgery, Maribor University Medical Centre, 2000 Maribor, Slovenia
| | - Urška Kšela
- Department of Endocrinology and Diabetology, Maribor University Medical Centre, 2000 Maribor, Slovenia
| | - Nenad Kljaić
- Department of Ophthalmology, Maribor University Medical Centre, 2000 Maribor, Slovenia
| | - Boštjan Lanišnik
- Department of Otorhinolaryngology, Head and Neck Surgery, Maribor University Medical Centre, 2000 Maribor, Slovenia
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Rudman Y, Duskin-Bitan H, Masri-Iraqi H, Akirov A, Shimon I. Visual morbidity in macroprolactinoma: A retrospective cohort study. Clin Endocrinol (Oxf) 2024. [PMID: 39155611 DOI: 10.1111/cen.15120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/03/2024] [Accepted: 07/13/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE The management of visual field damage in patients with macroprolactinomas is a major therapeutic challenge. We aimed to study the visual morbidity associated with macroprolactinoma and its outcomes following medical and surgical treatment. We aimed to identify predictors of visual recovery. METHODS We retrospectively reviewed patient's data including clinical presentation, serial pituitary magnetic resonance imaging, laboratory tests, visual symptoms and neuro-ophthalmologic examination, visual field tests and optical coherence tomography tests. The main outcome was complete visual field recovery. Descriptive analyses were conducted. Predictors of visual recovery were investigated. PATIENTS The study cohort included 150 patients with macroprolactinoma [median follow-up, 6.0 years (interquartile range (IQR) 2.9-10.6)]. RESULTS At diagnosis, visual field defects were evident in 40 patients (26.7%). At the end of follow-up, 24 out of 39 available visual field tests (61.5%) exhibited complete recovery. Patients that achieved complete visual recovery had smaller macroadenomas at diagnosis [30.5 mm (15.0-80.0) vs. 42.0 mm (30.0-85.0), p < .01], lower baseline serum prolactin levels [1414 mcg/L (489-3586) vs. 4119 mcg/L (2715-6315), p < .01], lower rates of central hypogonadism (78.3% vs. 93.3%, p = .05) and central hypothyroidism (20.8% vs. 53.3%, p = .04), lower rates of compressive optic neuropathy (35.3% vs. 87.5%, p = .02) and a better visual acuity (better than 6/8 in both eyes, 93.7% vs. 28.6%, p < .01). CONCLUSIONS In our cohort of 150 patients with macroprolactinoma, 40 patients (26.7%) presented with visual field defects, of which 61.5% achieved complete visual recovery with treatment. Patients that achieved complete visual recovery presented with smaller macroadenomas, lower serum prolactin levels, lower rates of central hypogonadism and central hypothyroidism, lower rates of compressive optic neuropathy and better visual acuity.
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Affiliation(s)
- Yaron Rudman
- Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Duskin-Bitan
- Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hiba Masri-Iraqi
- Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Akirov
- Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Shimon
- Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rosendal C, Arlien-Søborg MC, Nielsen EH, Andersen MS, Feltoft CL, Kistorp C, Dekkers OM, Jørgensen JOL, Dal J. The changing landscape of acromegaly - an epidemiological perspective. Rev Endocr Metab Disord 2024; 25:691-705. [PMID: 38337125 DOI: 10.1007/s11154-024-09875-z] [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] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
Acromegaly is a rare disease and thus challenging to accurately quantify epidemiologically. In this comprehensive literature review, we compare different approaches to studying acromegaly from an epidemiological perspective and describe the temporal evolution of the disease pertaining to epidemiological variables, clinical presentation and mortality. We present updated epidemiological data from the population-based Danish cohort of patients with acromegaly (AcroDEN), along with meta-analyses of existing estimates from around the world.Based on this, we conclude that the incidence, prevalence and age at acromegaly diagnosis are all steadily increasing, but with considerable variation between studies. An increased number of incidental cases may contribute to the increase in incidence and age at diagnosis, respectively. The clinical features at presentation are trending toward a milder disease phenotype at diagnosis, and advances in therapeutic options have reduced the mortality of patients with acromegaly to a level similar to that of the general population. Moreover, the underlying cause of death has shifted from cardiovascular to malignant neoplastic diseases.
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Affiliation(s)
- Christian Rosendal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
| | | | | | | | - Claus Larsen Feltoft
- Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Caroline Kistorp
- Department of Hormone and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Aarhus KEA, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
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7
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Kajal S, Ahmad YES, Halawi A, Gol MAK, Ashley W. Pituitary apoplexy: a systematic review of non-gestational risk factors. Pituitary 2024; 27:320-334. [PMID: 38935252 DOI: 10.1007/s11102-024-01412-0] [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] [Accepted: 06/01/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Pregnancy is a known risk factor for Pituitary Apoplexy (PA) but there is a lack of consistency in the literature regarding non-gestational risk factors responsible for PA. METHODS We did a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify the non-gestational risk factors associated with the development of PA in adult patients with pituitary adenoma. Also, we discuss here a case of an elderly female with pituitary macroadenoma who was initially planned for pituitary resection electively but underwent emergency surgery after she developed PA. RESULTS As per screening and eligibility criteria, seven studies with 4937 study participants were included in this systematic review out of which 490 (9.92%) patients had PA, including asymptomatic subclinical PA (SPA) and symptomatic clinical PA (CPA). The macroadenomas and negative staining of the tumor were found to be a significant risk factor consistently in multivariate analysis in three and two retrospective studies, respectively. However, the results were varied for any significant difference in the risk factors for apoplexy between SPA and CPA. Similarly, there was no consistency among the studies for risk factors significantly responsible for CPA or PA compared to controls. CONCLUSION No single non-gestational risk factor is solely responsible for the development of PA in a pituitary adenoma compared to the control population. Tumor size (macroadenoma) and the non-functioning status of the adenoma are the only significant factors contributing independently toward an apoplectic event in most patients. Such patients can be prioritized for early pituitary tumor resection.
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Affiliation(s)
- Smile Kajal
- MedStar Health Union Memorial Hospital, Baltimore, MD, 21218, USA.
| | | | - Akaber Halawi
- MedStar Health Union Memorial Hospital, Baltimore, MD, 21218, USA
- LifeBridge Health Sinai Hospital, Baltimore, MD, 21215, USA
- Maryland ENT Center, Baltimore, MD, 21218, USA
| | - Mohammad Abraham Kazemizadeh Gol
- MedStar Health Union Memorial Hospital, Baltimore, MD, 21218, USA
- LifeBridge Health Sinai Hospital, Baltimore, MD, 21215, USA
- Maryland ENT Center, Baltimore, MD, 21218, USA
| | - William Ashley
- LifeBridge Health Sinai Hospital, Baltimore, MD, 21215, USA
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Sahakian N, Goetz L, Appay R, Graillon T, Raingeard I, Piazzola C, Regis J, Castinetti F, Brue T, Dufour H, Cuny T. Outcome of non-functioning ACTH pituitary tumors: silent does not mean indolent. Pituitary 2024:10.1007/s11102-024-01428-6. [PMID: 38995473 DOI: 10.1007/s11102-024-01428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Silent corticotroph tumors (siACTH) represent a rare entity of pituitary tumors (PT), usually more aggressive than other PT. Few predictor factors of recurrence in the post-operative period have been proposed until now. This study aimed (1) to evaluate the clinical outcome of siACTH after surgery according to a five-tiered clinicopathological classification (2) to compare siACTH characteristics to ACTH-secreting macroadenomas (macroCD), and silent gonadotropinomas (siLH/FSH). PATIENTS AND METHODS Between 2008 and 2022, 29 siACTH out of 865 PT cases operated in one tertiary center were included. Clinical, paraclinical, histological, and surgical data were collected and compared to 25 macroCD and 143 siLH/FSH cases, respectively. The tumor grading was established according to both invasion (no = 1; yes = 2) and proliferation (no = a; yes = b). Progression-free survival was estimated using Kaplan-Meier method and log-rank test. RESULTS We identified 15 (51.7%) grade 1a, 11 (37.9%) grade 2a and 3 (10.3%) grade 2b siACTH with a trend for a 7-fold-time higher risk of progression/recurrence in grade 2b as compared to 1a (p = 0.06). The repartition of tumor grades was similar between the three subgroups, however a 5.7-fold-higher risk of progression was observed in grade 1a siACTH than in grade 1a siLH/FSH (p = 0.02). Compared to siLH/FSH, higher ACTH levels may help to preoperatively identify siACTH. CONCLUSION The five-tiered clinicopathological classification contribute to predict the risk of recurrence of operated siACTH tumors. Noteworthy, non-invasive and non-proliferative siACTH exhibit a less favorable outcomes than their siLH/FSH counterparts, which should prompt for a personalized follow up.
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Affiliation(s)
- Nicolas Sahakian
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception University Hospital, Department of Endocrinology, CRMR HYPO, Marseille, France
| | - Lise Goetz
- Department of Endocrinology, University Hospital of Montpellier, Montpellier, France
| | - Romain Appay
- Department of Pathological Anatomy and Neuropathology, Timone Hospital, APHM, Marseille, France
| | - Thomas Graillon
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, Timone Hospital, Department of Neurosurgery, CRMR HYPO, Marseille, France
| | - Isabelle Raingeard
- Department of Endocrinology, University Hospital of Montpellier, Montpellier, France
| | - Cécilia Piazzola
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception University Hospital, Department of Endocrinology, CRMR HYPO, Marseille, France
| | - Jean Regis
- Department of Functional and Stereotactic Neurosurgery, CHU Timone, Aix Marseille University, INS-UMR1106, Marseille, 13385, France
| | - Frédéric Castinetti
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception University Hospital, Department of Endocrinology, CRMR HYPO, Marseille, France
| | - Thierry Brue
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception University Hospital, Department of Endocrinology, CRMR HYPO, Marseille, France
| | - Henry Dufour
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, Timone Hospital, Department of Neurosurgery, CRMR HYPO, Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception University Hospital, Department of Endocrinology, CRMR HYPO, Marseille, France.
- Aix Marseille Univ, Hôpital de la Conception, Clinical Investigation Centre 1409, Inserm, Marseille, France.
- Service d'Endocrinologie, Hôpital de la Conception, APHM, 147 Boulevard Baille, Marseille, 13005, France.
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9
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Ishay A, Oleinikov K, Chertok Shacham E. SARS-CoV-2-Vaccine-Related Endocrine Disorders: An Updated Narrative Review. Vaccines (Basel) 2024; 12:750. [PMID: 39066388 PMCID: PMC11281608 DOI: 10.3390/vaccines12070750] [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: 04/30/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
The emergence of the COVID-19 pandemic has led to the rapid and worldwide development and investigation of multiple vaccines. While most side effects of these vaccines are mild and transient, potentially severe adverse events may occur and involve the endocrine system. This narrative review aimed to explore the current knowledge on potential adverse endocrine effects following COVID-19 vaccination, with thyroid disorders being the most common. Data about pituitary, adrenal, diabetes, and gonadal events are also reviewed. This review also provides a comprehensive understanding of the pathogenesis of endocrine disorders associated with SARS-CoV-2 vaccines. PubMed/MEDLINE, Embase database (Elsevier), and Google Scholar searches were performed. Case reports, case series, original studies, and reviews written in English and published online up to 31 August 2023 were selected and reviewed. Data on endocrine adverse events of SARS-CoV-2 vaccines are accumulating. However, their causal relationship with COVID-19 vaccines is not strong enough to make a definite conclusion, and further studies are needed to clarify the pathogenesis mechanisms of the endocrine disorders linked to COVID-19 vaccines.
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Affiliation(s)
- Avraham Ishay
- Endocrinology Unit, HaEmek Medical Center, Yitzhak Rabin Av. 21, Afula 18101, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
| | - Kira Oleinikov
- Endocrinology Unit, HaEmek Medical Center, Yitzhak Rabin Av. 21, Afula 18101, Israel
| | - Elena Chertok Shacham
- Endocrinology Unit, HaEmek Medical Center, Yitzhak Rabin Av. 21, Afula 18101, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
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10
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Gaydarski L, Popov D, Kolev D, Hadzhiyanev A. A Complex Case of Pituitary Apoplexy Mimicking a Stroke: A Case Report With a Review of the Literature. Cureus 2024; 16:e65332. [PMID: 39184687 PMCID: PMC11344273 DOI: 10.7759/cureus.65332] [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] [Accepted: 07/22/2024] [Indexed: 08/27/2024] Open
Abstract
Pituitary adenomas, benign tumors originating in the pituitary gland, are classified based on size and hormone activity. Pituitary apoplexy, defined by hemorrhage or infarction of these adenomas, poses a challenge in estimation due to its subtle presentation. It often manifests as sudden, severe headaches, visual disturbances, nausea, and hormone deficiencies. Diagnosis typically involves MRI or, if unavailable, CT scans, alongside hormonal and other laboratory assessments. Here, we present the case of a 71-year-old female patient who was transferred to the hospital for endovascular treatment of a hemorrhagic stroke after presenting with sudden-onset symptoms suggestive of a stroke. Neurological examination revealed right-sided ptosis, diplopia, and bitemporal hemianopsia. The initially performed CT imaging suggested hemorrhagic stroke. Subsequent MRI reviewed pituitary macroadenoma with apoplexy. Immediate surgical management via endoscopic, endonasal, transsphenoidal adenomectomy resulted in gradual symptom improvement. The patient was discharged three days after the procedure with complete symptom improvement and showed no signs of recurrence during regular follow-ups at one and three months post-surgery. This case emphasizes the critical role of accurate imaging in diagnosing and managing patients with pituitary macroadenomas complicated by apoplexy, which can mimic stroke. While CT scans may lack detail, MRI offers precise information. Prompt recognition and evaluation are vital for effective treatment, highlighting the importance of distinguishing between these conditions for optimal patient care.
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Affiliation(s)
- Lyubomir Gaydarski
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, BGR
| | - Deyan Popov
- Clinic of Neurosurgery, University Multiprofile Hospital for Active Treatment (UMHAT) ''St. Ivan Rilski'', Sofia, BGR
- Department of Neurosurgery, Medical University of Sofia, Sofia, BGR
| | - Danny Kolev
- Clinic of Neurosurgery, University Multiprofile Hospital for Active Treatment (UMHAT) ''St. Ivan Rilski'', Sofia, BGR
| | - Asen Hadzhiyanev
- Clinic of Neurosurgery, University Multiprofile Hospital for Active Treatment (UMHAT) ''St. Ivan Rilski'', Sofia, BGR
- Department of Neurosurgery, Medical University of Sofia, Sofia, BGR
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Moscona-Nissan A, Sidauy-Adissi J, Hermoso-Mier KX, Glick-Betech SS, Chávez-Vera LDJ, Martinez-Mendoza F, Delgado-Casillas OM, Taniguchi-Ponciano K, Marrero-Rodríguez D, Mercado M. Diagnosis and Treatment of Pituitary Apoplexy, A True Endocrine Emergency. Arch Med Res 2024; 55:103001. [PMID: 38703639 DOI: 10.1016/j.arcmed.2024.103001] [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: 03/05/2024] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
Pituitary apoplexy (PA) is a clinical syndrome resulting from a hemorrhagic infarction of the pituitary gland. It is characterized by the sudden onset of visual disturbances, nausea, vomiting, headache and occasionally, signs of meningeal irritation and an altered mental status. The exact pathogenesis of PA remains to be elucidated, although tumor overgrowth of its blood supply remains the most popular theory. Main risk factors for the development of PA include systemic, iatrogenic, and external factors as well as the presence of an underlying pituitary tumor. The diagnostic approach of PA includes both neuroimaging and evaluation of pituitary secretory function. PA is a potentially life-threatening condition which should be managed with hemodynamic stabilization, correction of electrolyte abnormalities and replacement of hormonal deficiencies. PA treatment should be individualized based on the severity of the clinical picture which may vary widely. Treatment options include conservative management with periodic follow-up or neurosurgical intervention, which should be decided by a multidisciplinary team. We conducted a systematic review of the literature to unveil the frequency of PA predisposing factors, clinical and biochemical presentations, management strategies and outcomes.
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Affiliation(s)
- Alberto Moscona-Nissan
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Jessica Sidauy-Adissi
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Karla Ximena Hermoso-Mier
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Shimon Shlomo Glick-Betech
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Leonel de Jesús Chávez-Vera
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Florencia Martinez-Mendoza
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Oscar Mario Delgado-Casillas
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Keiko Taniguchi-Ponciano
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Daniel Marrero-Rodríguez
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Moisés Mercado
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
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Srivastava A, Singh M, Yadav A, Srivastava C, Chandra A, Srivastava AD. Does New WHO 2022 Nomenclature of Pituitary Neuroendocrine Tumors Offer an Extra Edge to the Neurosurgeons for Its Management? A Narrative Review. Asian J Neurosurg 2024; 19:107-111. [PMID: 38974433 PMCID: PMC11226279 DOI: 10.1055/s-0043-1777264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
The new World Health Organization nomenclature of pituitary tumors was introduced in the year 2022 after much deliberation. This nomenclature clearly demarcates the anterior lobe (adenohypophyseal), posterior lobe (neurohypophyseal), and hypothalamic tumors. There is also focus on other tumors arising in the sellar region. The nomenclature has also advocated the routine use of immunohistochemistry in describing the pituitary transcription factors that plays a fundamental role in distinguishing the cell lineage of these tumors. However, the nomenclature is complex in understanding due to inclusion of pathological correlates like transcription factors, hormones, biomarkers, and various controversies that have emerged regarding the renaming of pituitary adenomas (PA) as PiTNETs ("Pituitary Neuroendocrine tumors") because majority of the adenomas are benign and have rare metastatic behavior while classifying them as PiTNETs will create unnecessary misinterpretation of these as aggressive tumors that will lead to apprehension among the patients. The new classification gives deeper insight into the histological picture of the various pituitary tumors but other than contributing to the follow-up strategy and postsurgery management, this classification does not add anything new that could be advantageous for the neurosurgeons in clinical practice and decision making, especially in deciding the plan of action for surgery. Hence, there is need of a more comprehensive, integrated, neuroradiological-based classification with more emphasis on the invasiveness of these tumors that would assist the neurosurgeons in planning the treatment strategy and managing patients of pituitary tumors.
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Affiliation(s)
- Alok Srivastava
- Department of Neurosurgery, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Uttar Pradesh, India
| | - Manish Singh
- Department of Neurosurgery, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Uttar Pradesh, India
| | - Awadhesh Yadav
- Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Chhitij Srivastava
- Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anil Chandra
- Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Akanksha D. Srivastava
- Department of Paediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
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Satou M, Wang J, Nakano-Tateno T, Teramachi M, Aoki S, Sugimoto H, Chik C, Tateno T. Autophagy inhibition suppresses hormone production and cell growth in pituitary tumor cells: A potential approach to pituitary tumors. Mol Cell Endocrinol 2024; 586:112196. [PMID: 38462123 DOI: 10.1016/j.mce.2024.112196] [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: 12/04/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
Pituitary tumors (PTs) represent about 10% of all intracranial tumors, and most are benign. However, some PTs exhibit continued growth despite multimodal therapies. Although temozolomide (TMZ), an alkylating chemotherapeutic agent, is a first-line medical treatment for aggressive PTs, some PTs are resistant to TMZ. Existing literature indicated the involvement of autophagy in cell growth in several types of tumors, including PTs, and autophagy inhibitors have anti-tumor effects. In this study, the expression of several autophagy-inducible genes, including Atg3, Beclin1, Map1lc3A, Map1lc3b, Ulk1, Wipi2, and Tfe3 in two PT cell lines, the mouse corticotroph AtT-20 cells and the rat mammosomatotroph GH4 cells were identified. Down regulation of Tfe3, a master switch of basal autophagy, using RNA interference, suppressed cell proliferation in AtT-20 cells, suggesting basal autophagy contributes to the maintenance of cellular functions in PT cells. Expectedly, treatment with bafilomycin A1, an autophagy inhibitor, suppressed cell proliferation, increased the cleavage of PARP1, and reduced ACTH production in AtT-20 cells. Treatment with two additional autophagy inhibitors, chloroquine (CQ) and monensin, demonstrated similar effects on cell proliferation, apoptosis, and ACTH production in AtT-20 cells. Also, treatment with CQ suppressed cell proliferation and growth hormone production in GH4 cells. Moreover, the combination of CQ and TMZ had an additive effect on the inhibition of cell proliferation in AtT-20 and GH4 cells. The additive effect of anti-cancer drugs such as CQ alone or in combination with TMZ may represent a novel therapeutic approach for PTs, in particular tumors with resistance to TMZ.
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Affiliation(s)
- Motoyasu Satou
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Biochemistry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Jason Wang
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Tae Nakano-Tateno
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mariko Teramachi
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Shigeki Aoki
- Laboratory of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Hiroyuki Sugimoto
- Department of Biochemistry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Constance Chik
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Toru Tateno
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Tiwari P, Saikia UK, Baro A, Bhuyan AK. Clinical Characteristics of Macroprolactinomas and Response to Medical Therapy. Indian J Endocrinol Metab 2024; 28:268-272. [PMID: 39086562 PMCID: PMC11288516 DOI: 10.4103/ijem.ijem_283_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/09/2023] [Accepted: 08/26/2023] [Indexed: 08/02/2024] Open
Abstract
Introduction The presentation of macroprolactinomas and response to treatment may vary according to age, sex and tumour characteristics. To analyse clinical phenotype, biochemical and radiological characteristics of macroprolactinomas presenting to a tertiary care centre. A retrospective observational study from January 2018 to December 2022. Methods Thirty diagnosed cases (18 females, 12 males) of macroprolactinomas were included and followed up for one year. Results The most common presentation was headache (73%), visual disturbances (50%), galactorrhoea (33.3%) and loss of libido (26.6%) along with menstrual cycle disturbances (94%), and infertility (55%) in females. Duration of symptoms (2.22 ± 2.87 vs 4.61 ± 3.4 years), tumour size (4.8 ± 2.09 vs 2.75 ± 1.24 cm) and prolactin levels (5153.5 ± 4755.3 vs 1803.5 ± 3785.5 ng/ml) were different significantly between males and females. Good response to medical therapy was observed in 84% of the treatment-naive patients. Conclusion Macroprolactinomas in males present with shorter duration of symptoms, larger size, higher prolactin levels and more resistant tumours, emphasizing the need for early diagnosis and aggressive management. Medical therapy remains the treatment of choice irrespective of gender.
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Affiliation(s)
- Pooja Tiwari
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Uma K. Saikia
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Abhamoni Baro
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Ashok K. Bhuyan
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
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Wu X, Gong L, Li B, Bai J, Li C, Zhang Y, Zhu H. TNF-α can promote membrane invasion by activating the MAPK/MMP9 signaling pathway through autocrine in bone-invasive pituitary adenoma. CNS Neurosci Ther 2024; 30:e14749. [PMID: 38739004 PMCID: PMC11090077 DOI: 10.1111/cns.14749] [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: 02/05/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024] Open
Abstract
AIMS A bone-invasive pituitary adenoma exhibits aggressive behavior, leading to a worse prognosis. We have found that TNF-α promotes bone invasion by facilitating the differentiation of osteoclasts, however, before bone-invasive pituitary adenoma invades bone tissue, it needs to penetrate the dura mater, and this mechanism is not yet clear. METHODS We performed transcriptome microarrays on specimens of bone-invasive pituitary adenomas (BIPAs) and noninvasive pituitary adenomas (NIPAs) and conducted differential expressed gene analysis and enrichment analysis. We altered the expression of TNF-α through plasmids, then validated the effects of TNF-α on GH3 cells and verified the efficacy of the TNF-α inhibitor SPD304. Finally, the effects of TNF-α were validated in in vivo experiments. RESULTS Pathway act work showed that the MAPK pathway was significantly implicated in the pathway network. The expression of TNF-α, MMP9, and p-p38 is higher in BIPAs than in NIPAs. Overexpression of TNF-α elevated the expression of MAPK pathway proteins and MMP9 in GH3 cells, as well as promoted proliferation, migration, and invasion of GH3 cells. Flow cytometry indicated that TNF-α overexpression increased the G2 phase ratio in GH3 cells and inhibited apoptosis. The expression of MMP9 was reduced after blocking the P38 MAPK pathway; overexpression of MMP9 promoted invasion of GH3 cells. In vivo experiments confirm that the TNF-α overexpression group has larger tumor volumes. SPD304 was able to suppress the effects caused by TNF-α overexpression. CONCLUSION Bone-invasive pituitary adenoma secretes higher levels of TNF-α, which then acts on itself in an autocrine manner, activating the MAPK pathway and promoting the expression of MMP9, thereby accelerating the membrane invasion process. SPD304 significantly inhibits the effect of TNF-α and may be applied in the clinical treatment of bone-invasive pituitary adenoma.
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Affiliation(s)
- Xinzhi Wu
- Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Lei Gong
- Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina
| | - Bin Li
- Department of NeurosurgeryPeking University People's HospitalBeijingChina
| | - Jiwei Bai
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Chuzhong Li
- Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yazhuo Zhang
- Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Haibo Zhu
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
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16
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Glezer A, Garmes HM, Kasuki L, Martins M, Elias PCL, Nogueira VDSN, Rosa-E-Silva ACJDS, Maciel GAR, Benetti-Pinto CL, Nácul AP. Hyperprolactinemia in women: diagnostic approach. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-FPS04. [PMID: 38765533 PMCID: PMC11078114 DOI: 10.61622/rbgo/2024fps04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
- Andrea Glezer
- Universidade de São Paulo Hospital das Clínicas Faculdade de Medicina São PauloSP Brazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Heraldo Mendes Garmes
- Universidade Estadual de Campinas Faculdade de Ciências Médicas CampinasSP Brazil Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Leandro Kasuki
- Universidade Federal do Rio de Janeiro Hospital Universitário Clementino Fraga Filho Rio de JaneiroRJ Brazil Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Manoel Martins
- Universidade Federal do Ceará Departamento de Medicina Clínica e Núcleo de Pesquisa e Desenvolvimento de Medicamentos FortalezaCE Brazil Departamento de Medicina Clínica e Núcleo de Pesquisa e Desenvolvimento de Medicamentos, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Paula Condé Lamparelli Elias
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Departamento de Clínica Médica, Hospital das Clínicas Ribeirão PretoSP Brazil Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Vania Dos Santos Nunes Nogueira
- Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Clínica Médica BotucatuSP Brazil Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Ana Carolina Japur de Sá Rosa-E-Silva
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Departamento de Ginecologia e Obstetrícia Ribeirão PretoSP Brazil Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Gustavo Arantes Rosa Maciel
- Universidade de São Paulo Departamento de Obstetrícia e Ginecologia Faculdade de Medicina Sao PauloSP Brazil Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Cristina Laguna Benetti-Pinto
- Universidade Estadual de Campinas Departamento de Obstetrícia e Ginecologia Faculdade de Ciências Médicas CampinasSP Brazil Departamento de Obstetrícia e Ginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Unicamp, Campinas, SP, Brazil
| | - Andrea Prestes Nácul
- Unidade de Reprodução Humana Hospital Fêmina Grupo Hospitalar Conceição Porto AlegreRS Brazil Unidade de Reprodução Humana, Hospital Fêmina, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
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17
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Iglesias P. Pituitary Apoplexy: An Updated Review. J Clin Med 2024; 13:2508. [PMID: 38731037 PMCID: PMC11084238 DOI: 10.3390/jcm13092508] [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: 04/01/2024] [Revised: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Pituitary apoplexy (PA) is an acute, life-threatening clinical syndrome caused by hemorrhage and/or infarction of the pituitary gland. It is clinically characterized by the sudden onset of headache. Depending on the severity, it may also be accompanied by nausea, vomiting, visual disturbances, varying degrees of adenohypophyseal hormone deficiency, and decreased level of consciousness. Corticotropic axis involvement may result in severe hypotension and contribute to impaired level of consciousness. Precipitating factors are present in up to 30% of cases. PA may occur at any age and sometimes develops during pregnancy or the immediate postpartum period. PA occurs more frequently in men aged 50-60, being rare in children and adolescents. It can develop in healthy pituitary glands or those affected by inflammation, infection, or tumor. The main cause of PA is usually spontaneous hemorrhage or infarction of a pituitary adenoma (pituitary neuroendocrine tumor, PitNET). It is a medical emergency requiring immediate attention and, in many cases, urgent surgical intervention and long-term follow-up. Although the majority of patients (70%) require surgery, about one-third can be treated conservatively, mainly by monitoring fluid and electrolyte levels and using intravenous glucocorticoids. There are scoring systems for PA with implications for management and therapeutic outcomes that can help guide therapeutic decisions. Management of PA requires proper evaluation and long-term follow-up by a multidisciplinary team with expertise in pituitary pathology. The aim of the review is to summarize and update the most relevant aspects of the epidemiology, etiopathogenesis, pathophysiology, clinical presentation and clinical forms, diagnosis, therapeutic strategies, and prognosis of PA.
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, 28222 Madrid, Spain
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Glezer A, Mendes Garmes H, Kasuki L, Martins M, Condé Lamparelli Elias P, Dos Santos Nunes Nogueira V, Rosa-E-Silva ACJDS, Maciel GAR, Benetti-Pinto CL, Prestes Nácul A. Diagnosis of hyperprolactinemia in women: A Position Statement from the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and the Brazilian Society of Endocrinology and Metabolism (SBEM). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e230502. [PMID: 38578472 PMCID: PMC11081055 DOI: 10.20945/2359-4292-2023-0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
Hyperprolactinemia is a frequent cause of menstrual irregularity, galactorrhea, hypogonadism, and infertility. The most common etiologies of hyperprolactinemia can be classified as physiological, pharmacological, and pathological. Among pathological conditions, it is essential to distinguish prolactinomas from other tumors and pituitary lesions presenting with hyperprolactinemia due to pituitary stalk disconnection. Proper investigation considering clinical data, laboratory tests, and, if necessary, imaging evaluation, is important to identify the correctcause of hyperprolactinemia and manage the patient properly. This position statement by the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and Brazilian Societyof Endocrinology and Metabolism (SBEM) addresses the recommendations for measurement of serum prolactin levels and the investigations of symptomatic and asymptomatic hyperprolactinemia and medication-induced hyperprolactinemia in women.
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Affiliation(s)
- Andrea Glezer
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil,
| | - Heraldo Mendes Garmes
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Leandro Kasuki
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Manoel Martins
- Departamento de Medicina Clínica e Núcleo de Pesquisa e Desenvolvimento de Medicamentos, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Paula Condé Lamparelli Elias
- Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | | | | | - Gustavo Arantes Rosa Maciel
- Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Cristina Laguna Benetti-Pinto
- Departamento de Obstetrícia e Ginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Unicamp, Campinas, SP, Brasil
| | - Andrea Prestes Nácul
- Unidade de Reprodução Humana, Hospital Femina, Grupo Hospitalar Conceição, Porto Alegre, RS, Brasil
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Chang YC, Tsao YN, Chuang CC, Li CY, Lee TJ, Fu CH, Wei KC, Huang CC. Risk Factors for Isolated Sphenoid Sinusitis after Endoscopic Endonasal Transsphenoidal Pituitary Surgery. Diagnostics (Basel) 2024; 14:758. [PMID: 38611671 PMCID: PMC11011803 DOI: 10.3390/diagnostics14070758] [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: 02/14/2024] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Transsphenoidal pituitary surgery can be conducted via microscopic or endoscopic approaches, and there has been a growing preference for the latter in recent years. However, the occurrence of rare complications such as postoperative sinusitis remains inadequately documented in the existing literature. (2) Methods: To address this gap, we conducted a comprehensive retrospective analysis of medical records spanning from 2018 to 2023, focusing on patients who underwent transsphenoidal surgery for pituitary neuroendocrine tumors (formerly called pituitary adenoma). Our study encompassed detailed evaluations of pituitary function and MRI imaging pre- and postsurgery, supplemented by transnasal endoscopic follow-up assessments at the otolaryngology outpatient department. Risk factors for sinusitis were compared using univariate and multivariate logistic regression analyses. (3) Results: Out of the 203 patients included in our analysis, a subset of 17 individuals developed isolated sphenoid sinusitis within three months postoperation. Further scrutiny of the data revealed significant associations between certain factors and the occurrence of postoperative sphenoid sinusitis. Specifically, the classification of the primary tumor emerged as a notable risk factor, with patients exhibiting nonfunctioning pituitary neuroendocrine tumors with 3.71 times the odds of developing sinusitis compared to other tumor types. Additionally, postoperative cortisol levels demonstrated a significant inverse relationship, with lower cortisol levels correlating with an increased risk of sphenoid sinusitis postsurgery. (4) Conclusions: In conclusion, our findings underscore the importance of considering tumor classification and postoperative cortisol levels as potential predictors of postoperative sinusitis in patients undergoing transsphenoidal endoscopic pituitary surgery. These insights offer valuable guidance for clinicians in identifying at-risk individuals and implementing tailored preventive and management strategies to mitigate the occurrence and impact of sinusitis complications in this patient population.
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Affiliation(s)
- Yun-Chen Chang
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
| | - Yu-Ning Tsao
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan (C.-Y.L.)
| | - Cheng-Yu Li
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan (C.-Y.L.)
| | - Ta-Jen Lee
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
- Department of Otolaryngology-Head and Neck Surgery, Xiamen Chang Gung Hospital, Xiamen 361028, China
| | - Chia-Hsiang Fu
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan District, Taoyuan City 333, Taiwan
| | - Kuo-Chen Wei
- Department of Neurosurgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), No. 6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City 236, Taiwan;
| | - Chi-Che Huang
- Department of Otolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Guishan District, Taoyuan City 333, Taiwan; (Y.-C.C.); (Y.-N.T.); (T.-J.L.); (C.-H.F.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan District, Taoyuan City 333, Taiwan
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Almalki MH, Alsuraikh MA, Almalki E, Aziz F, Almazrouei R, AlDahmani KM, Alshahrani F, Alaqeel M, Mahzari M, Ekhzaimy A. Impulse control disorders in patients with dopamine agonist-treated pituitary adenomas: a cross-sectional multicenter study. Pituitary 2024; 27:197-203. [PMID: 38345719 DOI: 10.1007/s11102-024-01383-2] [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] [Accepted: 01/31/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Impulse control disorders (ICDs) have been described as underrecognized side effects of dopamine agonists (DAs) in neurological disorders but are not sufficiently understood in endocrine conditions. OBJECTIVE To identify the prevalence of DAs induced ICDs and determine potential risk factors related to these disorders in patients with prolactinoma and non-function pituitary adenomas (NFPAs). METHODS This is a cross-sectional multicenter study involving 200 patients with prolactinoma and NFPAs, who received follow-ups in tertiary referral centers. DA-induced ICDs were assessed using ICD questionnaires modified from prior studies. RESULT At least one ICD was reported by 52% of participants, among whom 28.5% mentioned compulsive shopping, 24.5% punding, and 24.5% hypersexuality. Furthermore, 33% of the patients reported the presence of one type of ICD behavior, while 12% specified two and 7% had three types of such behavior. The multivariable logistic regression showed that the significant risk factors of ICD were younger age (adjusted odds ratio [AOR]: 0.92, 95% confidence interval [CI]: 0.88-0.97, p 0.001), being single (AOR: 0.15, 95%CI: 0.03-0.84, p 0.03), and a positive history of psychiatric illness (AOR: 7.67, 95% CI: 1.37-42.97, p 0.021). CONCLUSION ICDs with a broad range of psychiatric symptoms are common in individuals with DA-treated prolactinoma and NFPAs. Endocrinologists should be aware of this potential side effect, particularly in patients with a personal history of psychiatric disorder.
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Affiliation(s)
- Mussa H Almalki
- Obesity, Endocrine, and Metabolism Center, King Fahd Medical City, Second Health Cluster, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Moayad A Alsuraikh
- Obesity, Endocrine, and Metabolism Center, King Fahd Medical City, Second Health Cluster, Riyadh, Saudi Arabia
| | - Eyad Almalki
- College of Medicine, Shaqra University, Shaqra, Saudi Arabia
| | - Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Raya Almazrouei
- Division of Endocrinology, Department of Medicine, Tawam Hospital, Al Ain, United Arab Emirates
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Khaled M AlDahmani
- Division of Endocrinology, Department of Medicine, Tawam Hospital, Al Ain, United Arab Emirates
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fahad Alshahrani
- College of Medicine, King Saud bin, Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Meshal Alaqeel
- College of Medicine, King Saud bin, Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Psychiatry, Ministry of The National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Moeber Mahzari
- College of Medicine, King Saud bin, Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
- Department of Medicine, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.
| | - Aishah Ekhzaimy
- Endocrinology and Diabetes Unit, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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21
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Islam MYU, Akhtar S, Nasir R, Anis SB, Iftikhar H, Khan FR, Martins RS, Bari ME, Ahmed U. Comparing redo surgery and stereotactic radiosurgery for recurrent, residual, and/or tumors showing progression in nonfunctioning pituitary adenomas: A systematic review and meta-analysis. Surg Neurol Int 2024; 15:37. [PMID: 38468659 PMCID: PMC10927195 DOI: 10.25259/sni_907_2023] [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: 11/11/2023] [Accepted: 01/18/2024] [Indexed: 03/13/2024] Open
Abstract
Background Non-functioning pituitary adenomas (NFPAs) are well-differentiated benign tumors originating from the adenohypophyseal cells of the pituitary gland. They present with headaches, visual disorders, or cranial nerve deficits. NFPAs can recur, progress, or present as residual tumors. We, therefore, conducted this review to compare the effects of both revision surgery and stereotactic surgery on tumor size, visual status, endocrine status, and complications. Methods A systematic review of published literature on recurrent, residual, or progressing NFPAs that underwent redo surgery or stereotactic radiosurgery from the inception till June 2020 was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirteen records (1209 patients) were included, and risk ratio (RR) and 95% confidence intervals (CIs) estimated from each study were pooled using a random-effects meta-analysis model. Results Redo surgery was the preferred intervention in patients presenting with larger tumor sizes and was more effective in reducing the tumor size as compared to stereotactic radiosurgery (SRS) (risk ratio [RR] 56.14; 95% CI, 16.45-191.58). There was more visual loss with revision surgery as compared to SRS (risk ratio [RR] 0.08; 95% CI, 0.03-0.20). However, SRS was associated with fewer complications, such as new diabetes insipidus, as compared to the redo surgery (risk ratio [RR] 0.01; 95% CI 0.01-0.03). Conclusion Redo surgery is the superior choice in the treatment of recurrent/residual or progressing NFPAs if the tumor size is large and an immediate reduction in tumor burden through debulking is warranted. However, redo surgery is associated with a higher risk of visual loss, new endocrinopathies, and other complications, in contrast to SRS.
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Affiliation(s)
| | - Saad Akhtar
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan
| | - Roua Nasir
- Department of Neurosurgery, Aga Khan University, Karachi, Pakistan
| | - Saad Bin Anis
- Department of Neurosurgery, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Haissan Iftikhar
- Department of Neurosurgery, Aga Khan University, Karachi, Pakistan
| | - Farhan Raza Khan
- Department of Surgery, Section of Dental Surgery, Aga Khan University, Karachi, Pakistan
| | | | | | - Urooba Ahmed
- Medical School, Liaquat National Hospital and Medical College (LNMC), Liaquat National University, Karachi, Pakistan
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22
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Dzialach L, Sobolewska J, Zak Z, Respondek W, Witek P. Prolactin-secreting pituitary adenomas: male-specific differences in pathogenesis, clinical presentation and treatment. Front Endocrinol (Lausanne) 2024; 15:1338345. [PMID: 38370355 PMCID: PMC10870150 DOI: 10.3389/fendo.2024.1338345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Prolactinomas (PRLomas) constitute approximately half of all pituitary adenomas and approximately one-fifth of them are diagnosed in males. The clinical presentation of PRLomas results from direct prolactin (PRL) action, duration and severity of hyperprolactinemia, and tumor mass effect. Male PRLomas, compared to females, tend to be larger and more invasive, are associated with higher PRL concentration at diagnosis, present higher proliferative potential, are more frequently resistant to standard pharmacotherapy, and thus may require multimodal approach, including surgical resection, radiotherapy, and alternative medical agents. Therefore, the management of PRLomas in men is challenging in many cases. Additionally, hyperprolactinemia is associated with a significant negative impact on men's health, including sexual function and fertility potential, bone health, cardiovascular and metabolic complications, leading to decreased quality of life. In this review, we highlight the differences in pathogenesis, clinical presentation and treatment of PRLomas concerning the male sex.
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Affiliation(s)
- Lukasz Dzialach
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Sobolewska
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Zuzanna Zak
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Wioleta Respondek
- Department of Internal Medicine, Endocrinology and Diabetes, Mazovian Brodnowski Hospital, Warsaw, Poland
| | - Przemysław Witek
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
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23
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Salle H, Cane M, Rocher M, Auditeau E, Teissier MP, Raverot G, Salle L. Pituitary apoplexy score, toward standardized decision-making: a descriptive study. Pituitary 2024; 27:77-87. [PMID: 38150169 DOI: 10.1007/s11102-023-01372-x] [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] [Accepted: 11/30/2023] [Indexed: 12/28/2023]
Abstract
Pituitary apoplexy (PA), a rare and life-threatening complication of pituitary adenomas, prompts urgent glucocorticoid administration. The optimal surgical approach is debated, and the Pituitary Apoplexy Score (PAS) aids decision-making. Our retrospective study (2003-2022) assesses variables in PA patient groups (surgical vs. non-surgical), applying PAS to establish a significant threshold for surgical decisions. Additionally, we aim to compare the rates of ophthalmological and endocrine deficit between both groups and identify any associated variables. PAS discrepancies were observed, with averages of 1.7 ± 1.7 (p < 0.0001) for conservative and 3.9 ± 1.7 (p < 0.0001) for surgical groups, confirmed by multivariate analysis (p = 0.009). A PAS threshold of 5, showing over 80% positive predictive value, was established. Patients with low prolactin levels (< 5 ng/ml) had higher corticotropic deficiency prevalence at 3-month and 1-year follow-ups (p = 0.017 and 0.027). Our study supports PAS as a valuable PA management tool, suggesting potential variable adjustments. Multicenter studies are crucial due to PA's low incidence.
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Affiliation(s)
- Henri Salle
- Neurosurgery, CHU Limoges, Limoges, France.
- CAPTuR, Inserm, University of Limoges, CHU Limoges, Limoges, France.
| | | | | | - Emilie Auditeau
- Inserm U1094, IRD U270, EpiMaCT, University of Limoges, CHU Limoges, Limoges, France
| | | | - Gerald Raverot
- Endocrinology, Hospices Civils de Lyon and Lyon 1 University, Lyon, France
| | - Laurence Salle
- Endocrinology, CHU Limoges, Limoges, France
- Inserm U1094, IRD U270, EpiMaCT, University of Limoges, CHU Limoges, Limoges, France
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24
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Mamelak AN, Little AS, Gardner PA, Almeida JP, Recinos P, Soni P, Kshettry VR, Jane JA, Barkhoudarian G, Kelly DF, Dodd R, Mukherjee D, Gersey ZC, Fukuhara N, Nishioka H, Kim EH, Litré CF, Sina E, Mazer MW, Cui Y, Bonert V. A Prospective, Multicenter, Observational Study of Surgical vs Nonsurgical Management for Pituitary Apoplexy. J Clin Endocrinol Metab 2024; 109:e711-e725. [PMID: 37698130 DOI: 10.1210/clinem/dgad541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/14/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
CONTEXT Pituitary apoplexy (PA) has been traditionally considered a neurosurgical emergency, yet retrospective single-institution studies suggest similar outcomes among patients managed medically. OBJECTIVE We established a multicenter, international prospective registry to compare presentation and outcomes in PA patients treated with surgery or medical management alone. METHODS A centralized database captured demographics, comorbidities, clinical presentation, visual findings, hormonal status, and imaging features at admission. Treatment was determined independently by each site. Key outcomes included visual, oculomotor, and hormonal recovery, complications, and hospital length of stay. Outcomes were also compared based on time from symptom onset to surgery, and from admission or transfer to the treating center. Statistical testing compared treatment groups based on 2-sided hypotheses and P less than .05. RESULTS A total of 100 consecutive PA patients from 12 hospitals were enrolled, and 97 (67 surgical and 30 medical) were evaluable. Demographics, clinical features, presenting symptoms, hormonal deficits, and imaging findings were similar between groups. Severe temporal visual field deficit was more common in surgical patients. At 3 and 6 months, hormonal, visual, and oculomotor outcomes were similar. Stratifying based on severity of visual fields demonstrated no difference in any outcome at 3 months. Timing of surgery did not affect outcomes. CONCLUSION We found that medical and surgical management of PA yield similar 3-month outcomes. Although patients undergoing surgery had more severe visual field deficits, we could not clearly demonstrate that surgery led to better outcomes. Even without surgery, apoplectic tumor volumes regress substantially within 2 to 3 months, indicating that surgery is not always needed to reduce mass effect.
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Affiliation(s)
- Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Andrew S Little
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Medical Center, Phoenix, AZ 85013, USA
| | - Paul A Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | | | - Pablo Recinos
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Pranay Soni
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Varun R Kshettry
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - John A Jane
- Departments of Neurosurgery, Virginia Tech Medical Center, Roanoke, VA 24014, USA
| | - Garni Barkhoudarian
- Pacific Neuroscience Institute, Saint John's Medical Center, Santa Monica, CA 90404, USA
| | - Daniel F Kelly
- Pacific Neuroscience Institute, Saint John's Medical Center, Santa Monica, CA 90404, USA
| | - Robert Dodd
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA 94305, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Zachary C Gersey
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Noriaki Fukuhara
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo 105-8470, Japan
| | - Hiroshi Nishioka
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo 105-8470, Japan
| | - Eui-Hyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Korea
| | | | - Elliott Sina
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mia W Mazer
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Yujie Cui
- Biostatistic Core, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Vivien Bonert
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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25
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Cai Y, Liu S, Zhao X, Ren L, Liu X, Gang X, Wang G. Pathogenesis, clinical features, and treatment of plurihormonal pituitary adenoma. Front Neurosci 2024; 17:1323883. [PMID: 38260014 PMCID: PMC10800528 DOI: 10.3389/fnins.2023.1323883] [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: 10/18/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Plurihormonal pituitary adenoma (PPA) is a type of pituitary tumor capable of producing two or more hormones and usually presents as an aggressive, large adenoma. As yet, its pathogenesis remains unclear. This is the first study to systematically summarize the underlying pathogenesis of PPA. The pathogenesis is related to plurihormonal primordial stem cells, co-transcription factors, hormone co-expression, differential gene expression, and cell transdifferentiation. We conducted a literature review of PPA and analyzed its clinical characteristics. We found that the average age of patients with PPA was approximately 40 years, and most showed only one clinical symptom. The most common manifestation was acromegaly. Currently, PPA is treated with surgical resection. However, recent studies suggest that immunotherapy may be a potentially effective treatment.
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Affiliation(s)
| | | | | | | | | | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
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26
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Yan N, Xie W, Wang D, Fang Q, Guo J, Chen Y, Li X, Gong L, Wang J, Guo W, Zhang X, Zhang Y, Gu J, Li C. Single-cell transcriptomic analysis reveals tumor cell heterogeneity and immune microenvironment features of pituitary neuroendocrine tumors. Genome Med 2024; 16:2. [PMID: 38167466 PMCID: PMC10759356 DOI: 10.1186/s13073-023-01267-3] [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: 03/10/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Pituitary neuroendocrine tumors (PitNETs) are one of the most common types of intracranial tumors. Currently, the cellular characteristics of normal pituitary and various other types of PitNETs are still not completely understood. METHODS We performed single-cell RNA sequencing (scRNA-seq) on 4 normal samples and 24 PitNET samples for comprehensive bioinformatics analysis. Findings regarding the function of PBK in the aggressive tumor cells were validated by siRNA knockdown, overexpression, and transwell experiments. RESULTS We first constructed a reference cell atlas of the human pituitary. Subsequent scRNA-seq analysis of PitNET samples, representing major tumor subtypes, shed light on the intrinsic cellular heterogeneities of the tumor cells and tumor microenvironment (TME). We found that the expression of hormone-encoding genes defined the major variations of the PIT1-lineage tumor cell transcriptomic heterogeneities. A sub-population of TPIT-lineage tumor cells highly expressing GZMK suggested a novel subtype of corticotroph tumors. In immune cells, we found two clusters of tumor-associated macrophages, which were both highly enriched in PitNETs but with distinct functional characteristics. In PitNETs, the stress response pathway was significantly activated in T cells. While a majority of these tumors are benign, our study unveils a common existence of aggressive tumor cells in the studied samples, which highly express a set of malignant signature genes. The following functional experiments confirmed the oncogenic role of selected up-regulated genes. The over-expression of PBK could promote both tumor cell proliferation and migration, and it was also significantly associated with poor prognosis in PitNET patients. CONCLUSIONS Our data and analysis manifested the basic cell types in the normal pituitary and inherent heterogeneity of PitNETs, identified several features of the tumor immune microenvironments, and found a novel epithelial cell sub-population with aggressive signatures across all the studied cases.
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Affiliation(s)
- Nan Yan
- MOE Key Laboratory of Bioinformatics, Department of Automation, BNRIST Bioinformatics Division, Tsinghua University, Beijing, 100084, China
| | - Weiyan Xie
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China
| | - Dongfang Wang
- Biomedical Pioneering Innovative Center, Peking University, Beijing, 100871, China
| | - Qiuyue Fang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China
| | - Jing Guo
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China
| | - Yiyuan Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China
| | - Xinqi Li
- MOE Key Laboratory of Bioinformatics, Department of Automation, BNRIST Bioinformatics Division, Tsinghua University, Beijing, 100084, China
| | - Lei Gong
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China
| | - Jialin Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China
| | - Wenbo Guo
- MOE Key Laboratory of Bioinformatics, Department of Automation, BNRIST Bioinformatics Division, Tsinghua University, Beijing, 100084, China
| | - Xuegong Zhang
- MOE Key Laboratory of Bioinformatics, Department of Automation, BNRIST Bioinformatics Division, Tsinghua University, Beijing, 100084, China
| | - Yazhuo Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China.
- Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, 100070, China.
| | - Jin Gu
- MOE Key Laboratory of Bioinformatics, Department of Automation, BNRIST Bioinformatics Division, Tsinghua University, Beijing, 100084, China.
| | - Chuzhong Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China.
- Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, 100070, China.
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27
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Boukerrouni A, Cuny T, Anjou T, Raingeard I, Ferrière A, Grunenwald S, Maïza JC, Marquant E, Sahakian N, Fodil-Cherif S, Salle L, Niccoli P, Randrianaivo H, Sonnet E, Chevalier N, Thuillier P, Vezzosi D, Reynaud R, Dufour H, Brue T, Tabarin A, Delemer B, Kerlan V, Castinetti F, Barlier A, Romanet P. Genetic testing in prolactinomas: a cohort study. Eur J Endocrinol 2023; 189:567-574. [PMID: 37956455 DOI: 10.1093/ejendo/lvad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/28/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Prolactinomas represent 46%-66% of pituitary adenomas, but the prevalence of germline mutations is largely unknown. We present here the first study focusing on hereditary predisposition to prolactinoma. OBJECTIVE We studied the prevalence of germline mutations in a large cohort of patients with isolated prolactinomas. MATERIALS AND METHODS A retrospective study was performed combining genetic and clinical data from patients referred for genetic testing of MEN1, AIP, and CDKN1B between 2003 and 2020. SF3B1 was Sanger sequenced in genetically negative patients. RESULTS About 506 patients with a prolactinoma were included: 80 with microprolactinoma (15.9%), 378 with macroprolactinoma (74.7%), 48 unknown; 49/506 in a familial context (9.7%). Among these, 14 (2.8%) had a (likely) pathogenic variant (LPV) in MEN1 or AIP, and none in CDKN1B. All positive patients had developed a macroprolactinoma before age 30. The prevalence of germline mutations in patients with isolated macroprolactinoma under 30 was 4% (11/258) in a sporadic context and 15% (3/20) in a familial context. Prevalence in sporadic cases younger than 18 was 15% in men (5/33) and 7% in women (4/57). No R625H SF3B1 germline mutation was identified in 264 patients with macroprolactinomas. CONCLUSIONS We did not identify any LPVs in patients over 30 years of age, either in a familial or in a sporadic context, and in a sporadic context in our series or the literature. Special attention should be paid to young patients and to familial context.
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Affiliation(s)
- Amina Boukerrouni
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, MarMaRa Institute, 13005 Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Thibaut Anjou
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, MarMaRa Institute, 13005 Marseille, France
| | - Isabelle Raingeard
- CHRU de Montpellier, Service d'Endocrinologie, Diabète, Maladies Métaboliques, 34000 Montpellier, France
| | - Amandine Ferrière
- Department of Endocrinology, University Hospital of Bordeaux, Haut Lévêque, 33318 Pessac, France
| | - Solange Grunenwald
- Department of Endocrinology and Metabolic Disease, Hospital Larrey CHU (University Hospital Centre), 31029 Toulouse, France
| | - Jean-Christophe Maïza
- Department of Endocrinology, Diabetes and Nutrition, GHSR, Centre Hospitalo-Universitaire de la Réunion, 97416 Saint-Pierre, La Réunion, France
| | - Emeline Marquant
- Aix Marseille Univ, APHM, INSERM, MMG, Department of pediatrics, hospital La Timone Enfants, MarMaRa Institute, 13005 Marseille, France
| | - Nicolas Sahakian
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Sarah Fodil-Cherif
- CHRU de Montpellier, Service d'Endocrinologie, Diabète, Maladies Métaboliques, 34000 Montpellier, France
| | - Laurence Salle
- Inserm, University Limoges, CHU de Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France
| | | | - Hanitra Randrianaivo
- UF de Génétique Médicale, GHSR, CHU de La Réunion, 97416 Saint Pierre, La Réunion, France
| | - Emmanuel Sonnet
- Department of Endocrinology and Diabetes, Brest University Hospital, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Nicolas Chevalier
- Centre Hospitalier Universitaire de Nice, Hôpital de l'Archet 2, Service d'Endocrinologie, Diabétologie et Médecine de la Reproduction, 151 route de Saint-Antoine de Ginestière, CS 23079, Nice 06202 Cedex 3, France
| | - Philippe Thuillier
- Department of Endocrinology and Diabetes, Brest University Hospital, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Delphine Vezzosi
- Institut CardioMet, 31000 Toulouse, France
- Service d'endocrinologie, Hôpital Larrey, 24, Chemin de Pouvourville, Toulouse 31029 Cedex 9, France
| | - Rachel Reynaud
- Aix Marseille Univ, APHM, INSERM, MMG, Department of pediatrics, hospital La Timone Enfants, MarMaRa Institute, 13005 Marseille, France
| | - Henry Dufour
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Neurosurgery Hospital la Timone Adulte, MarMaRa Institute, 13005 Marseille, France
| | - Thierry Brue
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Antoine Tabarin
- Department of Endocrinology, University Hospital of Bordeaux, Haut Lévêque, 33318 Pessac, France
| | - Brigitte Delemer
- Endocrinology, Diabetology and Nutrition Unit, University Hospital of Reims, 51454 Reims, France
| | - Véronique Kerlan
- Department of Endocrinology and Diabetes, Brest University Hospital, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Frédéric Castinetti
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Anne Barlier
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, MarMaRa Institute, 13005 Marseille, France
| | - Pauline Romanet
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, MarMaRa Institute, 13005 Marseille, France
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Vargas-Ortega G, Gonzalez-Virla B, Romero-Gameros CA. Pharmacological Treatment of Non-Functioning Pituitary Adenomas. Arch Med Res 2023; 54:102917. [PMID: 37996269 DOI: 10.1016/j.arcmed.2023.102917] [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: 07/11/2023] [Revised: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
Treatment strategies for NFPA include surgery, radiotherapy, medical treatment, or follow-up. The treatment of NFPAs with compressive symptoms is surgical. However, in case of post-surgical tumor remnants, there may be treatment strategies that include observation and radiotherapy. Recently, medical treatment with cabergoline (CAB) has been recommended to contain and/or reduce the size of the tumor remnant. Based on the findings that many NFPAs show a dopamine receptor (DR) and somatostatin receptor (SR) expression, medical therapy with dopamine agonists (DAs) and somatostatin receptor ligands (SSRLs) has been tested as an alternative to prevent recurrence after surgery. The DAs have been the most extensively studied, showing some potential in terms of tumor shrinkage. SSRLs and other emerging medical options are much less studied. We will review and critically evaluate the current data on the medical therapy of NFPAs to elucidate their role in the management of this tumor type. In the case of actively growing remnants (more than 10% growth per year) and high-risk pituitary adenomas, treatment with CAB at a dose of 1.5-3.0 mg is indicated for tumor containment and/or reduction. In relation to combined chemotherapy with CAB, there is little information in the literature to support its use. In our experience, CAB treatment can be used after radiotherapy as an adjuvant treatment.
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Affiliation(s)
- Guadalupe Vargas-Ortega
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Baldomero Gonzalez-Virla
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Carlos Alfonso Romero-Gameros
- Otorhinolaryngology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Ho KKY, Kaiser UB, Chanson P, Gadelha M, Wass J, Nieman L, Little A, Aghi MK, Raetzman L, Post K, Raverot G, Borowsky AD, Erickson D, Castaño JP, Laws ER, Zatelli MC, Sisco J, Esserman L, Yuen KCJ, Reincke M, Melmed S. Pituitary adenoma or neuroendocrine tumour: the need for an integrated prognostic classification. Nat Rev Endocrinol 2023; 19:671-678. [PMID: 37592077 DOI: 10.1038/s41574-023-00883-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/19/2023]
Abstract
In the 2022 fifth edition of the WHO Classification of Endocrine Tumours and of Central Nervous System Tumours, pituitary adenomas are reclassified as neuroendocrine tumours (NETs). This change confers an oncology label to neoplasms that are overwhelmingly benign. A comprehensive clinical classification schema is required to guide prognosis, therapy and outcomes for all patients with pituitary adenomas. Pituitary adenomas and NETs exhibit some morphological and ultrastructural similarities. However, unlike NETs, pituitary adenomas are highly prevalent, yet indolent and rarely become malignant. This Perspective presents the outcomes of an interdisciplinary international workshop that addressed the merit and clinical implications of the classification change of pituitary adenoma to NET. Many non-histological factors provide mechanistic insight and influence the prognosis and treatment of pituitary adenoma. We recommend the development of a comprehensive classification that integrates clinical, genetic, biochemical, radiological, pathological and molecular information for all anterior pituitary neoplasms.
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Affiliation(s)
- Ken K Y Ho
- The Garvan Institute of Medical Research, Sydney, New South Wales, Australia.
- The University of New South Wales, Sydney, New South Wales, Australia.
| | - Ursula B Kaiser
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Phillippe Chanson
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Monica Gadelha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Lynnette Nieman
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | | | - Manish K Aghi
- University of California, San Francisco, San Francisco, CA, USA
| | - Lori Raetzman
- University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Kalmon Post
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gerald Raverot
- Hospices Civils de Lyon, Groupement Hospitalier Est, Université Claude Bernard Lyon 1, Bron, France
| | | | | | - Justo P Castaño
- Maimónides Biomedical Research Institute of Córdoba, University of Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
| | | | | | - Jill Sisco
- The Acromegaly Community, Grove, OK, USA
| | - Laura Esserman
- University of California, San Francisco, San Francisco, CA, USA
| | - Kevin C J Yuen
- Barrow Neurological Institute, Phoenix, AZ, USA
- University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, AZ, USA
| | - Martin Reincke
- Klinikum der Universität, Ludwig-Maximilians-Universität, München, Germany
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Calandrelli R, Pilato F, D'Apolito G, Schiavetto S, Gessi M, D'Alessandris QG, Lauretti L, Gaudino S. MRI and Trouillas' grading system of pituitary tumors: the usefulness of T2 signal intensity volumetric values. Neuroradiology 2023; 65:1567-1578. [PMID: 37233819 DOI: 10.1007/s00234-023-03162-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/07/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE To classify pituitary macroadenomas according to the Trouillas' grading system; to compare this grading system with T2 values of volumetric signal intensity to determine T2 values able to predict the final grade. METHODS A total of 106 patients with macroadenomas were grouped according to the grading system score combining proliferation and invasiveness criteria of Trouillas' classification. Normalized volumetric signal intensity values were extracted from coronal T2-weighted images (nT2mean, nT2Max, nT2min) and were compared with the final grading score system. RESULTS Thirty-three patients were in grade 1a (non-invasive, non-proliferative tumors), 17 patients in grade 1b (non-invasive, proliferative tumors), 36 patients in grade 2a (invasive, non-proliferative tumors), and 20 patients in grade 2b (invasive, proliferative tumors). No patient was in grade 3 (metastatic tumors). nT2Max and nT2min were the best quantitative values to discriminate invasive from non-invasive grades; in invasive grades, nT2Max intensity values were higher, and nT2min intensity values were lower than in non-invasive grades. Receiver operating characteristic analysis of nT2 values showed that nT2min values had a better diagnostic performance than nT2Max values because they allowed differentiating with a moderate accuracy invasive tumors (2a or 2b grades) from both non-invasive proliferative tumors (1b) and non-invasive-non proliferative tumors (1a) (2a vs 1b: AUCnT2min = 0.78, 2b vs 1b: AUCnT2min = 0.72, 2a vs 1a: AUCnT2min = 0.72, 2b vs 1a AUCnT2min = 0.69). CONCLUSION Volumetric nT2Max and nT2min values of MRI might be practical and non-invasive markers for assessing tumor invasiveness although nT2 min signal intensity values have more effects in discriminating tumor's invasive behavior.
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Affiliation(s)
- Rosalinda Calandrelli
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Fabio Pilato
- Research Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine and Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italia
| | - Gabriella D'Apolito
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Stefano Schiavetto
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Marco Gessi
- Neuropathology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Simona Gaudino
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University of the Sacred Heart, Institute of Radiology, L.go A. Gemelli, Rome, Italy
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Ollen-Bittle N, Lee D, Proulx A, Duggal N, Van Uum SH. The importance of measuring prolactin prior to surgical management of a pituitary lesion: An illustrative case. Radiol Case Rep 2023; 18:3889-3893. [PMID: 37670916 PMCID: PMC10475397 DOI: 10.1016/j.radcr.2023.08.047] [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: 07/16/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
The characterization of sellar and suprasellar lesions is reliant on patient presentation, medical imaging, and hormone profiling. Prolactinomas are the most common type of functional pituitary adenomas, accounting for up to 57%. Importantly, prolactinomas can present without clear symptoms and with doubtful or even normal imaging. A 41-year-old male patient was referred to neurosurgery for consideration for resection of a sellar lesion, as initial CT imaging suggested a large meningioma. Subsequent MRI of the sella favored macroadenoma, meningioma, and craniopharyngioma as the top differential considerations. These conditions all indicate a diagnosis that would require surgical management. Clinical evaluation of this patient did not elicit any obvious clinical features suggestive of hyperprolactinemia. Fortunately, we obtained a full hormone panel which revealed a significantly elevated prolactin level of 17,390 µg/L. Based on this elevated prolactin level, we diagnosed a pituitary giant prolactinoma. Treatment with a dopamine agonist therapy was initiated and the response confirmed this diagnosis. This case demonstrates the importance of obtaining a prolactin level prior to surgical management of a sellar lesion. Had a prolactin level not been obtained, this patient would have undergone surgical resection based on both the imaging and clinical judgment.
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Affiliation(s)
- Nikita Ollen-Bittle
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
- Department of Anatomy and Cell Biology, Western University, Ontario, Canada
| | - Donald Lee
- Radiology, London Health Sciences Centre, Ontario, Canada
| | - Alain Proulx
- Ophthalmology, London Health Sciences Centre, Ontario, Canada
| | - Neil Duggal
- Neurosurgery, London Health Sciences Centre, Ontario, Canada
| | - Stan H.M. Van Uum
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
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Papadimitriou E, Chatzellis E, Dimitriadi A, Kaltsas GA, Theocharis S, Alexandraki KI. Prognostic Biomarkers in Pituitary Tumours: A Systematic Review. TOUCHREVIEWS IN ENDOCRINOLOGY 2023; 19:42-53. [PMID: 38187082 PMCID: PMC10769480 DOI: 10.17925/ee.2023.19.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/07/2023] [Indexed: 01/09/2024]
Abstract
Pituitary tumours (PTs) are the second most common intracranial tumour. Although the majority show benign behaviour, they may exert aggressive behaviour and can be resistant to treatment. The aim of this review is to report the recently identified biomarkers that might have possible prognostic value. Studies evaluating potentially prognostic biomarkers or a therapeutic target in invasive/recurrent PTs compared with either non-invasive or non-recurrent PTs or normal pituitaries are included in this review. In the 28 included studies, more than 911 PTs were evaluated. A systematic search identified the expression of a number of biomarkers that may be positively correlated with disease recurrence or invasion in PT, grouped according to role: (1) insensitivity to anti-growth signals: minichromosome maintenance protein 7; (2) evasion of the immune system: cyclooxygenase 2, arginase 1, programmed cell death protein 1 (PD-1)/programmed death ligand 2, cluster of differentiation (CD) 80/CD86; (3) sustained angiogenesis: endothelial cell-specific molecule, fibroblast growth factor receptor, matrix metalloproteinase 9, pituitary tumour transforming gene; (4) self-sufficiency in growth signals: epidermal growth factor receptor; and (5) tissue invasion: matrix metalloproteinase 9, fascin protein. Biomarkers with a negative correlation with disease recurrence or invasion include: (1) insensitivity to anti-growth signals: transforming growth factor β1, Smad proteins; (2) sustained angiogenesis: tissue inhibitor of metalloproteinase 1; (3) tissue invasion: Wnt inhibitory factor 1; and (4) miscellaneous: co-expression of glial fibrillary acidic protein and cytokeratin, and oestrogen receptors α36 and α66. PD-1/programmed cell death ligand 1 showed no clear association with invasion or recurrence, while cyclin A, cytotoxic T lymphocyte-associated protein 4, S100 protein, ephrin receptor, galectin-3 , neural cell adhesion molecule, protein tyrosine phosphatase 4A3 and steroidogenic factor 1 had no association with invasion or recurrence of PT. With the aim to develop a more personalized approach to the treatment of PT, and because of the limited number of molecular targets currently studied in the context of recurrent PT and invasion, a better understanding of the most relevant of these biomarkers by well-d esigned interventional studies will lead to a better understanding of the molecular profile of PT. This should also meet the increased need of treatable molecular targets.
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Affiliation(s)
- Eirini Papadimitriou
- First Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Chatzellis
- Endocrinology Diabetes and Metabolism Department, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
| | | | - Gregory A Kaltsas
- First Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Jimenez-Canizales CE, Rojas W, Alonso D, Romero I, Tabares S, Veronesi Zuluaga LA, Modica R, Colao A. Clinical presentation and recurrence of pituitary neuroendocrine tumors: results from a single referral center in Colombia. J Endocrinol Invest 2023; 46:2275-2286. [PMID: 37002436 DOI: 10.1007/s40618-023-02080-w] [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: 10/30/2022] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Pituitary neuroendocrine tumors (PitNETs) represent 15-18.2% of all intracranial tumors. Their clinical presentation can range from chronic headache, visual defects, hypopituitarism to hormone excess syndromes. PitNETS are commonly classified as functioning neuroendocrine tumors (F-PitNETs) and non-functioning neuroendocrine tumors (NF-PitNETs). At the moment, new classification has emerged based on cell lineages. Almost 50% of all patients with PitNETs require surgical intervention, and about 25% of these have residual and persistent disease that may require additional management. SUBJECTS AND METHODS A retrospective cohort of medical records of patients with PitNETs, aiming to describe the incidence of recurrence of patients who received surgical treatment over a 12 month follow up period at San Jose Hospital (SJH) in Bogotá, Colombia, over an observation period of 10 years. Furthermore, clinical presentation, biochemical characteristics and immunohistochemistry, postoperative complications are detailed. RESULTS Eight hundred and eighty-seven patients with pituitary tumors were included in the cohort; 83% (737/887) had a diagnosis of PitNET. Of these, 18.9% (140) received surgical management. The majority 58% (98/140) had nonfunctional-PitNETs (NF-PitNETs), followed by growth-hormone-secreting pituitary adenoma (22.1%; 33/140), adrenocorticotropic- hormone-secreting pituitary adenoma (9.3%; 13/140), and prolactinomas (9.3%; 13/140). A recurrence was found in 45.71% (64/140), subclassified as biochemical in 15.71% (22/140), controlled with medications in 20% (28/140), and remission occurred in 18.57% (26/140). CONCLUSION Clinical presentation and incidence of recurrence in patients with PitNETs in a referral center in Colombia are similar to other surgical cohorts with low cure rates and high recurrence.
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Affiliation(s)
- C E Jimenez-Canizales
- Department of Endocrinology, Hospital de San José de Bogotá, University Foundation of Health Sciences, 111411, Bogotá, Colombia.
- Neuroendocrinology (MEDINE-FUCS) Research Group, Faculty of Health Sciences, University Foundation of Health Sciences, Bogotá, Colombia.
| | - W Rojas
- Department of Endocrinology, Hospital de San José de Bogotá, University Foundation of Health Sciences, 111411, Bogotá, Colombia
- Neuroendocrinology (MEDINE-FUCS) Research Group, Faculty of Health Sciences, University Foundation of Health Sciences, Bogotá, Colombia
| | - D Alonso
- Department of Endocrinology, Hospital de San José de Bogotá, University Foundation of Health Sciences, 111411, Bogotá, Colombia
- Neuroendocrinology (MEDINE-FUCS) Research Group, Faculty of Health Sciences, University Foundation of Health Sciences, Bogotá, Colombia
| | - I Romero
- Department of Endocrinology, Hospital de San José de Bogotá, University Foundation of Health Sciences, 111411, Bogotá, Colombia
- Neuroendocrinology (MEDINE-FUCS) Research Group, Faculty of Health Sciences, University Foundation of Health Sciences, Bogotá, Colombia
| | - S Tabares
- Department of Endocrinology, Hospital de San José de Bogotá, University Foundation of Health Sciences, 111411, Bogotá, Colombia
- Neuroendocrinology (MEDINE-FUCS) Research Group, Faculty of Health Sciences, University Foundation of Health Sciences, Bogotá, Colombia
| | - L A Veronesi Zuluaga
- Department of Endocrinology, Hospital de San José de Bogotá, University Foundation of Health Sciences, 111411, Bogotá, Colombia
- Neuroendocrinology (MEDINE-FUCS) Research Group, Faculty of Health Sciences, University Foundation of Health Sciences, Bogotá, Colombia
| | - R Modica
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - A Colao
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
- UNESCO Chair, Education for Health and Sustainable Development, Federico II University, Naples, Italy
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Huang R, Jin J, Zhang P, Yan K, Zhang H, Chen X, He W, Guan H, Liao Z, Xiao H, Li Y, Li H. Use of speckle tracking echocardiography in evaluating cardiac dysfunction in patients with acromegaly: an update. Front Endocrinol (Lausanne) 2023; 14:1260842. [PMID: 37929035 PMCID: PMC10623426 DOI: 10.3389/fendo.2023.1260842] [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: 07/18/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
In recent years, cardiovascular disease has garnered increasing attention as the second leading cause of death in individuals with acromegaly, following malignancy. Identifying cardiac dysfunction early in acromegaly patients for timely intervention has become a focal point of clinical research. Speckle tracking echocardiography, a well-established ultrasound technique, surpasses conventional Doppler ultrasound in its sensitivity to assess both local and global cardiac mechanics. It can accurately detect subclinical and clinical myocardial dysfunction, including myocardial ischemia, ventricular hypertrophy, and valvular changes. Over the past five years, the use of speckle tracking echocardiography in acromegaly patients has emerged as a novel approach. Throughout the cardiac cycle, speckle tracking echocardiography offers a sensitive evaluation of the global and regional myocardial condition by quantifying the motion of myocardial fibres in distinct segments. It achieves this independently of variations in ultrasound angle and distance, effectively simulating the deformation of individual ventricles across different spatial planes. This approach provides a more accurate description of changes in cardiac strain parameters. Importantly, even in the subclinical stage when ejection fraction remains normal, the strain parameters assessed by speckle tracking echocardiography hold a good predictive value for the risk of cardiovascular death and hospitalization in acromegaly patients with concomitant cardiovascular disease. This information aids in determining the optimal timing for interventional therapy, offering important insights for cardiac risk stratification and prognosis. In the present study, we comprehensively reviewed the research progress of speckle tracking echocardiography in evaluating of cardiac dysfunction in acromegaly patients, to pave the way for early diagnosis of acromegaly cardiomyopathy.
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Affiliation(s)
- Rong Huang
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiewen Jin
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Pengyuan Zhang
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kemin Yan
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hanrong Zhang
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xin Chen
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei He
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hongyu Guan
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhihong Liao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hai Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Zhang D, Guo X, Feng M, Bao X, Deng K, Yao Y, Lian W, Xing B, Wang H. Preoperative and postoperative blood testosterone levels in patients with acromegaly: a prospective study. Front Endocrinol (Lausanne) 2023; 14:1259529. [PMID: 37886642 PMCID: PMC10598850 DOI: 10.3389/fendo.2023.1259529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
Purpose To investigate the prevalence of low blood testosterone level (LTL) and its determinant factors among active male acromegaly patients, as well as the effect of surgery on LTL in male acromegaly patients. Methods A retrospective, single-center study focused on 252 male acromegaly patients aged 18 years-60 years diagnosed in the Peking Union Medical College Hospital from January 2015 to December 2018 was carried out. The measurements of preoperative and postoperative testosterone levels, serum growth hormone (GH), insulin-like growth factor 1 (IGF-1), and other clinical data were analyzed. Results Forty per cent of subjects included were diagnosed with LTL pre surgery. Patients were divided into normal testosterone level (NTL) and LTL groups based on their testosterone level. There were significant differences (p < 0.01) between groups in the presence of macroadenomas, invasion of the cavernous sinus, compression of the optic chiasm, and serum GH and prolactin levels pre surgery. Invasion of the cavernous sinus [odds ratio (OR) = 4.299; p = 0.000] and serum prolactin level (OR = 1.023, p = 0.001) were independent predictors of LTLs in male patients before surgical intervention. A total of 67.9% of LTL patients recovered during the follow-up, with a new-onset rate of 3.4%. Body mass index, invasion of the cavernous sinus, GH, IGF-1, and prolactin levels, the presence of a prolactin-secreting tumor, and recovery from acromegaly were significantly different (p < 0.05) in the NTL group and in the LTL group during the follow-up. The presence of a prolactin-secreting tumor (OR = 0.224; p = 0.001) and recovery from acromegaly (OR = 0.168; p = 0.006) were independent predictors of LTLs in male acromegaly patients during the follow-up. Conclusion The invasiveness of tumor and levels of blood prolactin are independent factors for LTLs before surgery, whereas GH and IGF-1 levels are not. Most male patients can recover from LTL after tumor restriction surgery: those who recover from acromegaly have a better chance of recovering from LTL.
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Affiliation(s)
- Duoxing Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Xinjie Bao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Wei Lian
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology, China Pituitary Adenoma Specialist Council, Beijing, China
| | - Hanbi Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
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Tufekci D, Nuhoglu I, Ayan SS, Gunay YE, Coskun H, Bilginer MC, Ucuncu O, Kocak M, Yaman SO, Karahan SC. Can signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1) be used as an indicator of endothelial dysfunction in acromegaly patients? Endocrine 2023; 82:152-160. [PMID: 37450216 DOI: 10.1007/s12020-023-03444-1] [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: 04/01/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Acromegaly is closely related to increased oxidative stress and endothelial dysfunction (ED). This study aimed to evaluate, for the first time in the literature, signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1) and endothelial nitric oxide synthase e(NOS) levels in the setting of acromegaly. METHOD A total of 56 acromegaly patients and a control group composed of 30 healthy volunteers were included in this study. In the postoperative follow-up, patients were grouped as active or in-remission according to their GH and IGF-1 levels in oral glucose stimulation test (OGST). After detailed physical examination of acromegaly patients and the control subjects, 8-hour fasting blood samples were collected to evaluate biochemical parameters including lipid profile, anterior pituitary hormones, and SCUBE-1 and e(NOS) levels. RESULTS Inactive and active acromegaly was noted in 78.6% and 21.4% of patients, respectively. The median (min-max) SCUBE-1 levels were significantly higher in the inactive acromegaly and active acromegaly groups than in the control group (1.6(0.4-2.4) and 1.8(1.1-2.5) vs. 0.4(0.2-1.0) ng/mL, respectively, p < 0.001 for each). The median (min-max) e(NOS) levels were significantly higher in the inactive acromegaly and active acromegaly groups than in the control group (132.7 (26.8-602.9) and 137.3 (69.7-488.7) vs. 83.9 (16.4-218.7) pg/mL, p = 0.018 and p = 0.048, respectively). We have also detected positive correlations of e(NOS) with leukocyte (r = 0.307, p = 0.021) and neutrophil counts (r = 0.309, p = 0.021). CONCLUSION Our study revealed for the first time in literature that SCUBE-1 levels, being a novel marker for ED, were significantly higher in acromegaly patients than in control subjects. When supported with clinical studies, SCUBE-1can be used as an early indicator of endothelial damage in acromegaly patients.
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Affiliation(s)
- Damla Tufekci
- Department of Endocrinology and Metabolism, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey.
| | - Irfan Nuhoglu
- Department of Endocrinology and Metabolism, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Sumeyye Sura Ayan
- Department of Biochemistry, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Yasemin Emur Gunay
- Clinics of Endocrinology and Metabolism, Giresun Training and Research Hospital, Giresun, Turkey
| | - Hulya Coskun
- Department of Endocrinology and Metabolism, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Muhammet Cuneyt Bilginer
- Department of Endocrinology and Metabolism, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Ozge Ucuncu
- Department of Endocrinology and Metabolism, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Mustafa Kocak
- Department of Endocrinology and Metabolism, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Serap Ozer Yaman
- Department of Biochemistry, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Suleyman Caner Karahan
- Department of Biochemistry, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
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Elbaum M, Kałużny M, Jawiarczyk-Przybyłowska A, Wojtczak B, Zieliński G, Bolanowski M. The Relationship between the Burden of Acromegaly, Associated Comorbidities, Complications and Disease Status. J Clin Med 2023; 12:6309. [PMID: 37834952 PMCID: PMC10573270 DOI: 10.3390/jcm12196309] [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: 05/25/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Uncontrolled acromegaly causes increased morbidity and mortality. The analysis of acromegaly comorbidities and complications is important when establishing a standard of care for the entire population of acromegaly patients. The aim of this study was to determine the frequency of comorbidities and complications of acromegaly and their dependence on the activity of the disease. A retrospective analysis of medical records from 124 patients with acromegaly was carried out, including 39 who were cured, 73 treated with somatostatin analogs and 12 newly diagnosed patients. The incidence of comorbidities and complications was very high, and those most frequently observed were arterial hypertension, multinodular goiter, lipid disorders, hypopituitarism and degenerative changes. At least one complication of acromegaly was observed in 92% of patients undergoing successful neurosurgery and in all pharmacologically treated patients. By contrast, two or more complications were observed in 77% of cured patients and in pharmacologically controlled and uncontrolled patients, 82% and 91%, respectively. Conclusions: Acromegaly is associated with a high prevalence of complications. Active acromegaly is associated with a higher incidence of complications than in treated groups. Untreated patients have more complications than treated patients. Successfully cured patients have significantly fewer complications than pharmacologically controlled patients and patients with active acromegaly.
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Affiliation(s)
- Michał Elbaum
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże L. Pasteura 4, 50-367 Wroclaw, Poland
| | - Marcin Kałużny
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże L. Pasteura 4, 50-367 Wroclaw, Poland
| | | | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Str. 213, 50-556 Wroclaw, Poland
| | - Grzegorz Zieliński
- Department of Neurosurgery, Military Institute of Medicine—National Research Institute, 128 Szaserów Str., 04-141 Warsaw, Poland
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże L. Pasteura 4, 50-367 Wroclaw, Poland
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Jha S, Simonds WF. Molecular and Clinical Spectrum of Primary Hyperparathyroidism. Endocr Rev 2023; 44:779-818. [PMID: 36961765 PMCID: PMC10502601 DOI: 10.1210/endrev/bnad009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/09/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
Recent data suggest an increase in the overall incidence of parathyroid disorders, with primary hyperparathyroidism (PHPT) being the most prevalent parathyroid disorder. PHPT is associated with morbidities (fractures, kidney stones, chronic kidney disease) and increased risk of death. The symptoms of PHPT can be nonspecific, potentially delaying the diagnosis. Approximately 15% of patients with PHPT have an underlying heritable form of PHPT that may be associated with extraparathyroidal manifestations, requiring active surveillance for these manifestations as seen in multiple endocrine neoplasia type 1 and 2A. Genetic testing for heritable forms should be offered to patients with multiglandular disease, recurrent PHPT, young onset PHPT (age ≤40 years), and those with a family history of parathyroid tumors. However, the underlying genetic cause for the majority of patients with heritable forms of PHPT remains unknown. Distinction between sporadic and heritable forms of PHPT is useful in surgical planning for parathyroidectomy and has implications for the family. The genes currently known to be associated with heritable forms of PHPT account for approximately half of sporadic parathyroid tumors. But the genetic cause in approximately half of the sporadic parathyroid tumors remains unknown. Furthermore, there is no systemic therapy for parathyroid carcinoma, a rare but potentially fatal cause of PHPT. Improved understanding of the molecular characteristics of parathyroid tumors will allow us to identify biomarkers for diagnosis and novel targets for therapy.
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Affiliation(s)
- Smita Jha
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-1752, USA
| | - William F Simonds
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-1752, USA
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Oommen S, Rice S. Case Report: Atypical presentation of non-functional gonadotropinoma. F1000Res 2023; 12:674. [PMID: 37691731 PMCID: PMC10483175 DOI: 10.12688/f1000research.133438.1] [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] [Accepted: 09/08/2023] [Indexed: 09/12/2023] Open
Abstract
Gonadotropinoma is the most common non-functional pituitary adenoma comprising 10%-30% of all pituitary adenomas. They are benign slow-growing tumours originating from adenohypophysis and rarely become malignant. Its presentation can be atypical, such as visual disturbance, and most patients presenting to an ophthalmologist for visual correction are eventually found to have a field defect. Here, we report a case of a 59-year-old patient who presented with a left-sided visual disturbance, which progressed over the years due to a left temporal hemianopia. The patient was referred to us by an ophthalmologist and was diagnosed with a giant non-functional gonadotropinoma. The patient was surgically treated. Postoperative follow-up magnetic resonance imaging after 3 months showed near complete resection of the tumour.
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Affiliation(s)
- Suresh Oommen
- Endocrinology & Diabetes Department, Bronglais Hospital, NHS Wales Hywel Dda University Health Board, Aberystwyth, Wales, SY231ER, UK
| | - Sam Rice
- Endocrinology & diabetes Department, Swansea University, Swansea, Wales, UK
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Kwancharoen R, Deerochanawong C, Peerapatdit T, Salvatori R. Pituitary adenomas registry in Thailand. J Clin Neurosci 2023; 115:138-147. [PMID: 37572520 DOI: 10.1016/j.jocn.2023.07.026] [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: 04/24/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Pituitary adenomas are the most common sellar tumors, and may cause adverse outcomes in terms of morbidity and mortality if left untreated or if diagnosis is delayed. No data exists on the prevalence, characteristics, and prognosis of pituitary adenomas in Thailand. The systematic registration of clinical characteristics may improve patient care and prognosis for this disease in Thailand. METHODS This was a retrospective study conducted in 11 academic referral centers. All patients diagnosed with pituitary adenomas during the 2011---2014 period were enrolled in the study. The information was correlated with two national databases. RESULTS A total of 1,283 pituitary adenoma patients were identified. The adenomas were: non-functioning 50.1%, prolactinoma 29.4%, acromegaly 14.7%, Cushing disease 3.8%, gonadotropin-producing tumor 1.0%, TSH-secreting tumor 0.6%. The mean age was 49.2±15.2 years. Sixty-three percent of patients were female. Most common complaint was visual impairment (27.7%). The average size of the tumor was 22.2±16.1 mm. Fifty-nine percent of patients underwent surgery. Median follow-up was 27.4 months (0-24 years). After treatment, 72.4% improved, and 10.4% were cured. Overall results of treatment in non-functioning adenoma, prolactinoma (medically treated), acromegaly, Cushing, TSH, gonadotropin producing adenoma were: improved/cured in 81/5.5, 86/5.7, 55.9/30, 54.2/31.2, 85.7/14.3, 69.2/15.4% respectively. CONCLUSION Pituitary adenomas in academic centers in Thailand were found predominantly in female in the 4th decade of life. After treatment 72.4% of patients improved and 10% had full recovery. A health promotion system aimed to improve patient and physician recognition and physician expertise may improve the prognosis of these diseases.
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Affiliation(s)
- Ratchaneewan Kwancharoen
- Division of Endocrinology and Metabolism, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand.
| | - Chaicharn Deerochanawong
- Division of Endocrinology and Metabolism, Rajavithi Hospital, College of Medicine, Rangsit University, Thailand
| | - Thawatchai Peerapatdit
- Division of Endocrinology and Metabolism, Faculty of Medicine Siriraj Hospital, Thailand
| | - Roberto Salvatori
- Division of Endocrinology and Metabolism Department of Medicine, Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kaur J, Deshmukh PT, Jain S, Singh CV, Gaurkar SS. A Rare Association of Pituitary Macroadenoma With Nasopharyngeal Angiofibroma: A Case Report. Cureus 2023; 15:e45565. [PMID: 37868480 PMCID: PMC10586793 DOI: 10.7759/cureus.45565] [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: 06/28/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Pituitary macroadenoma and angiofibroma are two distinct and diverse types of tumors that can develop in different anatomical locations and clinical characteristics and are not typically related to each other in terms of their hormonal or developmental aspects. This case describes an adult male with pituitary macroadenoma with nasal angiofibroma. A 35-year-old male was diagnosed with pituitary macroadenoma and incidentally found to have juvenile nasopharyngeal angiofibroma (NPA). The patient underwent a diagnostic workup, including imaging studies and hormonal assays, which confirmed the concomitant presence of both tumors. The patient underwent successful endoscopic surgical excision of the NPA and transnasal transsphenoidal endoscopic pituitary macroadenoma excision as a two-stage operation. The patient was followed up postoperatively and had no evidence of tumor recurrence or hormonal imbalances. The importance of complete and comprehensive diagnostic workup and multidisciplinary management in achieving successful and optimum treatment outcomes for coexisting NPA and pituitary macroadenoma in an adult patient is highlighted in the present report.
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Affiliation(s)
- Jasleen Kaur
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad T Deshmukh
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shraddha Jain
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chandra Veer Singh
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sagar S Gaurkar
- Department of Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kharel M, Hossain MF. Pituitary apoplexy associated with bacterial meningitis: Diagnostic dilemma. Clin Case Rep 2023; 11:e7887. [PMID: 37670816 PMCID: PMC10475759 DOI: 10.1002/ccr3.7887] [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: 06/04/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/07/2023] Open
Abstract
Pituitary apoplexy is a rare entity, which is characterized by severe neurological, ophthalmological, and endocrinological complications, with acute adrenal crisis being a major concern. The diagnosis of pituitary apoplexy is challenging, particularly in cases where it coexists with bacterial meningitis, leading to a diagnostic dilemma and delay in treatment. We report a case of a 23-year-old female diagnosed with pituitary apoplexy with concurrent bacterial meningitis.
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Wydra A, Stelmachowska-Banaś M, Czajka-Oraniec I. Skeletal complications in acromegaly. Reumatologia 2023; 61:248-255. [PMID: 37745143 PMCID: PMC10515128 DOI: 10.5114/reum/169918] [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: 03/04/2023] [Accepted: 07/24/2023] [Indexed: 09/26/2023] Open
Abstract
Hypersecretion of growth hormone (GH) is rare and typically results from a pituitary functional tumor - somatotropinoma. It leads to excessive linear bone growth and manifests as gigantism if occurring in childhood and adolescence, before the closure of epiphyses or as a acromegaly in adulthood. The excess of GH impacts bone metabolism directly as well as indirectly through increased insulin-like growth factor 1 (IGF-1). In acromegaly as a consequence of overproduction of GH and IFG-1 and the influence of these hormones on bone osteoblasts, bone metabolism, growth and density increase. However, bone turnover is accelerated causing impaired bone microstructure and strength, which may lead to increased risk of vertebral fractures irrespective of normal bone mineral density. Apart from the changes in bone architecture, acromegaly also results in a degenerative joint disease of a different nature than primary osteoarthritis. Moreover, acromegaly leads to cardiovascular, metabolic and respiratory complications, and thus significantly impairs the quality of life. In this review, authors summarize the pathophysiology, diagnosis, and treatment of bone and joint disease in acromegaly.
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Affiliation(s)
- Arnika Wydra
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
| | - Maria Stelmachowska-Banaś
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
| | - Izabella Czajka-Oraniec
- Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
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Al-Shamkhi N, Berinder K, Borg H, Burman P, Dahlqvist P, Höybye C, Olsson DS, Ragnarsson O, Ekman B, Edén Engström B. Pituitary function before and after surgery for nonfunctioning pituitary adenomas-data from the Swedish Pituitary Register. Eur J Endocrinol 2023; 189:217-224. [PMID: 37551511 DOI: 10.1093/ejendo/lvad104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Data on pre- and postoperative pituitary function in nonfunctioning pituitary adenomas (NFPA) are not consistent. We aimed to investigate pituitary function before and up to 5 years after transsphenoidal surgery with emphasis on the hypothalamic-pituitary-adrenal axis (HPA). DESIGN AND METHODS Data from the Swedish Pituitary Register was used to analyze anterior pituitary function in 838 patients with NFPA diagnosed between 1991 and 2014. Patients who were reoperated or had received radiotherapy were excluded. RESULTS Preoperative ACTH, TSH, LH/FSH, and GH deficiencies were reported in 31% (236/755), 39% (300/769), 51% (378/742), and 28% (170/604) of the patients, respectively. Preoperative median tumor volume was 5.0 (2.4-9.0) cm3. Among patients with preoperative, 1 year and 5 years postoperative data on the HPA axis (n = 428), 125 (29%) were ACTH-deficient preoperatively. One year postoperatively, 26% (32/125) of them had recovered ACTH function while 23% (70/303) patients had developed new ACTH deficiency. Thus, 1 year postoperatively, 163 (38%) patients were ACTH-deficient (P < .001 vs. preoperatively). No further increase was seen 5 years postoperatively (36%, P = .096). At 1 year postoperatively, recoveries in the TSH and LH/FSH axes were reported in 14% (33/241) and 15% (46/310), respectively, and new deficiencies in 22% (88/403) and 29% (83/288), respectively. CONCLUSIONS Adrenocorticotrophic hormone deficiency increased significantly at 1 year postoperatively. Even though not significant, some patients recovered from or developed new deficiency between 1 and 5 years postoperatively. This pattern was seen in all axes. Our study emphasizes that continuous individual evaluations are needed during longer follow-up of patients operated for NFPA.
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Affiliation(s)
- Nasrin Al-Shamkhi
- Department of Internal Medicine, Örebro University Hospital and School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Endocrinology and Diabetology, Uppsala University Hospital, Uppsala, Sweden
| | - Katarina Berinder
- Department of Endocrinology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Borg
- Department of Endocrinology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Pia Burman
- Department of Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Per Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Charlotte Höybye
- Department of Endocrinology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Daniel S Olsson
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Göteborg, Sweden
| | - Bertil Ekman
- Departments of Endocrinology in Linköping and Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Britt Edén Engström
- Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
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Kim J, Hong N, Choi J, Moon JH, Kim EH, Hong JW, Lee EJ, Kim SG, Ku CR. Sex differences in mortality in patients with acromegaly: a nationwide cohort study in Korea. Eur J Endocrinol 2023; 189:225-234. [PMID: 37548222 DOI: 10.1093/ejendo/lvad106] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE The results of previous studies on sex differences in mortality and comorbidities among patients with acromegaly are diverse. We assessed sex differences in mortality and the risk of complications in patients with acromegaly. METHODS We included 1884 patients with acromegaly with 1:50 age- and sex-matched 94 200 controls using the Korean nationwide claims database from 2009 to 2019. RESULTS During the median 5.51 years of follow-up, the acromegaly group had higher all-cause mortality than the control group (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.38-2.19), with higher risk in women than men (HR 2.17 vs 1.36). The most common cause of death was malignancy. Women with acromegaly aged ≥50 years exhibited significantly higher mortality than men with acromegaly aged ≥50 years (HR 1.74 vs 0.96). In a treatment subgroup other than surgery alone, women had a higher risk of mortality than men (HR 2.82 vs 1.58). Sex differences in mortality among patients with acromegaly remained equal after adjustment for the Charlson Comorbidity Index (CCI), socioeconomic status (SES), body mass index (BMI), alcohol consumption, smoking, fasting plasma glucose, creatinine, and total cholesterol. Patients with acromegaly had elevated risks of developing major adverse cardiovascular events (MACE), atrial fibrillation, obstructive sleep apnea (OSA), diabetes mellitus (DM), end-stage renal disease (ESRD), Parkinson's disease (PD), depression, and malignancy than age- and sex-matched controls, with a higher risk of OSA and DM in women than men. CONCLUSIONS The risk of mortality and complications in patients with acromegaly compared to age- and sex-matched controls was higher in women than in men.
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Affiliation(s)
- Jiwon Kim
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea, 10444
- Yonsei University Graduate School of Medicine, Seoul, Republic of Korea, 03722
| | - Namki Hong
- Endocrinology, Department of Internal Medicine, Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea, 03722
| | - Jimi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea, 02841
| | - Ju Hyung Moon
- Pituitary Tumor Center, Severance Hospital, Seoul, Republic of Korea, 03722
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea, 03722
| | - Eui Hyun Kim
- Pituitary Tumor Center, Severance Hospital, Seoul, Republic of Korea, 03722
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea, 03722
| | - Jae Won Hong
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea, 10380
| | - Eun Jig Lee
- Endocrinology, Department of Internal Medicine, Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea, 03722
- Pituitary Tumor Center, Severance Hospital, Seoul, Republic of Korea, 03722
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea, 02841
| | - Cheol Ryong Ku
- Endocrinology, Department of Internal Medicine, Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea, 03722
- Pituitary Tumor Center, Severance Hospital, Seoul, Republic of Korea, 03722
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Baba MS, Islam Mir SU, Bhat MH, Laway BA, Misgar RA. Gender Disparities in Prolactinomas: Unravelling Clinical Patterns, Metabolic Variations, and Treatment Responses. Cureus 2023; 15:e42911. [PMID: 37664314 PMCID: PMC10474902 DOI: 10.7759/cureus.42911] [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: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background and objective Individuals with prolactinoma exhibit elevated rates of obesity, metabolic syndrome (MS), and dyslipidemia compared to their healthy counterparts. However, there is a lack of data regarding metabolic variance between male and female prolactinoma patients. Consequently, this study aimed to investigate and compare sex-specific discrepancies in metabolic abnormalities among individuals diagnosed with prolactinoma. Methods In this prospective study, 80 treatment-naïve patients with prolactinoma (12 males and 68 females) underwent clinical assessments and laboratory investigations. The measured parameters included blood glucose, total cholesterol (TC), triglycerides (TG), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), urea, creatinine, uric acid, and blood glucose levels. The patients were treated with cabergoline, a dopamine agonist, and reevaluated after 12 weeks. Results Forty-eight patients had microprolactinomas (all females), and 32 had macroprolactinomas (20 females, 12 males). The mean age was 28.30±7.49 years for females and 28.91±7.12 years for males (p=0.71). The median symptom duration was 12 months (range 1-72 months, IQR 4-16 months), with no significant difference between males (median 12 months, IQR 5-54 months) and females (median 12 months, IQR 10-24 months, p=0.620). The median serum prolactin (PRL) was 988 ng/mL (IQR 471-1,439) in males and 165 ng/mL (IQR 90-425) in females (p<0.05). Males showed higher HbA1c, BGF, TC, TG, LDL-C, and higher rates of obesity, MS, and diabetes mellitus. Treatment with cabergoline resulted in significant improvements in the HbA1c, BGF, TC, TG, and LDL-C levels. Conclusion Males with prolactinomas had larger tumor sizes and higher serum PRL levels than females. Additionally, males exhibited worse metabolic parameters than females. However, there was no significant difference in the duration of symptoms or age at diagnosis between the two groups.
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Affiliation(s)
| | - Sajad Ul Islam Mir
- Endocrinology, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | | | - Bashir Ahmad Laway
- Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Raiz Ahmad Misgar
- Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, IND
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Ghafouri-Fard S, Khaledabadi M, Najafi G, Safarzadeh A, Hussen BM, Eslami S, Sharifi G, Taheri M, Dilmaghani NA. Expression pattern of lncRNAs in pituitary adenomas. Pathol Res Pract 2023; 248:154668. [PMID: 37418994 DOI: 10.1016/j.prp.2023.154668] [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: 06/15/2023] [Revised: 07/01/2023] [Accepted: 07/02/2023] [Indexed: 07/09/2023]
Abstract
Non-functioning pituitary adenomas (NFPAs) are a group of pituitary tumors lacking manifestations linked to high hormone production, such as acromegaly and Cushing's syndrome. NFPA carcinogenesis depends on several molecular players. Long non-coding RNAs (lncRNAs) are a class of molecular players whose role in tumorigenesis has just recently been recognized. In the current study, we appraised expressions of 5 lncRNAs, namely FGD5-AS1, ATP6V0E2-AS1, ARHGAP5-AS1, WWC2-AS2 and EPB41L4A-AS1 in NFPAs versus their corresponding non-tumoral samples. Expressions of ATP6V0E2-AS1, EPB41L4A-AS1, FGD5-AS1 and WWC2-AS2 were significantly increased in NFPA samples compared with adjacent non-tumoral samples (P values = 0.037, 0.007, 0.008 and 0.03, respectively). However, expression of ARHGAP5-AS1 was not different between NFPA samples and controls (P value = 0.62). EPB41L4A-AS1 and FGD5-AS1 could discriminate between NFPA samples and adjacent non-tumoral samples (P values = 0.03 and 0.04, respectively). However, the AUC values were not appropriate. There was a significant positive association between age of NFPA patients and invasiveness of NFPA (χ2 = 4.24, P value = 0.039). Moreover, there was a significant positive association between diseases duration and CSF leak (χ2 = 11.4, p value = 0.023). Finally, there was a significant positive association between tumor size and Knosp classification (χ2 = 11.5, p value = 0.02) and invasiveness of NFPA (χ2 = 6.12, p value = 0.04). The current study provides information about dysregulation of lncRNAs in NFPAs and warrants additional studies in this field.
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Affiliation(s)
- Soudeh Ghafouri-Fard
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Maryam Khaledabadi
- Department of Operating Room Technology, School of Allied Medical Sciences, International Campus, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Ghazal Najafi
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Arash Safarzadeh
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Bashdar Mahmud Hussen
- Department of Clinical Analysis, College of Pharmacy, Hawler Medical University, Kurdistan Region, Islamic Republic of Iran
| | - Solat Eslami
- Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Islamic Republic of Iran; Department of Medical Biotechnology, School of Medicine, Alborz University of Medical Sciences, Karaj, Islamic Republic of Iran
| | - Guive Sharifi
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Taheri
- Institute of Human Genetics, Jena University Hospital, Jena, Germany; Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Nader Akbari Dilmaghani
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
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Tanaka H, Nishimura F, Nakase K, Yokoyama S, Nakagawa I, Yamada S, Tamura K, Matsuda R, Takeshima Y, Kotsugi M, Park YS, Nakase H. Case report: Giant pituitary neuroendocrine tumor presented along with acute visual loss due to pituitary apoplexy after receiving COVID-19 vaccination. Front Surg 2023; 10:1220098. [PMID: 37576925 PMCID: PMC10413133 DOI: 10.3389/fsurg.2023.1220098] [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: 05/10/2023] [Accepted: 06/30/2023] [Indexed: 08/15/2023] Open
Abstract
Objective A case of giant pituitary neuroendocrine tumor presented along with acute visual loss due to pituitary apoplexy after receiving a COVID-19 vaccination is reported. Case presentation A 45-year-old man was referred for a giant pituitary tumor with bitemporal hemianopsia. A surgical procedure was planned and then delayed due to the COVID-19 outbreak in Japan, with a Pfizer/BioNTech vaccine administered while awaiting surgery. Three days after the second COVID-19 vaccination the patient noted a progressively worsening headache that caused pituitary apoplexy and then a decrease in vision. Emergency surgery was thus performed. Conclusion Pituitary apoplexy is a rare and life-threatening complication that may occur after undergoing a COVID-19 vaccination.
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Wang L, Wei C, Wang Y, Huang N, Zhang T, Dai Y, Xue L, Lin S, Wu ZB. Identification of the enhancer RNAs related to tumorgenesis of pituitary neuroendocrine tumors. Front Endocrinol (Lausanne) 2023; 14:1149997. [PMID: 37534217 PMCID: PMC10393250 DOI: 10.3389/fendo.2023.1149997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
Background Pituitary neuroendocrine tumors (PitNETs), which originate from the pituitary gland, account for 10%-15% of all intracranial neoplasms. Recent studies have indicated that enhancer RNAs (eRNAs) exert regulatory effects on tumor growth. However, the mechanisms underlying the eRNA-mediated tumorigenesis of PitNETs have not been elucidated. Methods Normal pituitary and PitNETs tissues were used to identify the differentially expressed eRNAs (DEEs). Immune gene sets and hallmarks of cancer gene sets were quantified based on single sample gene set enrichment analysis (ssGSEA) algorithm using GSVA. The perspective of immune cells among all samples was calculated by the CIBERSORT algorithm. Moreover, the regulatory network composed of key DEEs, target genes of eRNAs, hallmarks of cancer gene sets, differentially expressed TF, immune cells and immune gene sets were constructed by Pearson correlation analysis. Small molecular anti-PitNETs drugs were explored by CMap analysis and the accuracy of the study was verified by in vitro and in vivo experiments, ATAC-seq and ChIP-seq. Results In this study, data of 134 PitNETs and 107 non-tumorous pituitary samples were retrieved from a public database to identify differentially expressed genes. In total, 1128 differentially expressed eRNAs (DEEs) (494 upregulated eRNAs and 634 downregulated eRNAs) were identified. Next, the correlation of DEEs with cancer-related and immune-related gene signatures was examined to establish a co-expression regulatory network comprising 18 DEEs, 50 potential target genes of DEEs, 5 cancer hallmark gene sets, 2 differentially expressed transcription factors, 4 immune cell types, and 4 immune gene sets. Based on this network, the following four therapeutics for PitNETs were identified using Connectivity Map analysis: ciclopirox, bepridil, clomipramine, and alexidine. The growth-inhibitory effects of these therapeutics were validated using in vitro experiments. Ciclopirox exerted potential growth-inhibitory effects on PitNETs. Among the DEEs, GNLY, HOXB7, MRPL33, PRDM16, TCF7, and ZNF26 were determined to be potential diagnostic and therapeutic biomarkers for PitNETs. Conclusion This study illustrated the significant influence of eRNAs on the occurrence and development of PitNETs. By constructing the co-expression regulation network, GNLY, HOXB6, MRPL33, PRDM16, TCF7, and ZNF26 were identified as relatively significant DEEs which were considered as the novel biomarkers of diagnosis and treatment of PitNETs. This study demonstrated the roles of eRNAs in the occurrence and development of PitNETs and revealed that ciclopirox was a potential therapeutic for pituitary adenomas.
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Affiliation(s)
- Liangbo Wang
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenlu Wei
- Center for Reproductive Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Wang
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ning Huang
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tao Zhang
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuting Dai
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Xue
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaojian Lin
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhe Bao Wu
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ma J, Gooderham P, Akagami R, Makarenko S. Correlation of Pituitary Descent and Diabetes Insipidus After Transsphenoidal Pituitary Macroadenoma Resection. Neurosurgery 2023; 92:1269-1275. [PMID: 36700759 DOI: 10.1227/neu.0000000000002360] [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: 08/08/2022] [Accepted: 11/10/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Endoscopic transsphenoidal surgery remains the technique of choice for resection of pituitary adenoma. Postoperative diabetes insipidus (DI) is most often transient and observed in 1.6% to 34% of patients, whereas permanent DI has been reported in 0% to 2.7% of patients. The proposed mechanism was the transduction of traction forces exerted by the surgeon on the descended diaphragma sellae and through the pituitary stalk. OBJECTIVE To quantify and correlate the degree of pituitary gland descent with postoperative DI. METHODS Of 374 patients who underwent transsphenoidal resection of a pituitary adenoma between 2010 and 2020 at our institution, we report a cohort of 30 patients (Group A) DI. We also report a matched cohort by tumor volume of 30 patients who did not develop DI (Group B). We quantified the tension on the pituitary stalk by calculating pituitary descent interval (PDI) by comparing preoperative and postoperative position of the pituitary gland and using Pythagoras' formula where , with craniocaudal (CC) and anterior-posterior (AP) representing measurements of pituitary translation in respective directions after resection. RESULTS Patients who developed DI had significantly greater pituitary gland translations in the craniocaudal (23.0 vs 16.3 mm, P = .0015) and anteroposterior (2.4 vs 1.5 mm, P = .0168) directions. Furthermore, Group A had a statistically greater PDI, which was associated with development of DI (23.2 vs 16.6 mm, P = .0017). CONCLUSION We were able to quantify pituitary descent and subsequent tension on the pituitary stalk, while also associating it with development of postoperative DI after pituitary adenoma resection.
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Affiliation(s)
- Josh Ma
- Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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