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Potorac I, Bonneville JF, Daly AF, de Herder W, Fainstein-Day P, Chanson P, Korbonits M, Cordido F, Baranski Lamback E, Abid M, Raverot V, Raverot G, Anda Apiñániz E, Caron P, Du Boullay H, Bildingmaier M, Bolanowski M, Laloi-Michelin M, Borson-Chazot F, Chabre O, Christin-Maitre S, Briet C, Diaz-Soto G, Bonneville F, Castinetti F, Gadelha MR, Oliveira Santana N, Stelmachowska-Banaś M, Gudbjartsson T, Villar-Taibo R, Zornitzki T, Tshibanda L, Petrossians P, Beckers A. Pituitary MRI Features in Acromegaly Resulting From Ectopic GHRH Secretion From a Neuroendocrine Tumor: Analysis of 30 Cases. J Clin Endocrinol Metab 2022; 107:e3313-e3320. [PMID: 35512251 DOI: 10.1210/clinem/dgac274] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Ectopic acromegaly is a consequence of rare neuroendocrine tumors (NETs) that secrete GHRH. This abnormal GHRH secretion drives GH and IGF-1 excess, with a clinical presentation similar to classical pituitary acromegaly. Identifying the underlying cause for the GH hypersecretion in the setting of ectopic GHRH excess is, however, essential for proper management both of acromegaly and the NET. Owing to the rarity of NETs, the imaging characteristics of the pituitary in ectopic acromegaly have not been analyzed in depth in a large series. OBJECTIVE Characterize pituitary magnetic resonance imaging (MRI) features at baseline and after NET treatment in patients with ectopic acromegaly. DESIGN Multicenter, international, retrospective. SETTING Tertiary referral pituitary centers. PATIENTS Thirty ectopic acromegaly patients having GHRH hypersecretion. INTERVENTION None. MAIN OUTCOME MEASURE MRI characteristics of pituitary gland, particularly T2-weighted signal. RESULTS In 30 patients with ectopic GHRH-induced acromegaly, we found that most patients had hyperplastic pituitaries. Hyperplasia was usually moderate but was occasionally subtle, with only small volume increases compared with normal ranges for age and sex. T2-weighted signal was hypointense in most patients, especially in those with hyperplastic pituitaries. After treatment of the NET, pituitary size diminished and T2-weighted signal tended to normalize. CONCLUSIONS This comprehensive study of pituitary MRI characteristics in ectopic acromegaly underlines the utility of performing T2-weighted sequences in the MRI evaluation of patients with acromegaly as an additional tool that can help to establish the correct diagnosis.
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Affiliation(s)
- Iulia Potorac
- Departments of Endocrinology, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
| | - Jean-François Bonneville
- Departments of Endocrinology, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
- Medical Imaging, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
| | - Adrian F Daly
- Departments of Endocrinology, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
| | - Wouter de Herder
- Department of Internal Medicine, Section of Endocrinology, Erasmus University Medical Center, 3015 GD, Rotterdam, The Netherlands
| | - Patricia Fainstein-Day
- Department of Endocrinology, Hospital Italiano de Buenos Aires, 1199, Buenos Aires, Argentina
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 94270 Le Kremlin-Bicêtre, France
| | - Marta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, United Kingdom
| | - Fernando Cordido
- Department of Endocrinology, University Hospital A Coruña, 15006 A Coruña, Spain
| | - Elisa Baranski Lamback
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, 21941-617 Rio de Janeiro, Brazil
| | - Mohamed Abid
- Department of Endocrinology, Hedi Chaker Hospital, 3000 Sfax, Tunis
| | - Véronique Raverot
- Biochemistry Laboratory Department, Groupement Hospitalier Est, Hospices Civils de Lyon, 69002 Lyon, France
| | - Gerald Raverot
- Fédération d'Endocrinologie, Centre de Référence des Maladies Rares Hypophysaires HYPO, Groupement Hospitalier Est, Hospices Civils de Lyon, 69002 Lyon, France
| | - Emma Anda Apiñániz
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Philippe Caron
- Service d'Endocrinologie et Maladies Métaboliques, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France
| | - Helene Du Boullay
- Department of Endocrinology, General Hospital of Chambéry, 73000 Chambéry, France
| | - Martin Bildingmaier
- Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, 80539 Munich, Germany
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Marie Laloi-Michelin
- Department of Diabetes and Endocrinology, Lariboisière Hospital, 75010 Paris, France
| | - Francoise Borson-Chazot
- Hospices Civils de Lyon, Fédération d'Endocrinologie, Université Claude Bernard Lyon 1, 69002 Lyon, France
| | - Olivier Chabre
- Service d'Endocrinologie, Centre Hospitalier Universitaire de Grenoble, 38700 La Tronche, France
| | - Sophie Christin-Maitre
- Department of Endocrinology, Hôpital St Antoine, AP-HP, Sorbonne University, 75012 Paris, France
| | - Claire Briet
- Service d'endocrinologie, diabétologie et nutrition, CHU d'Angers, 49100 Angers, France
| | - Gonzalo Diaz-Soto
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Fabrice Bonneville
- Department of Neuroradiology, University Hospital Purpan, 31300 Toulouse, France
| | - Frederic Castinetti
- Department of Endocrinology, Aix Marseille Université, 13007 Marseille, France
| | - Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, 21941-617 Rio de Janeiro, Brazil
| | - Nathalie Oliveira Santana
- Laboratório de Endocrinologia Celular e Molecular (LIM25), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP 05403-000, Brasil
| | | | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | - Roció Villar-Taibo
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Taiba Zornitzki
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School, Rehovot 76100, Israel
| | - Luaba Tshibanda
- Medical Imaging, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
| | - Patrick Petrossians
- Departments of Endocrinology, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
| | - Albert Beckers
- Departments of Endocrinology, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
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Villar-Taibo R, Díaz-Ortega C, Sifontes-Dubon M, Fernández-Pombo A, Serramito-García R, Martínez-Capoccioni G, Bernabeu I. Pituitary surgery in elderly patients: a safe and effective procedure. Endocrine 2021; 72:814-822. [PMID: 33665774 DOI: 10.1007/s12020-021-02665-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The incidence of pituitary adenoma (PA) increases with age. Transsphenoidal surgery (TSS) in elderly patients is often considered to have greater risk compared to the younger population. The aim of this study is to compare surgical results, evolution and postoperative complications between elderly and young patients undergoing TSS. METHODS Retrospective review of patients undergoing TSS between 2011 and 2018 in our institution. Patients were divided into two cohorts: elderly (≥65 years) and non-elderly (<65 years). Characteristics and outcomes of both groups were compared at diagnosis, before surgery and for an average of 5.9 years of postoperative follow-up. RESULTS One hundred and twenty-five patients were included, 53 patients were ≥65 years (42%). The elderly patients were more likely to have non-functioning PA (NFPA) (90.5% vs. 45.8%, p: <0.01), a higher proportion of macroadenomas (92.4% vs. 77.8%, p = 0.029) and greater extrasellar extension (88.7% vs. 68.1%, p = 0.007). The elderly group also had more compressive symptoms (54.7% vs. 34.7%, p = 0.035) and hypopituitarism (66% vs. 47.2%, p = 0.029). Overall, surgical and endocrinological outcomes between the two groups were similar. Inpatient mortality in the elderly group was 1.8%. Regarding long-term outcomes, elderly patients had more postoperative hypopituitarism (67.9% vs. 45.8%, p = 0.03) with no differences in permanent diabetes insipidus, less residual tumours (24.5% vs. 40.3%, p = 0.019) and a higher rate of remission after surgery (71.7% vs. 52.8%, p = 0.034). When only NFPA cases were compared, the only significant difference was a higher frequency of macroadenomas in the elderly group. CONCLUSIONS Our results support the safety and efficacy of TSS in elderly patients with PA. Age should not be considered an exclusion criterion for TSS given that successful results can be achieved if an experienced pituitary team is available.
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Affiliation(s)
- R Villar-Taibo
- Endocrinology Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain.
- Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela (A Coruña), Spain.
| | - C Díaz-Ortega
- Endocrinology Department, University Hospital of A Coruña, A Coruña (A Coruña), Spain
| | - M Sifontes-Dubon
- Endocrinology Department, Mateu Orfila General Hospital, Menorca (Balearic Islands), Spain
| | - A Fernández-Pombo
- Endocrinology Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - R Serramito-García
- Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela (A Coruña), Spain
- Neurosurgery Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - G Martínez-Capoccioni
- Otolaryngology Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - I Bernabeu
- Endocrinology Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
- Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela (A Coruña), Spain
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González-Rodríguez M, Villar-Taibo R, Fernández-Pombo A, Pazos-Couselo M, Sifontes-Dubón MA, Ferreiro-Fariña S, Cantón-Blanco A, Martínez-Olmos MA. Early versus conventional nutritional intervention in head and neck cancer patients before radiotherapy: benefits of a fast-track circuit. Eur J Clin Nutr 2020; 75:748-753. [PMID: 33097829 DOI: 10.1038/s41430-020-00786-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 07/27/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Radiotherapy (RT) is a component of therapy for head and neck cancer (HNC) with a negative nutritional impact. Our aim was to compare an early versus a conventional nutritional intervention. SUBJECTS AND METHODS Retrospective study of HNC patients undergoing RT. Evolution before and after the establishment of a fast-track circuit was evaluated. A conventional group (CG) made up of patients submitted to the nutrition unit during RT after nutritional deterioration, was compared to an early group (EG) represented by patients included in a fast-track circuit, starting nutritional follow-up before the beginning of RT. Only patients with preserved oral intake were involved. Demographic, nutritional and clinical variables were analyzed. Data of hospitalizations and deaths were collected up to three months after RT. RESULTS 135 subjects constituted the EG and 39 the CG. At baseline, the prevalence of malnutrition was lower in the EG (31.9% vs 69.5%, p = 0.0001), as was the need for nutritional supplements (40% vs 79.5%, p = 0.0001) or nasogastric tube (0% vs 12.8%, p = 0.0001) in comparison to the CG. Three months after RT, there were less patients with oral nutritional support in the EG (79.1% vs 96.9%, p = 0.018), and the number of emergency visits (0.75 vs 1.1 episodes per patient, p = 0.021) and hospitalizations was also lower in this group (29% vs 59%, p = 0.044). CONCLUSIONS The fast-track approach made early intervention possible. Therefore, patients maintained a better nutritional status, needed less nutritional support and their evolution improved, with a significant decrease in hospitalizations.
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Affiliation(s)
- M González-Rodríguez
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - R Villar-Taibo
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain.
| | - A Fernández-Pombo
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - M Pazos-Couselo
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain.,Psychiatry, Radiology and Public Health Department, University of Santiago de Compostela, A Coruña, Spain
| | - M A Sifontes-Dubón
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - S Ferreiro-Fariña
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - A Cantón-Blanco
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - M A Martínez-Olmos
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain.,Psychiatry, Radiology and Public Health Department, University of Santiago de Compostela, A Coruña, Spain.,CIBERObn, Instituto de Salud Carlos III, Madrid, Spain
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