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Losa M, Albano L, Barzaghi LR, Bailo M, Mortini P. Gamma knife radiosurgery is effective in patients with thyrotropin-secreting pituitary adenomas. J Endocrinol Invest 2024:10.1007/s40618-023-02291-1. [PMID: 38244141 DOI: 10.1007/s40618-023-02291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE Thyrotropin (TSH)-secreting pituitary adenoma (TSHoma) is a rare cause of TSH-dependent hyperthyroidism. The first therapeutic option is surgery. Medical treatment with somatostatin analogs is also effective. To obviate the need for lifelong drug therapy, gamma knife radiosurgery (GKRS) might be considered in selected patients. We report the largest series of patients with TSHoma treated by GKRS at a single center. METHODS This study was a retrospective analysis of 18 consecutive patients with TSHoma treated by GKRS between 1994 and 2022. Normalization of hyperthyroidism, when present at the time of surgery, and control of tumor growth were the main outcomes of the study. RESULTS The median follow-up after GKRS treatment was 114 months (IQR, 57-213 months; range 17-285 months). No patients had growth of the residual tumor after GKRS. Remission of hyperthyroidism occurred in 9 of the 11 (81.8%) patients who were hyperthyroid before GKRS. The probability of hyperthyroidism remission three years after GKRS was 59.1% (95% CI 27.9-90.3%). No major side effects occurred after GKRS. One patient out of the 15 patients (6.7%) with normal baseline adrenal function and follow-up longer than 3 years developed new onset hypoadrenalism, while hypogonadism did not occur in the 13 patients with baseline normal function. CONCLUSION Our study shows that GKRS is an effective and safe adjuvant treatment for selected patients with residual or recurring TSHoma. The option of GKRS as an alternative treatment to lifelong medical treatment with somatostatin analogs should be thoroughly discussed with the patients.
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Affiliation(s)
- M Losa
- Neurosurgery and Radiosurgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
| | - L Albano
- Neurosurgery and Radiosurgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - L R Barzaghi
- Neurosurgery and Radiosurgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - M Bailo
- Neurosurgery and Radiosurgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - P Mortini
- Neurosurgery and Radiosurgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
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de Figueiredo RLP, de Souza Junior JF, Triarca PJL, Beer-Furlan A, Melo NAD, de Oliveira Santos BF, Oliveira AMP. Measuring pituitary tumor volume: a comparison of the simplified and non-simplified ellipsoid equation with the 3D planimetric volume assessment. Pituitary 2023:10.1007/s11102-023-01317-4. [PMID: 37115292 DOI: 10.1007/s11102-023-01317-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE The ellipsoid equation came in an attempt to facilitate the estimation of tumor volume, by measuring the height, width, and anteroposterior length of the lesion. The estimated tumor volume can sometimes be different between methods, thus, it is of extreme interest to evaluate if the methods are significantly different, as well as to discuss the main limitations of each one. METHODS This is an observational, analytical, cross-sectional study. A systematic review of the literature was also performed in order to discuss the results observed in the present study. RESULTS A total of 82 patients (43 males and 39 females) ranging in age from 15 to 78 years (mean 47.95 ± 14.76) were included in the study. Seven patients were classified as Knosp grade 0 (8.5%), 36 Knosp grade 1 (44%), 14 Knosp grade 2 (17%), 20 Knosp grade 3 (24.4%), 5 Knosp grade 4 (6.1%). The tumor volume estimated by 3D planimetric assessment, non-simplified ellipsoid equation, and simplified ellipsoid formula averaged 10.68 cm³, 10.36 cm³, and 9.9 cm³ respectively. CONCLUSION A simplified form of the ellipsoid equation increases the divergence between the measurement obtained in planimetry, and should be discouraged, in view of the new automated methods of performing quick calculations using periodic digits. The non-simplified form underestimated the tumor volume by 2.9% on average but did so regularly. In clinical practice, measurement should be accompanied by an evaluation of tumor morphology.
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Affiliation(s)
| | | | | | | | | | - Bruno Fernandes de Oliveira Santos
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil
- Department of Otolaryngology, Fundação Beneficência Hospital de Cirurgia, Aracaju, Sergipe, Brazil
| | - Arthur Maynart Pereira Oliveira
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil.
- Department of Otolaryngology, Fundação Beneficência Hospital de Cirurgia, Aracaju, Sergipe, Brazil.
- Department of Neurosurgery, Fundação Beneficência Hospital de Cirurgia, Aracaju, Sergipe, Brazil.
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Losa M, Detomas M, Bailo M, Barzaghi LR, Albano L, Piloni M, Pagnano A, Pedone E, Mortini P. Gamma knife radiosurgery in patients with Nelson's syndrome. J Endocrinol Invest 2021; 44:2243-2251. [PMID: 33611756 DOI: 10.1007/s40618-021-01531-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/23/2020] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Nelson's syndrome (NS) is a long-term complication of bilateral adrenalectomy in patients with Cushing's disease. The best therapeutic strategy in NS has not been well defined. Gamma knife radiosurgery (GKRS) is very effective to stop the growth of the pituitary adenoma, which is the main goal of the treatment of patients with NS. We report the largest series of patients with NS treated by GKRS at a single center. METHODS The study was an observational, retrospective analysis of 28 consecutive patients with NS treated by GKRS in our department between 1995 and 2019. All patients had a growing ACTH-secreting pituitary adenoma. The main outcome of the study was to assess by the Kaplan-Meier method the risk of tumor progression after GKRS. RESULTS The median follow-up after GKRS treatment was 98 months (IQR 61-155 months, range 7-250 months). Two patients (7.1%) had a recurrence of disease during follow-up. The 10-year progression-free survival was 91.7% (95% CI 80.5-100%). No patient had deterioration of visual function or oculomotor function after GKRS. New onset of hypogonadism and hypothyroidism occurred in 18.8% and 14.3% of the patients at risk. CONCLUSION Our study confirms that GKRS may stop the tumor growth in the majority of patients with NS, even though very aggressive adenomas may ultimately escape this treatment. Safety of GKRS was good in our experience, but due attention must be paid to planning the distribution of radiation to critical structures, especially in patients previously treated by radiation.
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Affiliation(s)
- M Losa
- Department of Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - M Detomas
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - M Bailo
- Department of Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - L R Barzaghi
- Department of Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - L Albano
- Department of Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - M Piloni
- Department of Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - A Pagnano
- Vita-Salute San Raffaele University, Milan, Italy
| | - E Pedone
- Vita-Salute San Raffaele University, Milan, Italy
| | - P Mortini
- Department of Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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Ho K, Fleseriu M, Kaiser U, Salvatori R, Brue T, Lopes MB, Kunz P, Molitch M, Camper SA, Gadelha M, Syro LV, Laws E, Reincke M, Nishioka H, Grossman A, Barkan A, Casanueva F, Wass J, Mamelak A, Katznelson L, van der Lely AJ, Radovick S, Bidlingmaier M, Boguszewski M, Bollerslev J, Hoffman AR, Oyesiku N, Raverot G, Ben-Shlomo A, Fowkes R, Shimon I, Fukuoka H, Pereira AM, Greenman Y, Heaney AP, Gurnell M, Johannsson G, Osamura RY, Buchfelder M, Zatelli MC, Korbonits M, Chanson P, Biermasz N, Clemmons DR, Karavitaki N, Bronstein MD, Trainer P, Melmed S. Pituitary Neoplasm Nomenclature Workshop: Does Adenoma Stand the Test of Time? J Endocr Soc 2021; 5:bvaa205. [PMID: 33604494 PMCID: PMC7874572 DOI: 10.1210/jendso/bvaa205] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
The WHO Classification of Endocrine Tumours designates pituitary neoplasms as adenomas. A proposed nomenclature change to pituitary neuroendocrine tumors (PitNETs) has been met with concern by some stakeholder groups. The Pituitary Society coordinated the Pituitary Neoplasm Nomenclature (PANOMEN) workshop to address the topic. Experts in pituitary developmental biology, pathology, neurosurgery, endocrinology, and oncology, including representatives nominated by the Endocrine Society, European Society of Endocrinology, European Neuroendocrine Association, Growth Hormone Research Society, and International Society of Pituitary Surgeons. Clinical epidemiology, disease phenotype, management, and prognosis of pituitary adenomas differ from that of most NETs. The vast majority of pituitary adenomas are benign and do not adversely impact life expectancy. A nomenclature change to PitNET does not address the main challenge of prognostic prediction, assigns an uncertain malignancy designation to benign pituitary adenomas, and may adversely affect patients. Due to pandemic restrictions, the workshop was conducted virtually, with audiovisual lectures and written précis on each topic provided to all participants. Feedback was collated and summarized by Content Chairs and discussed during a virtual writing meeting moderated by Session Chairs, which yielded an evidence-based draft document sent to all participants for review and approval. There is not yet a case for adopting the PitNET nomenclature. The PANOMEN Workshop recommends that the term adenoma be retained and that the topic be revisited as new evidence on pituitary neoplasm biology emerges.
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Affiliation(s)
- Ken Ho
- The Garvan Institute of Medical Research, Sydney, Australia
| | | | | | | | | | - M Beatriz Lopes
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Mark Molitch
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sally A Camper
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mônica Gadelha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luis V Syro
- Hospital Pablo Tobon Uribe and Clinica Medellin-Grupo Quirónsalud, Medellin, Colombia
| | - Edward Laws
- Brigham and Women's Hospital, Boston, MA, USA
| | - Martin Reincke
- Klinikum der Universität, Ludwig-Maximilians-Universität, München, Germany
| | | | - Ashley Grossman
- University of Oxford, Oxford, and Barts and the London School of Medicine, London, UK
| | - Ariel Barkan
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Felipe Casanueva
- Santiago de Compostela University, Santiago de Compostela, Spain
| | | | - Adam Mamelak
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Sally Radovick
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | | | | | | | - Gerald Raverot
- Hospices Civils de Lyon and Lyon 1 University, Lyon, France
| | | | - Rob Fowkes
- Royal Veterinary College, University of London, London, UK
| | - Ilan Shimon
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | | | | | - Yona Greenman
- Tel Aviv-Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Anthony P Heaney
- David Geffen School of Medicine University of California, Los Angeles, CA, USA
| | - Mark Gurnell
- University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - Gudmundur Johannsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Robert Y Osamura
- Nippon Koukan Hospital Kawasaki & Keio University School of Medicine, Tokyo, Japan
| | | | | | | | - Philippe Chanson
- University Paris-Saclay & Assistance Publique Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - David R Clemmons
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Oh JS, Kim HJ, Hann HJ, Kang TU, Kim DS, Kang MJ, Lee JY, Shim JJ, Lee MR, Ahn HS. Incidence, mortality, and cardiovascular diseases in pituitary adenoma in Korea: a nationwide population-based study. Pituitary 2021; 24:38-47. [PMID: 32949324 DOI: 10.1007/s11102-020-01084-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Accepted: 09/14/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Few nationally representative studies have evaluated the epidemiology of PA (pituitary adenoma). This South Korean study evaluated the incidence of different PA subtypes, cardiovascular disease (CVD), and related mortality. METHODS This population-based study evaluated 31,898 patients with PA during 2005-2015. The incidence of PA, mortality, and CVD occurrence in PA cases were evaluated during a median follow-up of 5.3 years (range: 0-10 years). Cox regression analysis was used to evaluate the associations between CVD and mortality. RESULTS The annual incidences (per 100,000 population) were 3.5 for non-functioning pituitary adenoma (NFPA), 1.6 for prolactinoma (PRL), 0.5 for growth hormone-secreting pituitary adenoma (GH), and 0.2 for adrenocorticotropic or thyroid-stimulating hormone-secreting pituitary adenoma (ACTH + TSH). The standardized mortality ratios were 1.9 for ACTH + TSH, 1.7 for NFPA with hypopituitarism, 1.4 for NFPA without hypopituitarism, 1.3 for GH, and 1.1 for PRL. During 2005-2015, the overall incidence of CVD among PA patients was 6.6% (2106 cases), and the standardized incidence ratios were 4.1 for hemorrhagic stroke, 3.0 for ischemic stroke, and 1.7 for acute myocardial infarction. The standardized incidence ratios for stroke were significantly higher in the ACTH + TSH and NFPA groups, which also had higher risks of CVD-related mortality, relative to the PRL and GH groups. CONCLUSION South Korea had a relatively high incidence of NFPA. The incidence of stroke was highest for ACTH + TSH and NFPA, which was directly related to mortality during long-term follow-up. Patients with these types of PA should receive stroke prevention measures to reduce their risk of mortality.
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Affiliation(s)
- Jae Sang Oh
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Asan, Republic of Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, 126-1, 5-ga, Anam-dong, Sungbuk-gu, Seoul, 136-705, Republic of Korea
| | - Hoo Jae Hann
- Medical Research Institute, Ewha Womans University, Seoul, Republic of Korea
| | - Tae Uk Kang
- Department of Public Health, Graduate School, Korea University, Seoul, Republic of Korea
| | - Dong Sook Kim
- Department of Research, Health Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Min Ji Kang
- Department of Public Health, Graduate School, Korea University, Seoul, Republic of Korea
| | - Ji Young Lee
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Asan, Republic of Korea
| | - Jai Joon Shim
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Asan, Republic of Korea
| | - Man Ryul Lee
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Republic of Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, 126-1, 5-ga, Anam-dong, Sungbuk-gu, Seoul, 136-705, Republic of Korea.
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Abstract
Lactotroph adenomas, also called prolactinomas and prolactin-secreting adenomas, constitute nearly 80% of functioning pituitary tumors and about 30-50% of all adenomas in the clinical practice. Lactotroph adenomas occur in the general population at a prevalence of 45/100,000, are more common in women, but also involve men and children of both sexes. Most lactotroph adenomas are microadenomas occurring in reproductive-age women who present with oligo/amenorrhea, galactorrhea, and infertility. In men and elderly women, lactotroph adenomas are usually macroadenomas and are most commonly associated with symptoms of a tumoral mass, including headaches, neurologic defects, and visual loss. Although clinical and laboratory features may differ depending on patient's gender and age, the histopathology of the tumors is similar. Lactotroph adenomas are histologically classified into three subtypes: the common sparsely granulated lactotroph adenoma, and the rare densely granulated lactotroph adenoma and acidophilic stem cell adenoma. We will review the main pathological features of the lactotroph adenomas and some of their characteristics that may predict biological behavior and responsiveness to treatment.
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Affiliation(s)
- M Beatriz S Lopes
- Division of Neuropathology, Department of Pathology, University of Virginia School of Medicine, 1215 Lee Street, HEP-Room 3060, Charlottesville, VA, 22908-0214, USA.
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Losa M, Allora A, Panni P, Righi C, Mortini P. Bilateral inferior petrosal sinus sampling in adrenocorticotropin-dependent hypercortisolism: always, never, or sometimes? J Endocrinol Invest 2019; 42:997-1000. [PMID: 30635826 DOI: 10.1007/s40618-019-1006-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Affiliation(s)
- M Losa
- Department of Neurosurgery, IRCCS San Raffaele, University Vita-Salute, Via Olgettina 60, 20132, Milan, Italy.
| | - A Allora
- Department of Neurosurgery, IRCCS San Raffaele, University Vita-Salute, Via Olgettina 60, 20132, Milan, Italy
| | - P Panni
- Department of Neurosurgery, IRCCS San Raffaele, University Vita-Salute, Via Olgettina 60, 20132, Milan, Italy
| | - C Righi
- Department of Neuroradiology, IRCCS San Raffaele, University Vita-Salute, Milan, Italy
| | - P Mortini
- Department of Neurosurgery, IRCCS San Raffaele, University Vita-Salute, Via Olgettina 60, 20132, Milan, Italy
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Abstract
PURPOSE Acromegaly may be associated with an increased risk of complex intraoperative management and anesthetic complications. No study addressed whether pretreatment with somatostatin receptor ligands (SRLs) affects anesthesiologic management. METHODS We studied 211 consecutive acromegalic patients who had a recorded intraoperative computerized anesthetic record (ICAR) available for analysis. Ninety-six (45.5%) patients were SRL-pretreated while 115 patients were treatment naïve. RESULTS Treatment with SRLs reduced mean basal growth hormone level from 23.8 ± 4.2 to 5.9 ± 1.3 µg/L. Normalization of insulin-like growth factor-1 was achieved in 26 patients (27.1%). The frequency of comorbidities at surgery was similar in the two groups. Five patients with difficult intubation were naïve (4.3%) as compared with 5 SRL-pretreated patients (5.2%; P = 1.0). ICAR registration did not show any significant change of intraoperative vital parameters in the two groups of patients as well as in the intraoperative utilization of drugs. Total duration of anesthesia and surgery were similar in the two groups. Four patients with an intraoperative adverse event were naïve (3.5%) as compared with 4 SRL-pretreated patients (4.2%; P = 1.00). Remission of disease occurred in 83 of 114 naïve patients (72.8%) and in 57 of 93 SRL-pretreated patients (61.3%; P = 0.11). CONCLUSIONS SRL-pretreatment of patients with acromegaly had no significant impact on intraoperative anesthesiologic management. Despite a better Cormack-Lehane score in SRL-pretreated than in naïve patients, the rate of difficult intubation was similar in both groups. SRL-pretreatment did not affect the rate of surgical remission or complications as well.
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Affiliation(s)
- Marco Losa
- Pituitary Unit of the Division of Neurosurgery, IRCCS San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - Carmine Antonio Donofrio
- Pituitary Unit of the Division of Neurosurgery, IRCCS San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Gemma
- Anesthesia and Intensive Care Unit, Fatebenefratelli Hospital, Milan, Italy
| | - Lina Raffaella Barzaghi
- Pituitary Unit of the Division of Neurosurgery, IRCCS San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Pietro Mortini
- Pituitary Unit of the Division of Neurosurgery, IRCCS San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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Losa M, Pieri V, Bailo M, Gagliardi F, Barzaghi LR, Gioia L, Del Vecchio A, Bolognesi A, Mortini P. Single fraction and multisession Gamma Knife radiosurgery for craniopharyngioma. Pituitary 2018; 21:499-506. [PMID: 30043097 DOI: 10.1007/s11102-018-0903-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE The optimal management of residual or recurring craniopharyngioma is still a matter of debate even though adjuvant radiation therapy plays a crucial role. Aim of our study is to report the results of single fraction or multisession Gamma Knife radiosurgery (GKRS) in patients with craniopharyngioma. METHODS We included 50 consecutive patients treated from 1994 to 2016. All patients had at least one post GKRS magnetic resonance imaging reviewed at our center. Vital status of all patients was assessed at the end of 2016. RESULTS There were 29 males (58.0%) and 21 females (42.0%). Mean age was 41.5 ± 2.8 year. Single session GKRS was delivered in 29 patients (58.0%). The mean tumor volume was 2.15 ± 0.3 cm3 and the mean prescription dose to the tumor margin was 14.3 ± 0.3 Gy. During a mean follow-up of 74.6 ± 8.4 months, seven patients (14.0%) had recurrence of disease. The 5- and 10-year recurrence-free survivals were 90.3% (95% CI, 81.0-99.6%) and 78.4% (95% CI, 59.9-96.9%), respectively. Multisession GKRS was not less effective than single fraction GKRS. Eighteen of the 28 patients (64.3%) had a tumor volume decrease of at least 10%. No serious side effects occurred after GKRS treatment, except for one case of mild visual worsening. CONCLUSIONS GKRS was effective for controlling the growth of residual or recurrent craniopharyngioma. Serious side effects were uncommon. Multisession GKRS seems a very promising tool to allow performing GKRS even in patients with large residual or recurrent craniopharyngioma.
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Affiliation(s)
- Marco Losa
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy.
| | - Valentina Pieri
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Michele Bailo
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Filippo Gagliardi
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Lina Raffaella Barzaghi
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Lorenzo Gioia
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
| | - Antonella Del Vecchio
- Department of Medical Physics Department, Istituto Scientifico San Raffaele, Vita-Salute University, Milan, Italy
| | - Angelo Bolognesi
- Department of Radiotherapy, Istituto Scientifico San Raffaele, Vita-Salute University, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milano, Italy
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Donofrio CA, Losa M, Gemma M, Giudice L, Barzaghi LR, Mortini P. Safety of transsphenoidal microsurgical approach in patients with an ACTH-secreting pituitary adenoma. Endocrine 2017; 58:303-311. [PMID: 28005257 DOI: 10.1007/s12020-016-1214-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 10/04/2016] [Accepted: 12/15/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE Patients affected by Cushing's disease often have important comorbidities directly linked to hypercortisolism that might enhance the operative risk. We report the safety of transsphenoidal surgery in patients affected by Cushing's disease as compared with patients with nonfunctioning pituitary adenoma. METHODS We have retrospectively analyzed 142 patients with Cushing's disease and 299 patients with nonfunctioning pituitary adenoma who underwent transsphenoidal surgery performed by a single experienced neurosurgeon between September 2007 and December 2014. For all of them, an intraoperative computerized anesthetic record for the automatic storage of data was available. RESULTS The intraoperative vital parameters and the frequency of drugs administered during anesthesia were comparable between Cushing's disease and nonfunctioning pituitary adenoma groups. The duration of surgery was similar between the two groups (41.2 ± 11.8 vs. 42.9 ± 15.6 min), while the duration of anesthesia was slightly shorter in Cushing's disease patients (97.6 ± 18.1 min) than in nonfunctioning pituitary adenoma patients (101.6 ± 20.6 min, p = 0.04). The total perioperative mortality rate was 0.2% (0% in Cushing's disease vs. 0.3% in nonfunctioning pituitary adenoma). Cushing's disease patients had surgical and medical complication rates of 3.5% each, not different from those occurring in nonfunctioning pituitary adenoma. The postoperative incidence of diabetes insipidus (10.6%) and isolated hyponatremia (10.6%) in Cushing's disease patients was significantly higher than in nonfunctioning pituitary adenoma patients (4.4 and 4.1%; p = 0.02 and p = 0.01, respectively). CONCLUSIONS In a large series of unselected and consecutive patients with Cushing's disease, transsphenoidal surgery performed by one dedicated experienced neurosurgeon had a reasonably low risk of complications. In particular, despite the higher burden of comorbidities typically associated with hypercortisolism, medical complications are rare and no more frequent than in patients with nonfunctioning pituitary adenoma.
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Affiliation(s)
- Carmine Antonio Donofrio
- Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
| | - Marco Losa
- Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Marco Gemma
- Service of Anesthesia and Intensive Care Unit, Head and Neck Department, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Lodoviga Giudice
- Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Lina Raffaella Barzaghi
- Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Pietro Mortini
- Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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11
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Abstract
PURPOSE Gonadotroph adenomas are pituitary adenomas with inefficient and variable secretory characteristics, that is why they are usually considered as a subgroup of nonfunctioning pituitary adenomas (NFPA) and are recognized only at immunohistochemistry. When gonadotroph adenomas secrete active hormones, they may cause spontaneous ovarian hyperstimulation syndrome (OHSS) in premenopausal women. Aim of our study is to describe three women with OHSS diagnosed before the removal of the adenoma and to calculate the prevalence of OHSS in premenopausal women with a clinical diagnosis of NFPA. METHODS We reviewed clinical records of premenopausal women that underwent neurosurgery for NFPA at our centre between 1993 and 2014. OHSS was diagnosed in patients with high levels of FSH, suppressed LH, hyperestrogenism, abdominal symptoms, polymenorrhea, enlarged ovaries with cysts or previous surgery for ovarian cysts. RESULTS 171 women were included into the study; 62 (36.6%) had a gonadotroph adenoma diagnosed at immunohistochemistry. Two patients were retrospectively diagnosed as having OHSS due to gonadotroph adenoma and three had OHSS diagnosed before neurosurgery. The prevalence of OHSS was 2.9% in the overall group of patients with NFPA and 8.1% among patients with a gonadotroph adenoma detected at immunohistochemistry. CONCLUSIONS Frequency of OHSS due to a gonadotroph adenoma is not negligible. Increased awareness of the characteristic clinical and hormonal picture should permit an early detection of this condition in premenopausal women with a pituitary adenoma.
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Affiliation(s)
- Amelia Caretto
- Department of Endocrinology and Metabolic Disease, Istituto Scientifico San Raffaele, Università Vita-Salute, via Olgettina 60, 20132, Milano, Italy
| | - Roberto Lanzi
- Department of Endocrinology and Metabolic Disease, Istituto Scientifico San Raffaele, Università Vita-Salute, via Olgettina 60, 20132, Milano, Italy
| | - Cecilia Piani
- Department of Endocrinology and Metabolic Disease, Istituto Scientifico San Raffaele, Università Vita-Salute, via Olgettina 60, 20132, Milano, Italy
| | - Michela Molgora
- Department of Obestetrics and Gynecology, Istituto Scientifico San Raffaele, Università Vita-Salute, via Olgettina 60, 20132, Milano, Italy
| | - Pietro Mortini
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Università Vita-Salute, via Olgettina 60, 20132, Milano, Italy
| | - Marco Losa
- Department of Neurosurgery, Istituto Scientifico San Raffaele, Università Vita-Salute, via Olgettina 60, 20132, Milano, Italy.
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12
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Losa M, Spatola G, Albano L, Gandolfi A, Del Vecchio A, Bolognesi A, Mortini P. Frequency, pattern, and outcome of recurrences after gamma knife radiosurgery for pituitary adenomas. Endocrine 2017; 56:595-602. [PMID: 27688011 DOI: 10.1007/s12020-016-1081-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 05/11/2016] [Accepted: 08/06/2016] [Indexed: 11/24/2022]
Abstract
Gamma Knife radiosurgery is often used in pituitary adenomas. Aim of our study is to describe the characteristics and long-term outcome of patients with adenoma recurrence after Gamma Knife radiosurgery. We conducted a retrospective analysis of patients with pituitary adenoma treated by Gamma Knife radiosurgery between 1994 and 2014. Tumor recurrence was labeled as "in field" when the tumor growth occurred adjacent or within the prescribed isodose, whereas it was classified as "out of field" when the tumor growth occurred outside the prescribed isodose. Five hundred forty-three patients were included, 272 (50.1 %) had a nonfunctioning pituitary adenoma (NFPA) and 271 (49.9 %) patients had a hormone secreting-pituitary adenoma. The median follow-up after GKRS was 78 months (IQR, 36-125 months). Thirty-nine patients (7.2 %) had recurrence of disease and it was more frequent in patients with NFPA than in patients with hormone secreting adenomas (9.6 % vs. 4.8 %). The 10-yr progression-free survival in patients with NFPA was 78.7 % (95 % CI 69.5 - 87.9 %), as compared with 93.3 % (95 % CI 89.3 - 97.3 %; p < 0.01) in hormone secreting adenomas. Tumor recurrence was "in field" in 17 cases (43.6 %) and "out of field" in 22 cases (56.4 %). Seven of the 39 patients with recurrence died despite further treatments. Six of these patients had an "in field" recurrence. Recurrence of a pituitary adenoma after GKRS may occur several years after initial treatment. Distinction between "in field" and "out of field" tumor recurrence probably reflects two different pathophysiological mechanisms and may have prognostic importance.
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Affiliation(s)
- Marco Losa
- From the Department of Neurosurgery, Milan, Italy.
| | | | - Luigi Albano
- From the Department of Neurosurgery, Milan, Italy
| | | | | | - Angelo Bolognesi
- Department of Radiotherapy, Istituto Scientifico San Raffaele, Vita-Salute University, Milan, Italy
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13
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Longo M, Binanti D, Zagarella PG, Iocca F, Zani DD, Ravasio G, Giancamillo MD, Zani DD. A rare case of pituitary chromophobe carcinoma in a dog: clinical, tomographic and histopathological findings. Open Vet J 2016; 6:158-161. [PMID: 27800300 PMCID: PMC5079424 DOI: 10.4314/ovj.v6i3.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/23/2016] [Indexed: 11/17/2022] Open
Abstract
A 9 year old male mixed-breed dog was presented for progressive aggressiveness towards the owner. The neurological evaluation was consistent with a forebrain syndrome. Magnetic Resonance Imaging (MRI) of the brain revealed enlargement of the third ventricle and presence of a large spheroidal neoplasm in the sellar/parasellar region suggestive of a pituitary macroadenoma. On the owner request, the dog was euthanized. Histopathological examination revealed the presence of a pituitary chromophobe carcinoma. To the author’s knowledge, pituitary carcinomas have been rarely described in dogs, especially the chromophobe subtype.
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Affiliation(s)
- M Longo
- Dipartimento di Medicina Veterinaria (DIMEVET), Università degli Studi di Milano, Az.Polo Veterinario di Lodi, Lodi, Italy; Centro Traumatologico Ortopedico Veterinario, Arenzano (GE), Italy
| | - D Binanti
- AbLab, Veterinary Diagnostic Laboratory, Sarzana (SP), Italy
| | - P G Zagarella
- Centro Traumatologico Ortopedico Veterinario, Arenzano (GE), Italy
| | - F Iocca
- Centro Traumatologico Ortopedico Veterinario, Arenzano (GE), Italy
| | - D De Zani
- Dipartimento di Medicina Veterinaria (DIMEVET), Università degli Studi di Milano, Az.Polo Veterinario di Lodi, Lodi, Italy
| | - G Ravasio
- Dipartimento di Medicina Veterinaria (DIMEVET), Università degli Studi di Milano, Az.Polo Veterinario di Lodi, Lodi, Italy
| | - M Di Giancamillo
- Dipartimento di Medicina Veterinaria (DIMEVET), Università degli Studi di Milano, Az.Polo Veterinario di Lodi, Lodi, Italy
| | - D D Zani
- Dipartimento di Medicina Veterinaria (DIMEVET), Università degli Studi di Milano, Az.Polo Veterinario di Lodi, Lodi, Italy
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14
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Abstract
PURPOSE Granular cell tumors of the neurohypophysis are rare, solitary lesions, mostly presenting in the adult age. They rarely grow to a sufficient size to cause mass effect related symptoms and they may be found in most cases incidentally at autopsy. Because of their rarity as of now they have been described only as case reports or included in small clinical series. METHODS We report a series of 11 patients, who underwent surgery for granular cell tumors of the neurohypophysis between 1996 and 2013 in a single center. RESULTS Mean follow-up time after treatment was 92.2 months (range 9-231 months). Mean age at surgery was 40.7 years (range 12-66 years). There were 7 males (63.6 %) and 4 females (36.4 %). Main symptoms at presentation were: hyperprolactinemia (72.7 %), visual impairment (45.5 %) and headache (36 %). Except for 2 patients, all the others underwent surgery as primary treatment at our Institution, through a transsphenoidal (54.5 %) or a transcranial approach (45.5 %). Overall- and progression-free survival times for the entire series (calculated from the time of diagnosis) were 112.9 and 100.5 months respectively. There was one case of perioperative death in a patient who had undergone repeat transcranial surgery for residual tumor. CONCLUSIONS Although extremely rare, granular cell tumors of the neurohypophysis have to be considered in the differential diagnosis of suprasellar masses, to avoid misleading interpretation and consequent wrong therapeutic management. Early diagnosis, extensive tumor removal, opportune indication of adjuvant radiotherapy are the keys to manage these cases.
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Affiliation(s)
- Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Lina Raffaella Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Maria Rosa Terreni
- Service of Pathology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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15
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Hong W, Liu Y, Chen M, Lin K, Liao Z, Huang S. Secondary headache due to aspergillus sellar abscess simulating a pituitary neoplasm: case report and review of literature. Springerplus 2015; 4:550. [PMID: 26435896 PMCID: PMC4582039 DOI: 10.1186/s40064-015-1343-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 11/10/2022]
Abstract
Fungal sellar abscess is rare. A 42-year-old man was admitted with 2-month headache characterized by right peri-orbital pain. An intrasellar mass was found to be simulated a pituitary neoplasm after magnetic resonance imaging examination, and operated on via an endoscopic trans-sphenoidal approach. Milk-like pus and a mass of ash black mixed and necrotic material were found and removed. Histopathology revealed numerous aspergillus hyphae. Itraconazole was given on a dosage of 200 mg twice a day orally for 6 weeks. No recurrence was observed during follow-up. Complete surgical resection through endoscopic trans-sphenoidal approach combined with systemic anti-fungal therapy, should be considered as the optimal treatment.
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Affiliation(s)
- Wenyao Hong
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China
| | - Yuqing Liu
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China
| | - Mingwu Chen
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China
| | - Kun Lin
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China
| | - Zhengjian Liao
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China
| | - Shengyue Huang
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China
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16
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Kim YH, Lee BJ, Lee KJ, Cho JH. A case of pituitary metastasis from breast cancer that presented as left visual disturbance. J Korean Neurosurg Soc 2012; 51:94-7. [PMID: 22500201 PMCID: PMC3322215 DOI: 10.3340/jkns.2012.51.2.94] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 07/27/2011] [Accepted: 02/24/2012] [Indexed: 11/27/2022] Open
Abstract
Tumors that metastasize to the pituitary gland are unusual, and are typically seen in elderly patients with diffuse malignant disease. The most common metastases to the pituitary are from primary breast and lung cancers. We report a 65-year-old woman with pituitary metastasis from breast cancer who presented with recent-onset left progressive deterioration of visual acuity and visual field. The clinical diagnosis was made after brain and sellar magnetic resonance imaging showed a large sellar mass compressing the optic chiasm and invading the pituitary stalk. An otorhinolaryngology and neurosurgery team removed the tumor via a transsphenoidal approach, and this procedure obtained symptomatic relief. Postoperatively, metastasis from breast invasive ductal adenocarcinoma was confirmed histologically. We report this unusual case with a review of the relevant literature.
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Affiliation(s)
- Young Ha Kim
- Department of Otolaryngology-HNS, College of Medicine, The Catholic University of Korea, Seoul, Korea
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17
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Maira G, Doglietto F. Pituitary carcinoma: a devastating disease in need of an earlier diagnosis and of effective therapies. World Neurosurg 2011; 80:e143-5. [PMID: 22120355 DOI: 10.1016/j.wneu.2011.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 06/10/2011] [Indexed: 10/15/2022]
Affiliation(s)
- Giulio Maira
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
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