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Askari A, Darabi MR, Eslami S, Jamali E, Sharifi G, Ghafouri-Fard S, Dilmaghani NA. Expression analysis of necroptosis related genes and lncRNAs in patients with pituitary neuroendocrine tumors. Pathol Res Pract 2024; 258:155332. [PMID: 38696856 DOI: 10.1016/j.prp.2024.155332] [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: 11/20/2023] [Revised: 04/02/2024] [Accepted: 04/24/2024] [Indexed: 05/04/2024]
Abstract
Necroptosis can either be the cause of tumorigenesis or it can impede its process. Recently, it has been proved that long non-coding RNAs (lncRNAs) have different crucial roles at cellular level, especially on cell death. Regarding the important role of necroptosis and lncRNAs in the pathogenesis of different cancers, especially pituitary adenomas (PAs), we assessed expression levels of two necroptosis related genes, namely TRADD and BIRC2, in addition to three related lncRNAs, namely FLVCR1-DT, MAGI2-AS3, and NEAT1 in PAs compared with adjacent normal tissues (ANTs). TRADD had no significant difference between two groups; however, BIRC2, FLVCR1-DT, MAGI2-AS3, and NEAT1 were upregulated in PAs compared to ANTs (Expression ratios [95% CI] = 2.3 [1.47-3.6], 2.13 [1.02-4.44], 3.01 [1.76-5.16] and 2.47 [1.37-4.45], respectively). When taking into account different types of PAs, significant upregulation of BIRC2, MAGI2-AS3 and NEAT1 was recorded in non-functioning PAs compared with corresponding ANTs (Expression ratios [95% CI] =1.9 [1.04-3.43], 2.69 [1.26-5.72] and 2.22 [0.98-5.01], respectively). Additionally, higher levels of BIRC2 were associated with higher flow of CSF (P value=0.048). Moreover, higher Knosp classified tumors had lower levels of BIRC2 (P value=0.001). Finally, lower levels of MAGI2-AS3 were associated with larger tumor size (P value=0.006). NEAT1 expression was correlated with FLVCR1-DT and TRADD. TRADD expression was correlated with FLVCR1-DT. Additional correlation was observed between expression of BIRC2 and MAGI2-AS3. In sum, this study provides evidence that dysregulated levels of studied genes could contribute to the pathogenesis of pituitary tumors.
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Affiliation(s)
- Arian Askari
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Darabi
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Solat Eslami
- Department of Medical Biotechnology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Elena Jamali
- Institute of Human Genetics, Jena University Hospital, Jena, Germany
| | - Guive Sharifi
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Nader Akbari Dilmaghani
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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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] [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: 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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Carbone F, Colamaria A, Corvino S, Sacco M, Iaconetta G, Corrivetti F, Di Maria D, Catapano G, Fochi NP, Leone A, Spetzger U, de Notaris M. Multimodal Use of Contact Endoscopy in Neurosurgery: Case Series with Technical Note and Literature Review. World Neurosurg 2024; 182:e657-e665. [PMID: 38070736 DOI: 10.1016/j.wneu.2023.12.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Originally adopted for the cytological screening of cervical and uterine cancer, contact endoscopy (CE) is now widely used in several fields of oncological surgery. The CE method, with magnification power up to 150x, was designed to enhance visualization and identify microscopic changes indicative of precancerous and cancerous lesions at early stages. In this pilot study, we evaluated the multimodal applications of CE during different endoscopic intracranial neurosurgical procedures. METHODS Twenty patients with skull base lesions underwent surgery using different minimally invasive endoscopic approaches (endonasal, transorbital, and supraorbital). CE was used to distinguish the pathology from the surrounding healthy tissue by positioning the endoscope either in proximity or directly onto the target tissue. Special attention was given to the visualization of the margins of the lesion to differentiate compression/displacement from infiltration of the normal surrounding tissue. RESULTS With its unprecedented range of magnification, CE could clearly identify the microvascular pattern and cytological architecture of a tissue not detectable by simple white light endoscopy, with no reported damage due to heat transmission or iatrogenic injuries. All the lesions diagnosed as "presumed neoplastic tissue" by CE were confirmed by histopathology. The most promising results were observed in surgeries for meningioma and pituitary adenoma, as these lesions exhibit distinctive microvascular networks. CONCLUSIONS CE represents a new and effective technique for the in vivo identification of pathological microvascular and tissue features, allowing preservation of normal tissue during different endoscopic approaches. The use of CE could improve diagnostic accuracy and assist in intraoperative decision-making, becoming a key tool in various applications in neurosurgical field.
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Affiliation(s)
- Francesco Carbone
- Department of Neurosurgery - Karlsruher Neurozentrum, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany; Division of Neurosurgery, University of Foggia, Foggia, Italy
| | | | - Sergio Corvino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University Federico II, Naples, Italy
| | - Matteo Sacco
- Division of Neurosurgery, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giorgio Iaconetta
- Division of Neurosurgery, School of Medicine "Scuola Medica Salernitana", University of Salerno, Fisciano, Italy
| | - Francesco Corrivetti
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL 1, Roma, Italy
| | | | - Giuseppe Catapano
- Division of Neurosurgery, "Ospedale del Mare" Hospital, Naples, Italy
| | | | - Augusto Leone
- Department of Neurosurgery - Karlsruher Neurozentrum, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany; Faculty of Human Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Uwe Spetzger
- Department of Neurosurgery - Karlsruher Neurozentrum, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Matteo de Notaris
- Department of Neuroscience, Neurosurgery Operative Unit, "San Pio" Hospital, Benevento, Italy
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Li H, Liu Z, Li F, Shi F, Xia Y, Zhou Q, Zeng Q. Preoperatively Predicting Ki67 Expression in Pituitary Adenomas Using Deep Segmentation Network and Radiomics Analysis Based on Multiparameter MRI. Acad Radiol 2024; 31:617-627. [PMID: 37330356 DOI: 10.1016/j.acra.2023.05.023] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/19/2023]
Abstract
RATIONALE AND OBJECTIVES Ki67 proliferation index is associated with more aggressive tumor behavior and recurrence of pituitary adenomas (PAs). Recently, radiomics and deep learning have been introduced into the study of pituitary tumors. The present study aimed to investigate the feasibility of predicting the Ki67 proliferation index of PAs using the deep segmentation network and radiomics analysis based on multiparameter MRI. MATERIALS AND METHODS First, the cfVB-Net autosegmentation model was trained; subsequently, its performance was evaluated in terms of the dice similarity coefficient (DSC). In the present study, 1214 patients were classified into the high Ki67 expression group (HG) and the low Ki67 expression group (LG). Analyses of three classification models based on radiomics features were performed to distinguish HG from LG. Clinical factors, imaging features, and Radscores were collectively used to create a nomogram in order to effectively predict Ki67 expression. RESULTS The cfVB-Net segmentation model demonstrated good performance (DSC: 0.723-0.930). Overall, 18, 15, and 11 optimal features in contrast-enhanced (CE) T1WI, T1WI, and T2WI were obtained for differentiating between HG and LG, respectively. Notably, the best results were presented in the bagging decision tree when CE T1WI and T1WI were combined (area under the receiver operating characteristic curve: training set, 0.927; validation set, 0.831; and independent testing set, 0.825). In the nomogram, age, Hardy' grade, and Radscores were identified as risk predictors of high Ki67 expression. CONCLUSION The deep segmentation network and radiomics analysis based on multiparameter MRI exhibited good performance and clinical application value in predicting the expression of Ki67 in PAs.
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Affiliation(s)
- Hongxia Li
- Department of Radiology, The Second Hospital of Shandong University, Jinan 250033, China (H.L.)
| | - Zhiling Liu
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan 250098, China (Z.L.)
| | - Fuyan Li
- Department of Radiology, Shandong Medical Imaging Research Institute, Jinan 250021, China (F.L.)
| | - Feng Shi
- Shanghai United Imaging Intelligence, Co., Ltd., 701 Yunjin Road, Xuhui District, Shanghai 200030, China (F.S., Y.X., Q.Z.)
| | - Yuwei Xia
- Shanghai United Imaging Intelligence, Co., Ltd., 701 Yunjin Road, Xuhui District, Shanghai 200030, China (F.S., Y.X., Q.Z.)
| | - Qing Zhou
- Shanghai United Imaging Intelligence, Co., Ltd., 701 Yunjin Road, Xuhui District, Shanghai 200030, China (F.S., Y.X., Q.Z.)
| | - Qingshi Zeng
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No.16766 Jingshi Road, Jinan 250013, China (Q.Z.).
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Marrero-Rodríguez D, Vela-Patiño S, Martinez-Mendoza F, Valenzuela-Perez A, Peña-Martínez E, Cano-Zaragoza A, Kerbel J, Andonegui-Elguera S, Glick-Betech SS, Hermoso-Mier KX, Mercado-Medrez S, Moscona-Nissan A, Taniguchi-Ponciano K, Mercado M. Genomics, Transcriptomics, and Epigenetics of Sporadic Pituitary Tumors. Arch Med Res 2023; 54:102915. [PMID: 37981525 DOI: 10.1016/j.arcmed.2023.102915] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
Pituitary tumors (PT) are highly heterogeneous neoplasms, comprising functioning and nonfunctioning lesions. Functioning PT include prolactinomas, causing amenorrhea-galactorrhea in women and sexual dysfunction in men; GH-secreting adenomas causing acromegaly-gigantism; ACTH-secreting corticotrophinomas causing Cushing disease (CD); and the rare TSH-secreting thyrotrophinomas that result in central hyperthyroidism. Nonfunctioning PT do not result in a hormonal hypersecretion syndrome and most of them are of gonadotrope differentiation; other non-functioning PT include null cell adenomas and silent ACTH-, GH- and PRL-adenomas. Less than 5% of PT occur in a familial or syndromic context whereby germline mutations of specific genes account for their molecular pathogenesis. In contrast, the more common sporadic PT do not result from a single molecular abnormality but rather emerge from several oncogenic events that culminate in an increased proliferation of pituitary cells, and in the case of functioning tumors, in a non-regulated hormonal hypersecretion. In recent years, important advances in the understanding of the molecular pathogenesis of PT have been made, including the genomic, transcriptomic, epigenetic, and proteomic characterization of these neoplasms. In this review, we summarize the available molecular information pertaining the oncogenesis of PT.
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Affiliation(s)
- Daniel Marrero-Rodríguez
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Sandra Vela-Patiño
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Florencia Martinez-Mendoza
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Alejandra Valenzuela-Perez
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Eduardo Peña-Martínez
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Amayrani Cano-Zaragoza
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Jacobo Kerbel
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Sergio Andonegui-Elguera
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Shimon S Glick-Betech
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Karla X Hermoso-Mier
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Sophia Mercado-Medrez
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Alberto Moscona-Nissan
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Keiko Taniguchi-Ponciano
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Moises Mercado
- Endocrine Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Xiao T, Jiao R, Yang S, Wang Y, Bai X, Zhou J, Li R, Wang L, Yang H, Yao Y, Deng K, Gong F, Pan H, Duan L, Zhu H. Incidence and risk factors of cancers in acromegaly: a Chinese single-center retrospective study. Endocrine 2023; 82:368-378. [PMID: 37442901 PMCID: PMC10543525 DOI: 10.1007/s12020-023-03447-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE To evaluate the incidence of malignancies in acromegaly and to identify risk factors for newly-diagnostic cancers, especially the excessive growth hormone (GH) and insulin-like growth factor-1 (IGF-1). METHODS A retrospective cohort including 1738 consecutive hospitalized patients with acromegaly in a single referral center between 2012 and 2020 (mean follow-up 4.3 years). A gender- and age-matched case-control study (280 patients from the cohort) was performed for risk factor analysis. RESULTS One hundred thirteen malignancies (67 diagnosed after acromegaly) were observed. The overall newly-diagnostic cancer risk of acromegaly was higher than the general population (standardized incidence ratio (SIR) 2.81; 95% CI 2.18-3.57). The risk of thyroid cancer (n = 33, SIR 21.42; 95% CI 13.74-30.08) and colorectal cancer (n = 8, SIR 3.17; 95% CI 1.37-6.25) was elevated. In the overall cohort, IGF-1 (ULN: 1.27 vs. 0.94, p = 0.057), GH (1.30 vs. 1.00 ng/ml, p = 0.12), and disease-controlled rate (34.9% vs. 45.9%, p = 0.203) at the last visit did not reach significance between patients with and without post-diagnostic cancer. In the case-control study, GH (1.80 vs. 0.90 ng/ml, p = 0.018) and IGF-1 (ULN: 1.27 vs. 0.91, p = 0.003) at the last visit were higher in patients with post-diagnostic cancers, with a lower disease-controlled rate. Elder age was a risk factor for cancer. Other metabolic comorbidities and the size of pituitary tumors were similar. CONCLUSION The risk of malignancies, especially thyroid cancer, was increased in patients with acromegaly in our center. More cancer screening should be considered when managing acromegaly, especially in patients with higher posttreatment GH and IGF-1.
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Affiliation(s)
- Tongxin Xiao
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Jiao
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengmin Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Wang
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Bai
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingya Zhou
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ran Li
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Linjie Wang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongbo Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengying Gong
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lian Duan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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7
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Giustina A, Uygur MM, Frara S, Barkan A, Biermasz NR, Chanson P, Freda P, Gadelha M, Kaiser UB, Lamberts S, Laws E, Nachtigall LB, Popovic V, Reincke M, Strasburger C, van der Lely AJ, Wass JAH, Melmed S, Casanueva FF. Pilot study to define criteria for Pituitary Tumors Centers of Excellence (PTCOE): results of an audit of leading international centers. Pituitary 2023; 26:583-596. [PMID: 37640885 PMCID: PMC10539196 DOI: 10.1007/s11102-023-01345-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE The Pituitary Society established the concept and mostly qualitative parameters for defining uniform criteria for Pituitary Tumor Centers of Excellence (PTCOEs) based on expert consensus. Aim of the study was to validate those previously proposed criteria through collection and evaluation of self-reported activity of several internationally-recognized tertiary pituitary centers, thereby transforming the qualitative 2017 definition into a validated quantitative one, which could serve as the basis for future objective PTCOE accreditation. METHODS An ad hoc prepared database was distributed to nine Pituitary Centers chosen by the Project Scientific Committee and comprising Centers of worldwide repute, which agreed to provide activity information derived from registries related to the years 2018-2020 and completing the database within 60 days. The database, provided by each center and composed of Excel® spreadsheets with requested specific information on leading and supporting teams, was reviewed by two blinded referees and all 9 candidate centers satisfied the overall PTCOE definition, according to referees' evaluations. To obtain objective numerical criteria, median values for each activity/parameter were considered as the preferred PTCOE definition target, whereas the low limit of the range was selected as the acceptable target for each respective parameter. RESULTS Three dedicated pituitary neurosurgeons are preferred, whereas one dedicated surgeon is acceptable. Moreover, 100 surgical procedures per center per year are preferred, while the results indicated that 50 surgeries per year are acceptable. Acute post-surgery complications, including mortality and readmission rates, should preferably be negligible or nonexistent, but acceptable criterion is a rate lower than 10% of patients with complications requiring readmission within 30 days after surgery. Four endocrinologists devoted to pituitary diseases are requested in a PTCOE and the total population of patients followed in a PTCOE should not be less than 850. It appears acceptable that at least one dedicated/expert in pituitary diseases is present in neuroradiology, pathology, and ophthalmology groups, whereas at least two expert radiation oncologists are needed. CONCLUSION This is, to our knowledge, the first study to survey and evaluate the activity of a relevant number of high-volume centers in the pituitary field. This effort, internally validated by ad hoc reviewers, allowed for transformation of previously formulated theoretical criteria for the definition of a PTCOE to precise numerical definitions based on real-life evidence. The application of a derived synopsis of criteria could be used by independent bodies for accreditation of pituitary centers as PTCOEs.
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Affiliation(s)
- A Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Via Olgettina 60, 20132, Milan, Italy.
| | - M M Uygur
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Via Olgettina 60, 20132, Milan, Italy
- Department of Endocrinology and Metabolism Disease, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - S Frara
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - A Barkan
- Division of Endocrinology, University of Michigan Health System, Ann Arbor, MI, USA
| | - N R Biermasz
- Leiden University Medical Center, Center for Endocrine Tumors Leiden, Leiden, The Netherlands
| | - P Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, APHP, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Le Kremlin-Bicêtre, Paris, France
| | - P Freda
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - M Gadelha
- Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - U B Kaiser
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Lamberts
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - E Laws
- Pituitary/Neuroendocrine Center, Brigham & Women's Hospital, Boston, MA, USA
| | - L B Nachtigall
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - V Popovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - M Reincke
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - C Strasburger
- Department of Medicine for Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - A J van der Lely
- Pituitary Center Rotterdam, Endocrinology Section, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J A H Wass
- Department of Endocrinology, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - S Melmed
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - F F Casanueva
- Division of Endocrinology, Santiago de Compostela University and Ciber OBN, Santiago, Spain
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Al-Salihi MM, Ahmed A, Al-Jebur MS, Al-Salihi Y, Rahman MM, Ayyad A. A rare case of pituicytoma-related hyperprolactinemia due to mass effect on infundibular stalk-Case report. Int J Surg Case Rep 2023; 107:108348. [PMID: 37269767 DOI: 10.1016/j.ijscr.2023.108348] [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] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Pituicytomas are extremely rare cancers of the sellar and suprasellar region that appear from the infundibulum or posterior pituitary. World Health Organization in 2007, described pituicytoma as a low-grade tumour (Grade I) in the taxonomy of CNS cancers. The tumour can frequently simulate a pituitary adenoma and is also linked with hormonal disorders. Distinguishing a pituitary adenoma from a pituicytoma can be challenging. We present a rare case report where an elderly female showed high levels of prolactin mainly due to mass effects along with diagnostic, imaging, and immunohistochemical characteristics of pituicytoma. CASE PRESENTATION A 50-year-old female known case of hypothyroidism, complained of headache associated with dizziness and blurry vision. Her prolactin levels were high which led to the suspicion of pituitary involvement and underwent MRI. The imaging study revealed a well-defined, completely suprasellar, homogenously enhancing mass lesion arising from the left lateral aspect of the pituitary infundibulum. The initial differential diagnosis from the imaging included an ectopic pituitary gland, adenoma, pituicytoma, or hypothalamic glioma. She underwent a right supra-orbital craniotomy for debulking of the pituitary stalk lesion. The histopathological diagnosis was pituicytoma, WHO grade I. CLINICAL DISCUSSION The clinical manifestations are mostly depended upon the tumour mass and position. They typically present due to mass effects leading to hormonal disorders. The imaging studies are the backbone of the clinical diagnosis along with the histopathological findings. Surgical resection is the preferred treatment for pituicytoma, with an exceptionally low recurrence rate (4.3 %) following complete removal. CONCLUSION Pituicytomas are slow-growing, benign glial growths. It is challenging to diagnose before surgery as its clinical manifestations and imaging findings look like those of non-functional pituitary adenomas. The effective treatment for pituicytoma is gross total resection by the endoscopic method or transcranial technique.
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Affiliation(s)
- Mohammed Maan Al-Salihi
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar; Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Alaaeldin Ahmed
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar.
| | | | | | - Md Moshiur Rahman
- Neurosurgery Department, Holy Family Red Crescent Medical College, Dhaka, Bangladesh.
| | - Ali Ayyad
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar; Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
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Balogun JA, Daniel A, Idowu OK. Navigating the learning curve with large and giant tumors: Initial experience with endoscopic endonasal transphenoidal resection of PitNETs. J Clin Neurosci 2023; 112:6-11. [PMID: 37023497 DOI: 10.1016/j.jocn.2023.04.001] [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] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/21/2023] [Accepted: 04/01/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The endoscopic endonasal approach (EEA) has progressively become the preferred choice of surgical intervention for PitNETs. However, the adoption in Sub-Saharan Africa has been low. We report our initial experience with the utility of the EEA in PitNETs particularly in large and giant tumors despite limited resources. METHODS The study was over a 73-month period at the University College Hospital, Ibadan, Nigeria. Pre and post-operative clinical, imaging and neuro-ophthalmological findings were documented. Perioperative and postoperative outcomes were recorded. We compared the outcomes between the early 23 and later 22 patients. Data were analyzed using descriptive statistics, student's t test, Mann-Whitney U test and Chi square test at α = 0.05. RESULTS There were 45 patients; 25(55.6%) were males. Mean age was 49.9 ± 13.4 years. Visual symptoms predominated with 12(26%) blind in at least one eye. Median tumor volume was 20.9 cm3 and mean tumor diameter was 4.09 ± 0.89 cm. 31(68.9%) had gross or near total excision. Vision improved in 31(68.9%). There were 2 procedure related mortality from CSF leak/meningitis. The mean of the tumor diameter of the earlier patients was less than that of the latter (3.84 vs 4.40 cm, p = 0.04,). The latter group also had more gross or near total resections (26.8% versus 41.5%) but this was not statistically significant. There was no difference in postoperative complications. CONCLUSIONS EEA remains a veritable option for PitNETs, including for large and huge tumors, even within resource challenged environments, with acceptable limits of complications.
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Affiliation(s)
- James Ayokunle Balogun
- Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, Nigeria; Department of Neurosurgery, University College Hospital, Ibadan, Nigeria.
| | - Adekunle Daniel
- Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olusola Kayode Idowu
- Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Araujo-Castro M, Paredes I, Pérez-López C, García Feijoo P, Alvarez-Escola C, Calatayud M, Lagares A, Soledad Librizzi M, Acitores Cancela A, Rodríguez Berrocal V. Differences in clinical, hormonal, and radiological presentation and in surgical outcomes in patients presenting with and without pituitary apoplexy. A multicenter study of 245 cases. Pituitary 2023; 26:250-258. [PMID: 37103720 PMCID: PMC10134712 DOI: 10.1007/s11102-023-01315-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE To compare the clinical, hormonal, and radiological presentation and surgical outcomes of patients with macroadenomas presenting with pituitary apoplexy and patients not presenting pituitary apoplexy. METHODS Multicentre retrospective study of patients presenting with macroadenomas and pituitary apoplexy in three Spanish tertiary hospitals between 2008 and 2022. We selected as control group (non-pituitary apoplexy), patients with pituitary macroadenomas without apoplexy who underwent pituitary surgery between 2008 and 2020. RESULTS A total of 60 patients with apoplexy and 185 without apoplexy were enrolled. Patients with pituitary apoplexy were more frequently men (70% vs. 48.1%, p = 0.003), had higher prevalence of hypertension (43.3% vs. 26.0%, p = 0.011) and of obesity (23.3% vs. 9.7%, P = 0.007), were under treatment with anticoagulants more commonly (11.7% vs. 4.3%, P = 0.039) and had larger (27.5 ± 11.03 vs. 23.6 ± 12.55 mm, p = 0.035) and invasive pituitary macroadenomas more frequently (85.7% vs. 44.3%, P < 0.001) than those without apoplexy. Surgical remission was more frequent in patients with pituitary apoplexy than those without apoplexy (OR 4.55, P < 0.001), but they developed new pituitary deficits (OR 13.29, P < 0.001) and permanent diabetes insipidus (OR 3.40, P = 0.022) more commonly. However, visual improvement (OR 6.52, p < 0.001) and complete pituitary function recovery (OR 2.37, P < 0.001) was more common in patients without apoplexy. CONCLUSION Surgical resection is more common in patients presenting with pituitary apoplexy than those without apoplexy; however, visual improvement and complete recovery of pituitary function is more common in patients without apoplexy. The risk of new pituitary deficits and permanent diabetes insipidus is higher in patients with apoplexy than in those without it.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal. , Colmenar Viejo Street km 9, Madrid, 28034, Spain.
| | - Igor Paredes
- Department of Neurosurgery, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Carlos Pérez-López
- Department of Neurosurgery, Hospital Universitario La Paz. Madrid, Madrid, Spain
| | - Pablo García Feijoo
- Department of Neurosurgery, Hospital Universitario La Paz. Madrid, Madrid, Spain
| | - Cristina Alvarez-Escola
- Department of Endocrinology and Nutrition, Hospital La Paz & Universidad Autónoma de Madrid, Madrid, Spain
| | - María Calatayud
- Department of Endocrinology and Nutrition, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Maria Soledad Librizzi
- Department of Endocrinology and Nutrition, Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | - Víctor Rodríguez Berrocal
- Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Neurosurgery, Hospital Universitario Puerta del Sur. Madrid, Madrid, Spain
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Tsukamoto T, Miki Y. Imaging of pituitary tumors: an update with the 5th WHO Classifications-part 2. Neoplasms other than PitNET and tumor-mimicking lesions. Jpn J Radiol 2023:10.1007/s11604-023-01407-0. [PMID: 36913010 PMCID: PMC10366287 DOI: 10.1007/s11604-023-01407-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/24/2023] [Indexed: 03/14/2023]
Abstract
Many types of tumors can develop in the pituitary gland. In the recently revised 5th editions of the World Health Organization (WHO) classifications (2021 WHO Classification of Central Nervous System Tumors and the 2022 WHO Classification of Endocrine and Neuroendocrine Tumors), various changes have been made to the tumors other than pituitary neuroendocrine tumor (PitNET)/pituitary adenoma, as well as PitNET. Adamantinomatous craniopharyngioma and papillary craniopharyngioma are now considered separate tumors in the 5th edition of the WHO classification. Tumors positive for thyroid transcription factor 1, a marker of posterior pituitary cells, are now grouped together in the pituicyte tumor family in the 5th edition of the WHO classification of Endocrine and Neuroendocrine Tumors. Poorly differentiated chordoma is newly listed in the 5th edition of the WHO Classification of Endocrine and Neuroendocrine Tumors. In this paper, we present the latest WHO classification of pituitary tumors (adamantinomatous craniopharyngioma, papillary craniopharyngioma, pituitary blastoma, pituicyte tumor family, tumors of pituitary origin other than those of the pituicyte tumor family, germinoma, meningioma, chordoma, metastatic tumors, lymphoma, and pituitary incidentaloma), review diseases requiring differentiation from tumors (pituitary abscess, hypophysitis, pituitary hyperplasia, Rathke's cleft cyst, arachnoid cyst, and aneurysm), and discuss diagnoses based on imaging findings.
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Affiliation(s)
- Taro Tsukamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan.
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12
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Fiore G, Bertani GA, Conte G, Ferrante E, Tariciotti L, Kuhn E, Runza L, Pluderi M, Borsa S, Caroli M, Sala E, Platania G, Kremenova K, Ferrero S, Triulzi FM, Mantovani G, Locatelli M. Predicting tumor consistency and extent of resection in non-functioning pituitary tumors. Pituitary 2023:10.1007/s11102-023-01302-x. [PMID: 36808379 DOI: 10.1007/s11102-023-01302-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/08/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To (1) identify a radiological parameter to predict non-functioning pituitary tumor (NFPT) consistency, (2) examine the relationship between NFPT consistency and extent of resection (EOR), (3) investigate if tumor consistency predictors can anticipate EOR. METHODS The ratio (T2SIR) between the T2 min signal intensity (SI) of the tumor and the T2 mean SI of the CSF was the main radiological parameter, being determined through a radiomic-voxel analysis and calculated using the following formula: T2SIR = [(T2 tumor mean SI - SD)/T2 CSF SI]. The tumor consistency was pathologically estimated as collagen percentage (CP). EOR of NFPTs was evaluated by exploiting a volumetric technique and its relationship with the following explanatory variables was explored: CP, Knosp-grade, tumor volume, inter-carotid distance, sphenoidal sinus morphology, Hardy-grade, suprasellar tumor extension. RESULTS A statistically significant inverse correlation between T2SIR and CP was demonstrated (p = 0.0001), with high diagnostic power of T2SIR in predicting NFPT consistency (ROC curve analysis' AUC = 0.88; p = 0.0001). The following predictors of EOR were identified in the univariate analysis: CP (p = 0.007), preoperative volume (p = 0.045), Knosp grade (p = 0.0001), tumor suprasellar extension (p = 0.044). The multivariate analysis demonstrated two variables as unique predictors of EOR: CP (p = 0.002) and Knosp grade (p = 0.001). The T2SIR was a significant predictor of EOR both in the univariate (p = 0.01) and multivariate model (p = 0.003). CONCLUSION This study offers the potential to improve NFPT preoperative surgical planning and patient counseling by employing the T2SIR as a preoperative predictor of tumor consistency and EOR. Meanwhile, tumor consistency and Knosp grade were found to play an important role in predicting EOR.
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Affiliation(s)
- Giorgio Fiore
- Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
- Unit of Oncology and Onco-Hematology, University of Milan, Milan, Italy.
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
| | - Giulio Andrea Bertani
- Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giorgio Conte
- Unit of Neuroradiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Unit of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Emanuele Ferrante
- Unit of Endocrinology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Elisabetta Kuhn
- Unit of Pathology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Letterio Runza
- Unit of Pathology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Pluderi
- Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Stefano Borsa
- Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Manuela Caroli
- Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elisa Sala
- Unit of Endocrinology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Platania
- Unit of Neuroradiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Karin Kremenova
- Unit of Neuroradiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Ferrero
- Unit of Pathology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Fabio Maria Triulzi
- Unit of Neuroradiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Unit of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanna Mantovani
- Unit of Endocrinology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Locatelli
- Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Unit of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Guerrero-Pérez F, Marengo AP, Vilarrasa N, Vidal N, Ruiz-Roig N, Sánchez-Fernández JJ, Torres-Díaz A, Sanmillán JL, Pérez-Maraver M, Villabona C. Xanthogranuloma of the sellar region: a systematic review. Hormones (Athens) 2023; 22:199-210. [PMID: 36695986 DOI: 10.1007/s42000-023-00432-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/13/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
Knowledge of xanthogranuloma (XG) of the sellar region comes from short series or single cases. We performed a systematic review, using the PubMed, Web of Science, Embase, Scopus, eLibrary, and BIOSIS Preview databases, of all cases reported from 2000 to the present. We also describe one unreported patient treated in our institution. A search of the literature revealed that of 71 patients 50.7% were male and that mean age at diagnosis was 34.7 ± 19.2 years old. Median time from clinical onset until diagnosis was 7 (3-21) months. Hypopituitarism (70.4%), visual disorders (64.7%), headache (53.5%), and polyuria-polydipsia (28.2%) were the most common symptoms. On MRI, median tumor size was 20 (16-29) mm, while 71.8% were sellar/suprasellar and less frequently exclusively suprasellar (15.5%) or sellar (12.7%). On T1-weighted imaging, XG was hyperintense in 76.3% of patients, while it showed variable appearance on T2-weighted imaging. The tumor showed cystic features in 50.7%, gadolinium enhancement in 45.1%, and calcification in 22.5% of patients. All patients underwent surgery (77.4% transphenoidal approach and 18.3% craniotomy), with hypopituitarism (56.4%), diabetes insipidus (34.5%), and visual defects (7.3%) being the most common complications. Total/subtotal resection was achieved in 93.5%, while the tumor was partially removed in 6.6%. Median follow-up was 24 (6-55) months and no tumor recurrence or remnant growth was reported in 97.5% of cases. In conclusion, XG affects the younger population, manifested by hormonal deficit and mass effect symptoms. Surgery is safe and offers excellent outcomes, though hypopituitarism is frequent post-surgery. Tumor recurrence or remnant growth is rare and radiological surveillance is a good option for patients with remnant lesions.
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Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology, Bellvitge University Hospital-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | | | - Nuria Vilarrasa
- Department of Endocrinology, Bellvitge University Hospital-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
| | - Noemi Vidal
- Department of Pathology, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Neuro-Oncology Unit-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Ruiz-Roig
- Department of Pathology, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan José Sánchez-Fernández
- Institut de Diagnòstic per la Imatge, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Torres-Díaz
- Department of Neurosurgery, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Sanmillán
- Department of Neurosurgery, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Pérez-Maraver
- Department of Endocrinology, Bellvitge University Hospital-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
| | - Carles Villabona
- Department of Endocrinology, Bellvitge University Hospital-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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Yang Y, Babayan L, Mirzakhanian A, Sisliyan N, Zhang D, Hurtado C, Zahid A, Bergsneider M, Kim W, Wang MB, Heaney AP. Circulating FK506 binding protein 51 mRNA expression in patients with pituitary adenomas. Heliyon 2023; 9:e12678. [PMID: 36699264 PMCID: PMC9868367 DOI: 10.1016/j.heliyon.2022.e12678] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/03/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023] Open
Abstract
Background FK506 binding protein 51 (FKBP5) is a co-chaperone regulator of the glucocorticoid receptor (GR). Recent studies have reported increased FKBP5 mRNA in the circulation from patients with Cushing disease (CD) which returned to comparable levels seen in healthy controls following successful trans-nasal trans-sphenoidal (TNTS) surgical corticotroph tumor removal. However, the expression of circulating FKBP5 mRNA levels in other pituitary tumor subtypes and its specificity to corticotroph tumors is unknown. Methods Pre-operative blood was collected from consecutive patients undergoing TNTS for pituitary tumors (n = 57) at our center between 2015 and 2019. Total RNA was isolated from whole blood using RiboPure blood RNA isolation kit and real-time qPCR was used to quantitate circulating FKBP5 mRNA expression. Results Consistent with the prior report, higher circulating FKBP5 mRNA levels were observed in 20 patients with CD prior to surgical tumor removal, compared to 21 healthy controls (p < 0.0005) and compared to 8 patients harboring gonadotroph pituitary tumors (p < 0.05) and 6 patients with silent corticotroph pituitary tumors (p < 0.05). However, circulating FKBP5 mRNA levels were higher in 10 patients with prolactin (PRL)-secreting pituitary tumors compared to healthy controls (p < 0.05), and did not differ between patients with CD and patients with growth hormone secreting tumors (GH-omas). Conclusions Although we confirm that circulating FKBP5 mRNA is higher in patients with corticotroph tumors compared to healthy subjects, measurement of circulating FKBP5 does not appear to be helpful to distinguish corticotroph tumors from other pituitary tumor sub-types.
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Affiliation(s)
- Yingying Yang
- Departments of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Lilit Babayan
- Departments of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Argishty Mirzakhanian
- Departments of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nvard Sisliyan
- Departments of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Dongyun Zhang
- Departments of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Carolina Hurtado
- Departments of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Abdul Zahid
- Departments of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Marvin Bergsneider
- Departments of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Won Kim
- Departments of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Marilene B. Wang
- Departments of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Anthony P. Heaney
- Departments of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA,Departments of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA,Corresponding author. Departments of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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15
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Albano L, Losa M, Barzaghi LR, Mortini P. Benign and Malignant Tumors of the Pituitary Gland. Adv Exp Med Biol 2023; 1405:281-297. [PMID: 37452942 DOI: 10.1007/978-3-031-23705-8_10] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Pituitary gland tumors represent approximately 10-15% of all brain tumors and the most common neoplasms of the sellar region. Among them, pituitary adenomas are the widespread accounting for more than 80%. Recently, the fourth edition of the World Health Organization (WHO) 2017 classified pituitary tumors focusing on histopathologic and molecular genetics features and introduced new entities like pituitary blastoma. Most of pituitary gland neoplasms occur sporadically, whereas 5% are related to familial syndromes. They present with several clinical manifestations including signs and symptoms related to excessive hormone secretion by the tumor, signs of hormone deficits by the normal pituitary gland and others commonly secondary to mass effects, and compression of nearby structures such as the optic chiasm; headache and visual disturbance are the most frequent mass effect symptoms. Some tumors, however, are detected as an incidental finding on magnetic resonance imaging (MRI) or computed tomography (CT) scans performed for some other reasons. A correct evaluation involves the assessment of hypothalamic-pituitary hormonal function and an ophthalmological examination once a pituitary lesion is encountered. Surgery, more specifically transsphenoidal approach, represents the primary treatment chosen for the majority of pituitary tumors (except for prolactinomas where medical treatment is indicated) allowing for pathologic analysis and complete or partial tumor removal. On the contrary, to date, craniotomy is rarely performed. Sometimes, due to the proximity of critical structures and to tumor's location and characteristics, a successful surgical procedure may often not be achievable due to the high risks related to the procedure itself. Therefore, the treatment of pituitary tumors commonly requires a multimodal approach, including surgery, radiosurgery, radiation therapy, and medical therapy. Aggressive pituitary tumors or carcinomas are associated with poor prognosis due to limited therapeutic options. Furthermore, they tend to recur quickly after initial surgical treatment or present metastasis, may be unresponsive to therapy, and are difficult to manage. In this chapter, we provide an overview of the most common pituitary gland tumors focusing on epidemiology, new pathological features, diagnosis, available treatment, and prognosis.
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Affiliation(s)
- Luigi Albano
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Lina Raffaella Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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Taniguchi-Ponciano K, Portocarrero-Ortiz LA, Guinto G, Moreno-Jimenez S, Gomez-Apo E, Chavez-Macias L, Peña-Martínez E, Silva-Román G, Vela-Patiño S, Ordoñez-García J, Andonegui-Elguera S, Ferreira-Hermosillo A, Ramirez-Renteria C, Espinosa-Cardenas E, Sosa E, Espinosa-de-Los-Monteros AL, Salame-Khouri L, Perez C, Lopez-Felix B, Vargas-Ortega G, Gonzalez-Virla B, Lisbona-Buzali M, Marrero-Rodríguez D, Mercado M. The kinome, cyclins and cyclin-dependent kinases of pituitary adenomas, a look into the gene expression profile among tumors from different lineages. BMC Med Genomics 2022; 15:52. [PMID: 35260162 PMCID: PMC8905767 DOI: 10.1186/s12920-022-01206-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/10/2021] [Accepted: 03/04/2022] [Indexed: 12/11/2022] Open
Abstract
Background Pituitary adenomas (PA) are the second most common intracranial tumors and are classified according to hormone they produce, and the transcription factors they express. The majority of PA occur sporadically, and their molecular pathogenesis is incompletely understood. Methods Here we performed transcriptome and proteome analysis of tumors derived from POU1F1 (GH-, TSH-, and PRL-tumors, N = 16), NR5A1 (gonadotropes and null cells adenomas, n = 17) and TBX19 (ACTH-tumors, n = 6) lineages as well as from silent ACTH-tumors (n = 3) to determine expression of kinases, cyclins, CDKs and CDK inhibitors. Results The expression profiles of genes encoding kinases were distinctive for each of the three PA lineage: NR5A1-derived tumors showed upregulation of ETNK2 and PIK3C2G and alterations in MAPK, ErbB and RAS signaling, POU1F1-derived adenomas showed upregulation of PIP5K1B and NEK10 and alterations in phosphatidylinositol, insulin and phospholipase D signaling pathways and TBX19-derived adenomas showed upregulation of MERTK and STK17B and alterations in VEGFA-VEGFR, EGF-EGFR and Insulin signaling pathways. In contrast, the expression of the different genes encoding cyclins, CDK and CDK inhibitors among NR5A1-, POU1F1- and TBX19-adenomas showed only subtle differences. CDK9 and CDK18 were upregulated in NR5A1-adenomas, whereas CDK4 and CDK7 were upregulated in POUF1-adenomas. Conclusions The kinome of PA clusters these lesions into three distinct groups according to the transcription factor that drives their terminal differentiation. And these complexes could be harnessed as molecular therapy targets. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01206-y.
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Affiliation(s)
- Keiko Taniguchi-Ponciano
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | | | | | - Sergio Moreno-Jimenez
- Instituto Nacional de Neurología Y Neurocirugía "Manuel Velasco Suarez", Mexico, Mexico.,Centro Neurológico, Centro Medico ABC, Mexico, Mexico
| | - Erick Gomez-Apo
- Área de Neuropatología, Servicio de Anatomía Patológica, Hospital General de México Dr. Eduardo Liceaga, Mexico, Mexico
| | - Laura Chavez-Macias
- Área de Neuropatología, Servicio de Anatomía Patológica, Hospital General de México Dr. Eduardo Liceaga, Mexico, Mexico.,Facultad de Medicina, Universidad Nacional Autonoma de México, Mexico, Mexico
| | - Eduardo Peña-Martínez
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | - Gloria Silva-Román
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | - Sandra Vela-Patiño
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | - Jesús Ordoñez-García
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | - Sergio Andonegui-Elguera
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | - Aldo Ferreira-Hermosillo
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico.,Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Claudia Ramirez-Renteria
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico.,Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Etual Espinosa-Cardenas
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Ernesto Sosa
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Ana Laura Espinosa-de-Los-Monteros
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Latife Salame-Khouri
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Carolina Perez
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Blas Lopez-Felix
- Servicio de Neurocirugia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Guadalupe Vargas-Ortega
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Baldomero Gonzalez-Virla
- Servicio de Endocrinologia, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
| | - Marcos Lisbona-Buzali
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico
| | - Daniel Marrero-Rodríguez
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico.
| | - Moisés Mercado
- CONACyT-Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, D.F. 06720, Mexico, Mexico.
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Damianse SSP, Nascimento GC, Rocha VCC, Nascimento AGPAC, Gaido NC, Azulay RSS, Dos Santos WC, Rodrigues VP, Quidute ARP, Magalhães M, Faria MDS. The Importance of Periodical Screening for Primary Hyperparathyroidism in a Pituitary Tumor Cohort in Searching Patients with MEN1 and its Genetic Profile. Endocr Pract 2022; 28:509-514. [PMID: 35247589 DOI: 10.1016/j.eprac.2022.02.010] [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: 10/19/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Multiple endocrine neoplasia type 1 (MEN1) is a rare genetic syndrome characterized by parathyroid, anterior pituitary, and/or duodenopancreatic neuroendocrine tumors. Studies have indicated that investigating primary hyperparathyroidism (pHPT) with subsequent genetic screening may be an essential tool for the early diagnosis of MEN1 in patients with pituitary tumors (PTs). This study aimed to investigate the presence of pHPT in patients with PTs and, subsequently, to screen for genetic mutations and related tumors in those with MEN1 Syndrome. METHODS This study included 255 patients with PTs who were assessed for the presence of MEN1 from serum calcium and parathyroid hormone measurements. Mutation screening of the MEN1, CDKN1B, and AIP genes was performed in the index cases showing the MEN1 phenotype. RESULTS Five PT-evaluated patients presented a clinical condition compatible with MEN1. These patients had a younger age of onset and a more severe clinical condition. Genetic analysis identified a frameshift mutation in the MEN1 gene in one of the cases with the MEN1 phenotype, but point mutations in CDKN1B and AIP were not detected in any of these patients. CONCLUSION Our findings show that periodic screening for pHPT in patients with PTs may be useful to detect MEN1 syndrome; thus, it is recommended in those patients genetic analysis of MEN1 gene and an additional search of related tumors. By contrast, our results suggest that CDKN1B and AIP mutations do not seem to play a relevant role in the pathogenesis of MEN1.
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Affiliation(s)
- Sabrina S P Damianse
- Service of Endocrinology, Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil; Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, Brazil; Clinical Research Center (CEPEC), Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil; Postgraduate Program in Adult Health (PPGSAD), Federal University of Maranhão (UFMA), São Luís, Brazil
| | - Gilvan C Nascimento
- Service of Endocrinology, Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil; Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, Brazil; Clinical Research Center (CEPEC), Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil
| | - Viviane C C Rocha
- Service of Endocrinology, Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil; Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, Brazil; Clinical Research Center (CEPEC), Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil
| | - Ana Gisélia P A C Nascimento
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, Brazil; Clinical Research Center (CEPEC), Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil; Pathology Unit, Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA), São Luís, Brazil
| | - Nadja C Gaido
- Pathology Unit, Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA), São Luís, Brazil
| | - Rossana S S Azulay
- Service of Endocrinology, Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil; Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, Brazil; Clinical Research Center (CEPEC), Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil
| | - Wellyandra C Dos Santos
- Clinical Research Center (CEPEC), Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil; Postgraduate Program in Adult Health (PPGSAD), Federal University of Maranhão (UFMA), São Luís, Brazil
| | - Vandilson P Rodrigues
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, Brazil; Clinical Research Center (CEPEC), Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil; Department of Morphology, Federal University of Maranhão (UFMA), São Luís, Brazil
| | - Ana Rosa P Quidute
- Department of Physiology and Pharmacology, Federal University of Ceará (UFC), Fortaleza, Brazil
| | - Marcelo Magalhães
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, Brazil; Clinical Research Center (CEPEC), Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil; Research and Extension Nucleus (NUPE), UNDB University Center, São Luís, Brazil
| | - Manuel Dos S Faria
- Service of Endocrinology, Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil; Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, Brazil; Clinical Research Center (CEPEC), Presidente Dutra University Hospital of the Federal University of Maranhão (HUUFMA/EBSERH), São Luís, Brazil.
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Prieto R, Barrios L, Pascual JM. Papillary Craniopharyngioma: A Type of Tumor Primarily Impairing the Hypothalamus - A Comprehensive Anatomo-Clinical Characterization of 350 Well-Described Cases. Neuroendocrinology 2022; 112:941-965. [PMID: 35108706 DOI: 10.1159/000521652] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 09/21/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Papillary craniopharyngiomas (PCPs) represent a rare histological type of craniopharyngiomas (CPs) usually involving the hypothalamus. This study systematically analyzes the clinical-anatomical correlation between tumor topography and symptoms related to hypothalamic dysfunction in the largest series of PCPs ever gathered. METHODS From 5,346 CP reports published from 1856 to 2021, we selected 350 well-described cases of the squamous-papillary type. Clinical presentation, tumor topography, severity of hypothalamic adhesion, patient outcome, and tumor recurrence were thoroughly analyzed. RESULTS PCPs predominantly occur in adult (96.3%), male (61.7%) patients presenting with headache (63.4%), visual alterations (56.2%), and psychiatric disturbances (50.4%). Most PCPs are solid (50%), round (72%) lesions that occupy the third ventricle (3V, 94.8%) and show low-risk severity adhesions to the hypothalamus (66.8%). Two major topographical categories can be found: strictly 3V (57.5%), growing above an intact 3V floor, and not-strictly or infundibulo-tuberal (32.9%), expanding at the infundibulum and/or tuber cinereum. The hypothalamic syndrome predominated among strictly 3V PCPs (p < 0.001). Psychiatric symptoms (p < 0.001) and high-risk hypothalamic attachments (p = 0.031) related to unfavorable postoperative outcomes among patients treated from 2006 onwards. The not-strictly 3V topography was identified as the major predictor of high-risk hypothalamic attachments (71.2% correctly predicted), which, along with incomplete tumor removal (p = 0.018), underlies the higher tumor recurrence of this topography (p = 0.001). CONCLUSIONS This systematic review evidences that PCP topography is a major determinant of hypothalamic-related symptoms, type of hypothalamic attachments, and tumor recurrence rate. Accurate preoperative definition of PCP-hypothalamus relationships is essential for the judicious, safe management of these complex lesions.
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Affiliation(s)
- Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Laura Barrios
- Department of Statistics, Computing Center, CSIC, Madrid, Spain
| | - José M Pascual
- Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain
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Wan X, Yan Z, Tan Z, Cai Z, Qi Y, Lu L, Xu Y, Chen J, Lei T. MicroRNAs in Dopamine Agonist-Resistant Prolactinoma. Neuroendocrinology 2022; 112:417-426. [PMID: 34034260 DOI: 10.1159/000517356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/10/2021] [Accepted: 04/23/2021] [Indexed: 11/19/2022]
Abstract
Dopamine agonists (DAs) are preferred for the treatment of prolactinomas and are usually very effective. Nonetheless, 20-30% of bromocriptine- and approximately 10% of cabergoline-treated individuals exhibit resistance to DAs. In addition, the mechanism underlying this phenomenon remains elusive. In this study, we summarize the major findings regarding the role of microRNAs (miRNAs) in the pathogenesis of DA-resistant prolactinoma (DARP). Currently available evidence suggests that miRNAs are usually dysregulated in DARP and that, although controversial, the dysregulated miRNAs target the transforming growth factor (TGF)-β, dopamine 2 receptor (D2R), or estradiol (E2)/estrogen receptor (ER) signaling pathways to mediate the therapeutic effect of DAs. These findings provide new incentives for research on innovative strategies for predicting patients' responsiveness to dopamine therapies and for developing treatment approaches. Unfortunately, recent studies tended to focus exclusively on the differential miRNA expression profiles between DARP and dopamine-sensitive prolactinoma, and no definitive consensus has been reached regarding the role of these miRNAs in the modulation mechanism. Therefore, current and future efforts should be directed toward the exploration of the mechanism underlying the dysregulation of miRNAs as well as of the target proteins that are affected by the dysregulated miRNAs. Furthermore, the modulation of the expression of dysregulated miRNAs, which target the D2R, TGF-β, or E2/ER signaling pathways, might be a promising alternative to treat patients with DARP and improve their prognosis.
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Affiliation(s)
- Xueyan Wan
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zisheng Yan
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhoubin Tan
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi Cai
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiwei Qi
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Lu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Xu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Juan Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Lei
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Spada A, Mantovani G, Lania AG, Treppiedi D, Mangili F, Catalano R, Carosi G, Sala E, Peverelli E. Pituitary Tumors: Genetic and Molecular Factors Underlying Pathogenesis and Clinical Behavior. Neuroendocrinology 2022; 112:15-33. [PMID: 33524974 DOI: 10.1159/000514862] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 12/06/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Abstract
Pituitary neuroendocrine tumors (PitNETs) are the most common intracranial neoplasms. Although generally benign, they can show a clinically aggressive course, with local invasion, recurrences, and resistance to medical treatment. No universally accepted biomarkers of aggressiveness are available yet, and predicting clinical behavior of PitNETs remains a challenge. In rare cases, the presence of germline mutations in specific genes predisposes to PitNET formation, as part of syndromic diseases or familial isolated pituitary adenomas, and associates to more aggressive, invasive, and drug-resistant tumors. The vast majority of cases is represented by sporadic PitNETs. Somatic mutations in the α subunit of the stimulatory G protein gene (gsp) and in the ubiquitin-specific protease 8 (USP8) gene have been recognized as pathogenetic factors in sporadic GH- and ACTH-secreting PitNETs, respectively, without an association with a worse clinical phenotype. Other molecular factors have been found to significantly affect PitNET drug responsiveness and invasive behavior. These molecules are cytoskeleton and/or scaffold proteins whose alterations prevent proper functioning of the somatostatin and dopamine receptors, targets of medical therapy, or promote the ability of tumor cells to invade surrounding tissues. The aim of the present review is to provide an overview of the genetic and molecular alterations that can contribute to determine PitNET clinical behavior. Understanding subcellular mechanisms underlying pituitary tumorigenesis and PitNET clinical phenotype will hopefully lead to identification of new potential therapeutic targets and new markers predicting the behavior and the response to therapeutic treatments of PitNETs.
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Affiliation(s)
- Anna Spada
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanna Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea G Lania
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Donatella Treppiedi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Mangili
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Rosa Catalano
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Carosi
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Sala
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Erika Peverelli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy,
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Giuffrida G, Ferraù F, Alessi Y, Cannavò S. Shrinkage of a pituitary metastasis of melanoma induced by pembrolizumab: a case report. J Med Case Rep 2021; 15:555. [PMID: 34758866 PMCID: PMC8582141 DOI: 10.1186/s13256-021-03150-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/12/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pituitary metastases are rare, often deriving from lung or breast cancer owing to the upper vena cava proximity. Pituitary metastases can manifest with signs and symptoms of pituitary tumors, consequent to mass effect (headache, visual impairment) and/or hormonal alterations (hyperprolactinemia, hypopituitarism, and diabetes insipidus). Immune checkpoint inhibitors burst immunity against tumors, significantly increasing patients' survival, but their autoimmune side effects frequently involve the skin, the gastrointestinal tract, and the endocrine glands (pituitary, thyroid, pancreas). CASE PRESENTATION A 77-year-old Caucasian man had undergone trans-nasal sphenoidal surgery for a nonsecreting pituitary macroadenoma in 2001, without remnant or endocrine deficits. In 2016, he was operated for a shoulder melanoma. In February 2018, imaging evaluation demonstrated metastases in lung, liver, and femur. Therefore, treatment with pembrolizumab (anti-programmed death 1) was scheduled in May 2018, but, before starting this therapy, a brain computed tomography performed for a sudden loss of consciousness detected a sellar mass of 17 × 12 mm, which extended to the pituitary stalk and compressed the optic chiasma. Focused magnetic resonance imaging confirmed the size and characteristics of the lesion, while emergency evaluation of the hormonal profile demonstrated an impairment of adrenal and thyroid function. The pituitary lesion demonstrated a remarkable shrinkage (8 × 6 mm), which was confirmed by subsequent imaging evaluations. CONCLUSIONS This is the first case reporting on effectiveness of immune checkpoint inhibitors in a patient with pituitary metastasis from a melanoma.
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Affiliation(s)
- Giuseppe Giuffrida
- Endocrine Unit of University Hospital "G. Martino", Messina, Italy
- Department of Human Pathology of Childhood and Adulthood "G. Barresi", University of Messina, Messina, Sicily, Italy
| | - Francesco Ferraù
- Endocrine Unit of University Hospital "G. Martino", Messina, Italy.
- Department of Human Pathology of Childhood and Adulthood "G. Barresi", University of Messina, Messina, Sicily, Italy.
| | - Ylenia Alessi
- Endocrine Unit of University Hospital "G. Martino", Messina, Italy
| | - Salvatore Cannavò
- Endocrine Unit of University Hospital "G. Martino", Messina, Italy
- Department of Human Pathology of Childhood and Adulthood "G. Barresi", University of Messina, Messina, Sicily, Italy
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22
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Abstract
Surgery, more specifically transsphenoidal approach, remains the primary treatment chosen for the majority of pituitary tumors (except for prolactinomas where medical treatment is indicated) allowing for pathologic analysis and complete or partial tumor removal. Transcranial approaches, employing craniotomies, are still needed in some patients with giant pituitary adenomas and in many of those harboring craniopharyngiomas. However, the surgical treatment of pituitary tumors is challenging because of their complex anatomical location and their heterogenous histology. Due to the proximity of critical structures, a successful surgical procedure may often not be achievable due to the high risks related to the procedure itself. Therefore, the treatment of pituitary tumors in 2020 commonly requires a multimodal approach, including surgery, radiosurgery, radiation therapy, and medical therapy. Recently, efforts have been made to develop intraoperative imaging, by increasing the diffusion of radiosurgery. Furthermore, the development of Pituitary Tumor Centers of Excellence (PTCOE) is becoming crucial to provide the optimal treatment for a single patient. There is in fact sufficient evidence that the best and optimal outcome in terms of tumor resection and correction of hormonal over secretion as well as the lowest rate of complications are obtained in centers of excellence with sufficiently experienced, specialized surgeons and a high patient load. Technological developments will probably even gain increasing importance in the future.
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Affiliation(s)
- Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy.
| | - Luigi Albano
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Lina Raffaella Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
| | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132 Milan, Italy
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Guarda FJ, Yu X, Shiraliyeva N, Haines MS, Bradbury M, Saylor PJ, Nachtigall LB. GnRH agonist-associated pituitary apoplexy: a case series and review of the literature. Pituitary 2021; 24:681-689. [PMID: 33835355 DOI: 10.1007/s11102-021-01143-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine the clinical presentation and longitudinal outcome of Pituitary Apoplexy (PA) after gonadotropin-releasing hormone agonist (GnRHa) in a series of patients and compare to prior reports. METHODS A retrospective chart review was performed on seven patients receiving GnRHa who developed PA. Prior reported cases were analyzed. RESULTS Six men (median age 72 years) with prostate cancer and one woman (aged 22 years) undergoing oocyte donation presented with PA between 1990 and 2020. Most presented with within 24 h of the first dose, but two developed PA 1 to 5 months after GnRHa initiation. The main clinical manifestations were headache (100%), nausea and vomiting (86%). While no patients had a previously known pituitary tumor, all had imaging demonstrating sellar mass and/or hemorrhage at presentation. Among those surgically treated (5/7), 80% (4/5) of patients had pathologic specimens that stained positive for gonadotropins; the remaining patient's pathologic specimen was necrotic. At the time of PA, the most common pituitary dysfunction was hypocortisolism. Central adrenal insufficiency and central hypothyroidism were reversible in a subset. Pituitary imaging remained stable. CONCLUSIONS This is the first report of a case series with PA after GnRHa administration with longitudinal follow-up. Although infrequent, PA can be life-threatening and should be suspected among patients receiving GnRHa, with or without a known pituitary adenoma, who develop acute headache, nausea and/or vomiting. Since hypopituitarism was reversible in a subset, ongoing pituitary function testing may be indicated.
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Affiliation(s)
- Francisco J Guarda
- Department of Endocrinology and Center for Translational Endocrinology (CETREN-UC), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Pituitary Tumor Program. Red de Salud UC-CHRISTUS, Santiago, Chile
| | - Xiaoling Yu
- Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA
| | - Naila Shiraliyeva
- Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA
| | - Melanie S Haines
- Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA
| | - Michael Bradbury
- Department of Ophthalmology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Philip J Saylor
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lisa B Nachtigall
- Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA.
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24
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Peltz-Sinvani N, Percik R, Uri I, Kfir SK, Tirosh A, Tirosh A. Low risk for all-cause mortality among patients with lung neuroendocrine tumors co-diagnosed with pituitary adenomas. Endocrine 2021; 73:745-751. [PMID: 33982234 DOI: 10.1007/s12020-021-02740-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Lung neoplasms often co-occur with pituitary adenoma (PA). However, whether co-diagnosis of lung neuroendocrine tumors (LNETs) and PA constitute a unique entity and the impact of such co-diagnosis on patients' outcome is yet to be defined. The study objective was to compare patients' clinical characteristics with LNET to patients co-diagnosed with PA. METHODS A Retrospective, case-control study based on the Surveillance, Epidemiology, and End Results (SEER) registry database between 2000 and 2016. A total of 2947 patients with LNET, including 2913 with LNET alone ("Sporadic") and 34 patients with both LNET and PA ("LNET-PA"). RESULTS PA preceded LNET diagnosis in 85.3% of patients and had higher rates among LNET patients (34/2947) than with any cancer (p < 0.00001) and compared to patients with non-small cell lung cancer (NSCLC) (15/2378, p = 0.047). LNET-PA patients were younger at diagnosis compared with NSCLC patients and PA (p = 0.04). Among patients <60 years with LNET, co-diagnosis with PA was associated with lower all-cause mortality (ACM) risk (Log-rank test, p = 0.03). Adjusted ACM risk of patients with LNET-PA was lower than sporadic LNET (hazard ratio 0.553, 95% confidence interval 0.309-0.99, p = 0.046), especially among Caucasians, and lower overall-mortality risk in patients <60 years with borderline statistical significance (p = 0.071). CONCLUSIONS Patients with both LNET and PA constitute a distinct morbidity and mortality profile than sporadic LNET, possibly suggesting an undefined MEN syndrome. Additional studies to further investigate patients' natural course and genetic profile with these neoplasms are needed.
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Affiliation(s)
- Naama Peltz-Sinvani
- Division of Endocrinology, Diabetes and Metabolism, The Chaim Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ruth Percik
- Division of Endocrinology, Diabetes and Metabolism, The Chaim Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Inbal Uri
- Division of Endocrinology, Diabetes and Metabolism, The Chaim Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sapir Kon Kfir
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine D, The Chaim Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel
| | - Amir Tirosh
- Division of Endocrinology, Diabetes and Metabolism, The Chaim Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amit Tirosh
- Division of Endocrinology, Diabetes and Metabolism, The Chaim Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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25
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Torregrosa-Quesada ME, García-Martínez A, Sánchez-Barbie A, Silva-Ortega S, Cámara R, Fajardo C, Lamas C, Aranda I, Pico A. The silent variants of pituitary tumors: demographic, radiological and molecular characteristics. J Endocrinol Invest 2021; 44:1637-1648. [PMID: 33476035 DOI: 10.1007/s40618-020-01468-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/09/2020] [Accepted: 11/15/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Tumors of the anterior pituitary gland (PTs) are mostly benign tumors with a low prevalence, which has nevertheless increased with advances in brain radiology techniques. Nearly half of PTs are not associated with a clinical endocrine syndrome. These tumors have been indistinctly named non-functioning pituitary adenomas (NFPAs) or silent pituitary tumors (SPTs) and the mechanisms of silencing are not fully known. AIM To study the frequency and characterize the silent variant of PTs in a large local series, and to assess their pituitary adenohypophyseal gene expression. METHODS This observational, cross-sectional study was performed in a Pituitary Tumor Center of Excellence and involved 268 PTs. After identifying the different subtypes according to the immunohistochemical (IHC) expression of adenohypophyseal hormones, we studied their gene expression by RT-qPCR. RESULTS We found that silent tumors were larger and more invasive, but not more proliferative than their functional counterparts. The RT-qPCR complements the IHC typification of PTs, reducing the proportion of null-cell subtype. Finally, some silent PT subtype variants showed lower specific adenohypophyseal hormone gene expression than their functional counterparts, which may contribute to the absence of endocrine manifestations. CONCLUSIONS This paper highlights the importance of identifying the silent variant of the PTs subtypes. As expected, silent tumors were larger and more invasive than their functioning counterparts. However, there was no difference in the proliferation activity between them. Finally, the lower specific gene expression in the silent than in the functioning counterparts of some PTs subtypes gives insights into the silencing mechanisms of PTs.
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Affiliation(s)
- M E Torregrosa-Quesada
- Department of Biochemical Analysis, Alicante General University Hospital-Institute for Health and Biomedical Research (ISABIAL), 03010, Alicante, Spain
| | - A García-Martínez
- Research Laboratory, Alicante General University Hospital-Institute for Health and Biomedical Research (ISABIAL). CIBER Rare Diseases, 03010, Alicante, Spain
| | - A Sánchez-Barbie
- Centro de Investigación Operacional (CIO), Miguel Hernández University, 03010, Alicante, Spain
| | - S Silva-Ortega
- Department of Pathology, Alicante General University Hospital-Institute for Health and Biomedical Research (ISABIAL), 03010, Alicante, Spain
| | - R Cámara
- Department of Endocrinology and Nutrition, Polytechnic University Hospital La Fe, 46026, Valencia, Spain
| | - C Fajardo
- Department of Endocrinology and Nutrition, Hospital La Ribera, Alzira, 46600, Valencia, Spain
| | - C Lamas
- Department of Endocrinology and Nutrition, Albacete General University Hospital, 02006, Albacete, Spain
| | - I Aranda
- Department of Pathology, Alicante General University Hospital-Institute for Health and Biomedical Research (ISABIAL), 03010, Alicante, Spain
| | - A Pico
- Department of Endocrinology and Nutrition, Alicante General University Hospital. Institute for Health and Biomedical Research (ISABIAL). University Miguel Hernandez. CIBER Rare Diseases, 03010, Alicante, Spain.
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Torres A, Sanmillan JL, Lau R, Gabarros A. Final Outcome in Growth Hormone-Secreting Adenomas After Combination of Maximal Tumor Resection and Medical Treatment. World Neurosurg 2021; 154:e292-e301. [PMID: 34252630 DOI: 10.1016/j.wneu.2021.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Gross total resection (GTR) is not always possible in acromegalic patients, especially in patients with invasive growth hormone-secreting adenomas. We analyzed the biochemical remission outcome in relation to extent of tumor resection and effectiveness of medical treatment in cases of remnant tumor. METHODS Retrospective analysis was performed of acromegalic patients operated on between 2002 and 2017. Preoperative imaging, tumor invasiveness, extent of resection, and biochemical remission were collected. Patients with tumor remnant not amenable to second surgery began medical treatment. The relationship between pituitary adenoma remnant volume and final biochemical outcome was analyzed. RESULTS Of 120 acromegalic patients operated on, 82 underwent transsphenoidal microsurgery and 38 underwent endonasal endoscopic approach. GTR was achieved in 72 cases (60%); subtotal resection (STR), 21 (17.5%) cases; and partial resection, 27 (22.5%) cases. There was a nonsignificant higher rate of GTR/STR in patients who underwent endonasal endoscopic approach. However, a significantly higher remission rate (89.45% vs. 67.1%) was achieved in these patients (P < 0.01). Greater tumor volume and invasiveness were associated with a lower remission (P < 0.05). Patients with tumor remnant who achieved biochemical remission with added medical therapy had a significantly smaller tumor volume (P < 0.001). CONCLUSIONS The more aggressive surgical resection is, the greater the chance of attaining final biochemical remission, whether or not GTR is achieved. Medical therapy effectiveness is enhanced in cases with STR. Invasive growth hormone-secreting macroadenomas that are not surgically amenable to total resection are best managed with a combination of safe STR and medical treatment.
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Affiliation(s)
- Alberto Torres
- Department of Neurological Surgery, Bellvitge University Hospital, Barcelona, Spain.
| | - Jose Luis Sanmillan
- Department of Neurological Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Ruth Lau
- Department of Neurological Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Andreu Gabarros
- Department of Neurological Surgery, Bellvitge University Hospital, Barcelona, Spain
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Aranda F, García R, Guarda FJ, Nilo F, Cruz JP, Callejas C, Balcells ME, González G, Rojas R, Villanueva P. Rathke's cleft cyst infections and pituitary abscesses: case series and review of the literature. Pituitary 2021; 24:374-383. [PMID: 33433887 DOI: 10.1007/s11102-020-01115-2] [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] [Accepted: 11/28/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Pituitary abscesses (PAs) are a rare clinical entity which may arise from normal pituitary tissue or underlying lesions within the gland. Rathke's cleft cysts (RCCs) are not commonly associated with the development of PA. METHODS Retrospective chart review of three patients with PAs within RCCs at a single university center and review of the literature. RESULTS Three cases are reported. The first case presented with fever and headache and a history of prior surgery due to RCC and a recent respiratory tract infection. The second case had a history of recent skin infections and presented with sudden onset headache and hypopituitarism. In the third case, chronic visual field impairment prompted an ophthalmologic evaluation resulting in a diagnosis of an adenoma and an infected RCC. In all three cases, an endoscopic endonasal approach was performed to drain infected tissue and allowed microbiological identification of gram-positive cocci, followed by treatment with antibiotics for at least three weeks. Cases in the literature are scarce and the diagnosis is usually made intraoperatively due to non-specific manifestations and imaging. PAs arising from underlying pituitary lesions are less common than primary PAs. Differential diagnosis should include pituitary apoplexy, hypophysitis and other cystic lesions. CONCLUSION PAs occurring in RCCs are infrequent. Clinical manifestations are commonly subacute, without septic symptoms. Imaging is usually non-specific. Preoperative diagnosis is infrequent and a broad differential diagnosis should be considered. Empirical antimicrobial therapy should be initiated and adjusted after obtaining cultures to reduce the rate of recurrence and improve clinical outcomes.
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Affiliation(s)
- F Aranda
- Neurosurgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R García
- Endocrinology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F J Guarda
- Endocrinology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Pituitary Tumor Program, Red de Salud UC-CHRISTUS, Santiago, Chile
- Center for Translational Endocrinology (CETREN), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Nilo
- Endocrinology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Pituitary Tumor Program, Red de Salud UC-CHRISTUS, Santiago, Chile
- Center for Translational Endocrinology (CETREN), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J P Cruz
- Pituitary Tumor Program, Red de Salud UC-CHRISTUS, Santiago, Chile
- Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Callejas
- Pituitary Tumor Program, Red de Salud UC-CHRISTUS, Santiago, Chile
- Otorhinolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M E Balcells
- Department of Infectious Diseases, School of Medicine, PontificiaUniversidad Católica de Chile, Santiago, Chile
| | - G González
- Endocrinology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Translational Endocrinology (CETREN), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Rojas
- Neurosurgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Villanueva
- Neurosurgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Pituitary Tumor Program, Red de Salud UC-CHRISTUS, Santiago, Chile.
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Hallén T, Olsson DS, Hammarstrand C, Farahmand D, Olofsson AC, Jakobsson Ung E, Jakobsson S, Bergquist H, Blennow K, Zetterberg H, Johannsson G, Skoglund T. Circulating brain injury biomarkers increase after endoscopic surgery for pituitary tumors. J Clin Neurosci 2021; 89:113-121. [PMID: 34119253 DOI: 10.1016/j.jocn.2021.04.030] [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] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/23/2021] [Accepted: 04/25/2021] [Indexed: 11/27/2022]
Abstract
Pituitary tumors and subsequent treatment with endoscopic transsphenoidal surgery (ETSS) may cause injury to suprasellar structures, causing long-term fatigue and neurocognitive impairment. A method to quantify brain injury after ETSS is not available. In this prospective, exploratory study of patients undergoing ETSS for pituitary tumors, a novel approach to detect possible neuronal damage is presented. Plasma concentrations of brain injury biomarkers (glial fibrillary acidic protein [GFAP], tau, and neurofilament light [NFL]) were measured the day before surgery, immediately after surgery, at day 1 and 5, and at 6 and 12 months after surgery, using enzyme-linked immunosorbent assays. The association between the increase of biomarkers with preoperative tumor extension and postoperative patient-perceived fatigue was evaluated. Suprasellar tumor extension was assessed from MRI scans, and self-perceived fatigue was assessed using the Multidimensional Fatigue Inventory before and 6 months after surgery. Thirty-five patients were included in the analysis. Compared to baseline, GFAP showed a maximal increase at day 1 after surgery (p = 0.0005), tau peaked postoperatively on the day of surgery (p = 0.019), and NFL reached its maximum at day 5 after surgery (p < 0.0001). The increase in GFAP correlated with preoperative chiasmal compression (p = 0.020). The increase in tau was correlated with preoperative chiasmal (p = 0.011) and hypothalamus compression (p = 0.016), and fatigue score 6 months after surgery (p = 0.016). In conclusion, the concentrations of brain injury biomarkers in blood increased after ETSS for pituitary tumors. The results indicate that postoperative plasma GFAP and tau might reflect astroglial and neuronal damage after ETSS.
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Affiliation(s)
- Tobias Hallén
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Daniel S Olsson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Casper Hammarstrand
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Farahmand
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Eva Jakobsson Ung
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sofie Jakobsson
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Bergquist
- Department of ENT/H&N Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Otorhinolaryngology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, Institute of Neurology, University College of London, London, UK; UK Dementia Research Institute, University College of London, London, UK
| | - Gudmundur Johannsson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Skoglund
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Mirfakhraee S, Chan AVC, Ganji N, Abramowitz J. Dual treatment of acromegaly and hormone-receptor-positive breast cancer with tamoxifen: a case report. J Med Case Rep 2021; 15:207. [PMID: 33910628 PMCID: PMC8082960 DOI: 10.1186/s13256-021-02792-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Adjuvant endocrine therapy is recommended for the treatment of hormone-receptor-positive breast cancer. Aromatase inhibitors are associated with significant musculoskeletal adverse effects, likely through growth hormone/insulin-like growth factor 1 modulation, while tamoxifen reduces insulin-like growth factor 1 production. We describe the case of a patient who was treated successfully with tamoxifen for her hormone-receptor-positive breast cancer and acromegaly. Case presentation A 57-year old White female with hormone-receptor-positive breast cancer was diagnosed with acromegaly. She received adjuvant endocrine therapy with anastrozole but could not tolerate this medication because of severe arthralgia, so she was switched to tamoxifen. Shortly after starting tamoxifen, the patient’s musculoskeletal symptoms resolved and her insulin-like growth factor 1 levels normalized. She has remained in remission of her acromegaly and breast cancer since initiating tamoxifen. Conclusion This case highlights the dual benefit of tamoxifen therapy in the treatment of hormone-receptor-positive breast cancer and acromegaly. Unlike anastrozole, tamoxifen has the benefit of lowering insulin-like growth factor 1 levels, which underscores its advantage in reducing adverse musculoskeletal symptoms during the treatment of hormone-receptor-positive breast cancer. We offer the first reported use of tamoxifen monotherapy for the successful treatment of acromegaly and hormone-receptor-positive breast cancer. While tamoxifen may offer an additional, oral option for acromegaly patients who do not respond to or tolerate conventional growth-hormone-lowering therapy, additional studies are necessary.
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Affiliation(s)
- Sasan Mirfakhraee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,UT Southwestern Medical Center, WCB3 8th Floor, 2001 Inwood Rd, Dallas, TX, 75390, USA.
| | - Alberto V Cabo Chan
- Division of Mineral Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Niloofar Ganji
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Jessica Abramowitz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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30
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Zoli M, Guaraldi F, Zoia C, La Corte E, Asioli S, Bongetta D, Rustici A, Mazzatenta D. Management of sellar and parasellar tumors becoming symptomatic during pregnancy: a practical algorithm based on multi-center experience and systematic literature review. Pituitary 2021; 24:269-283. [PMID: 33200305 PMCID: PMC7966198 DOI: 10.1007/s11102-020-01107-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Sellar/parasellar tumors (SPTs) very rarely become symptomatic during pregnancy. No specific guidelines exist for their management, that is extremely challenging as mother and fetus health can be jeopardized. MATERIALS AND METHODS Data of patients with SPTs becoming symptomatic during pregnancy treated at two Italian referral Centers were retrospectively collected. Systematic literature review was also performed. RESULTS Our series consisted of 6 cases, 3 meningiomas, 1 ACTH-secreting adenoma, 1 pituicytoma and 1 craniopharyngioma. Mean age at presentation was 33.6 ± 6.0 years. Five patients complained of visual disturbances, associated with headache in one case, that occurred between gestation week (GW) 22 and 34. In 5 cases, pregnancy was uneventful with the delivery of a healthy baby between GW 33 and 35, followed by endoscopic surgical tumor exeresis (n = 4) or proton bean therapy (n = 1). Another patient presented with stigmata typical of Cushing's syndrome and rapidly worsening pre-eclampsia, that required pregnancy interruption and adenomectomy. Based on personal and literature cases, a practical algorithm was proposed to help clinicians dealing with these patients. CONCLUSIONS SPTs becoming symptomatic in pregnancy deserve careful monitoring and multidisciplinary management. Overall, wait-and-see approach is suggested, reserving surgery to patients with rapidly progressive/life-threatening situations, significant risk of permanent neurological impairment or malignant lesions.
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Affiliation(s)
- Matteo Zoli
- Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | - Federica Guaraldi
- Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele La Corte
- Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Unit of Anatomic Pathology 'M. Malpighi', Bellaria Hospital, Azienda USL Bologna, Bologna, Italy
| | | | - Arianna Rustici
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Cortês Nascimento G, de Araujo Cortês Nascimento AGP, de Maria Ribeiro Veiga Parente C, Rodrigues VP, de Sousa Azulay RS, de Carvalho Rocha VC, da Silva Pereira Damianse S, Magalhães M, Dos Santos Faria M, Gomes MB. Pituitary neuroendocrine tumors and differentiated thyroid cancer: do metabolic and inflammatory risk factors play roles? J Endocrinol Invest 2021; 44:735-744. [PMID: 32681462 DOI: 10.1007/s40618-020-01357-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE It is postulated that patients with different types of pituitary neuroendocrine tumors (PitNETs) may present a higher incidence of cancer. Factors underlying individuals becoming overweight, such as insulin resistance, hyperleptinemia, and low-grade inflammation, may play a role in the risk of differentiated thyroid carcinoma (DTC) in such patients. This study aimed to investigate the frequency of and obesity-related risk factors associated with DTC in patients with PitNETs. METHODS This cross-sectional study involved 149 patients with nonacromegalic PitNETs (AG group), 71 patients with acromegaly (ACRO group), and 156 controls (CG group). All participants underwent insulin and blood glucose measurements with the determination of the homeostatic model assessment-insulin resistance (HOMA-IR) index, leptin, and high-sensitivity C-reactive protein (hsCRP), and they also underwent thyroid ultrasound. Clinically significant nodules were biopsied for subsequent cytopathological evaluation, and participants were operated on when indicated. RESULTS Patients in the AG group had high levels of insulin resistance and significantly higher levels of leptin and hsCRP compared with those of patients in the ACRO group. There were no cases of DTC in the AG group; two findings, one incidental, of DTC occurred in the CG group, and three cases of DTC were present in the ACRO group. Acromegaly was associated with DTC after adjusted analysis. CONCLUSIONS Our findings in patients with nonacromegalic PitNETs do not indicate a high risk for DTC despite the presence of metabolic and inflammatory risk factors for neoplastic events. In contrast, acromegaly promotes a greater risk of DTC.
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Affiliation(s)
- G Cortês Nascimento
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil.
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil.
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil.
| | - A G P de Araujo Cortês Nascimento
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
- Department of Pathology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
| | | | - V P Rodrigues
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
- Department of Morphology, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
| | - R S de Sousa Azulay
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - V C de Carvalho Rocha
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - S da Silva Pereira Damianse
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - M Magalhães
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - M Dos Santos Faria
- Service of Endocrinology, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Clinical Research Center, Presidente Dutra University Hospital, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luís, MA, Brazil
| | - M B Gomes
- Diabetes Unit-Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
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Guerrero-Pérez F, Vidal N, López-Vázquez M, Sánchez-Barrera R, Sánchez-Fernández JJ, Torres-Díaz A, Vilarrasa N, Villabona C. Sarcomas of the sellar region: a systematic review. Pituitary 2021; 24:117-129. [PMID: 32785833 DOI: 10.1007/s11102-020-01073-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/26/2022]
Abstract
PURPOSE AND METHODS Sarcomas of the sellar region are uncommon and unexpected tumors. Here, we review the cases reported in literature via a systematic search. RESULTS Ninety-four patients, 58.5% male with mean age of 39.2 ± 17.2 years were included. Fifty-seven (62%) had soft tissue sarcomas (STS) and 35 (38%) bone sarcomas (BS). Sarcoma was a primary tumor in 66%, developed after radiotherapy in 31.9% and 7.4% were metastatic. Median time between radiotherapy and sarcoma development was 10.5 (11) years. Main presentation symptoms were visual disorders (87.9%), headache (61.5%) and III cranial nerve palsy (24.1%). After surgery, sarcoma persisted or recurred in 82.3% and overall mortality reported was 44.6% with 6.5 (14) months of median survival. Tumor appeared earlier in BS compared to STS (34.4 ± 15.1 vs. 42.6 ± 17.6 years), p = 0.034 and complete tumor resection was achieved more often (41.3% vs. 4.4%), p = < 0.001. Condrosarcoma and rhabdomyosarcoma were more frequent subtypes among primary tumors while fibrosarcoma was among post-radiation sarcomas. Tumor size was larger in radiation associated sarcomas (mean maximum diameter 46.3 ± 9.3 vs. 29.1 ± 8.0 mm, p = 0.004) and persistency/recurrence was similar in both groups (70.1 vs. 73.3%, p = 0.259). CONCLUSION Sarcomas appear as mass effect symptoms in the middle aged population, mainly as primary tumors, but one third is associated with radiotherapy. Surgery is commonly not curative, mortality rate is high and death ensues shortly after diagnosis.
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Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Noemi Vidal
- Department of Pathology, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Macarena López-Vázquez
- Department of Endocrinology, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Reinaldo Sánchez-Barrera
- Department of Endocrinology, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Juan José Sánchez-Fernández
- Institut de Diagnòstic Per La Imatge, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Alberto Torres-Díaz
- Department of Neurosurgery, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Carles Villabona
- Department of Endocrinology, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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Worrell SL, Kirschner ML, Shatz RS, Sengupta S, Erickson MG. Interdisciplinary Approaches to Survivorship with a Focus on the Low-grade and Benign Brain Tumor Populations. Curr Oncol Rep 2021; 23:19. [PMID: 33471214 PMCID: PMC7817573 DOI: 10.1007/s11912-020-01004-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW "Brain tumor is a bump in the road." Sheryl Crow a famous singer was quoted talking about her meningioma, a benign brain tumor that caused her to forget her lyrics. In this review, we focus on low-grade gliomas in adults and benign brain tumors, such as meningiomas, vestibular schwannomas, and pituitary tumors, since these individuals survive a long time and morbidity is a major issue. RECENT FINDINGS As per the NCI dictionary definition, cancer survivorship focuses on the health and well-being of a person with cancer from the time of diagnosis until the end of life. This includes the physical, mental, emotional, social, and financial effects of cancer that begin at diagnosis and continue through treatment and beyond. The survivorship experience also includes issues related to follow-up care (including regular health and wellness checkups), late effects of treatment, cancer recurrence, second cancers, and quality of life. Family members, friends, and caregivers are also considered part of the survivorship experience (NCI Dictionary: https://www.cancer.gov/publications/dictionaries/cancer-terms ).
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Affiliation(s)
- Stacey L Worrell
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, 234 Goodman St, Cincinnati, OH, 45219, USA
| | | | - Rhonna S Shatz
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, 234 Goodman St, Cincinnati, OH, 45219, USA
| | - Soma Sengupta
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati, 234 Goodman St, Cincinnati, OH, 45219, USA.
| | - Melissa G Erickson
- Department of Family Medicine, University of Cincinnati, Cincinnati, OH, USA
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Prencipe N, Parasiliti-Caprino M, Gatti F, Penner F, Berton AM, Bona C, Caputo M, D'Angelo V, Cappiello V, Gasco V, Ghigo E, Zenga F, Grottoli S. Second-Day Morning Cortisol Levels after Transsphenoidal Surgery Are Accurate Predictors of Secondary Adrenal Insufficiency with Diagnostic Cut-Offs Similar to Those in Non-Stressed Conditions. Neuroendocrinology 2021; 111:639-649. [PMID: 32492678 DOI: 10.1159/000509092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 04/03/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Multiple studies tried to identify cortisol cut-offs after pituitary surgery that could accurately assess hypothalamic-pituitary-adrenal (HPA) axis function; however, there is no consensus nowadays. This study aimed to evaluate the accuracy of morning cortisol after transsphenoidal surgery in predicting long-term secondary adrenal insufficiency. METHODS In our tertiary center, we prospectively determined first- and second-day cortisol after transsphenoidal surgery in 92 patients without preoperative adrenal -insufficiency and not treated with glucocorticoids perioperatively. Definitive diagnosis of secondary adrenal insufficiency was obtained with re-evaluation 3 months after trans-sphenoidal surgery and clinical follow-up of at least 1 year. RESULTS Ten patients (10.8%) developed long-term postoperative secondary adrenal insufficiency. The ROC curves demonstrated that first-day cortisol had a moderate diagnostic accuracy, while a second-day cortisol ≤9.3 µg/dL (257 nmol/L) showed the best performance in predicting adrenal insufficiency (sensitivity [Se] 88.9%, specificity [Sp] 86.9%, AUC 0.921). Moreover, a second-day cortisol ≤3.2 µg/dL (89 nmol/L) was able to diagnose adrenal insufficiency in 100% of cases (Se 22.2%, Sp 100%) and >14 µg/dL (386 nmol/L) was able to exclude ACTH deficiency (Se 100%, Sp 57.4%). CONCLUSIONS Adrenal function can be carefully studied on the second day after pituitary surgery, using cut-off values that international guidelines suggested for non-stressed conditions. In fact, second-day cortisol levels ≤3.2 μg/dL (89 nmol/L) and >14 μg/dL (386 nmol/L) are diagnostic of secondary adrenal insufficiency and normal function, respectively. We also suggest performing a definitive re-evaluation with an HPA axis stimulation test when second-day cortisol values are between 3.3 and 14 μg/dL (90-386 nmol/L).
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Affiliation(s)
- Nunzia Prencipe
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mirko Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy,
| | - Filippo Gatti
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Federica Penner
- Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Alessandro Maria Berton
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Bona
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marina Caputo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Valentina D'Angelo
- Oncologic Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Vincenzo Cappiello
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Valentina Gasco
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ezio Ghigo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Zenga
- Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Silvia Grottoli
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
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Sowithayasakul P, Boekhoff S, Bison B, Müller HL. Pregnancies after Childhood Craniopharyngioma: Results of KRANIOPHARYNGEOM 2000/2007 and Review of the Literature. Neuroendocrinology 2021; 111:16-26. [PMID: 32074615 DOI: 10.1159/000506639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 12/12/2019] [Accepted: 02/19/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Data on female fertility, pregnancy, and outcome of offspring after childhood-onset craniopharyngioma (CP) are rare. STUDY DESIGN Observational study on pregnancy rate and offspring outcome in female CP patients recruited in KRANIOPHARYNGEOM 2000/2007 since 2000. RESULTS A total of 451 CP patients (223 female) have been recruited, and 269 (133 female) were postpubertal at study. Six of 133 female CP patients (4.5%) with a median age of 14.9 years at CP diagnosis had 9 pregnancies, giving birth to 10 newborns. Three patients achieved complete surgical resections. No patient underwent postoperative irradiation. Five natural pregnancies occurred in 3 CP patients without pituitary deficiencies. Four pregnancies in 3 CP patients with hypopituitarism were achieved under assisted reproductive techniques (ART) (median 4.5 cycles, range: 3-6 cycles). Median maternal age at pregnancy was 30 years (range: 22-41 years). Six babies (60%) were delivered by caesarean section. Median gestational age at delivery was 38 weeks (range: 34-43 weeks); median birth weight was 2,920 g (range: 2,270-3,520 g), the rate of preterm delivery was 33%. Enlargements of CP cysts occurred in 2 women during pregnancy. Other complications during pregnancy, delivery, and postnatal period were not observed. CONCLUSIONS Pregnancies after CP are rare and were only achieved after ART in patients with hypopituitarism. Close monitoring by an experienced reproductive physician is necessary. Due to a potentially increased risk for cystic enlargement, clinical, ophthalmological, and MRI monitoring are recommended in patients at risk. Severe perinatal complications, birth defects, and postnatal morbidity of mothers and offspring were not observed.
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Affiliation(s)
- Panjarat Sowithayasakul
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital, Würzburg, Germany
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany,
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Araujo-Castro M, Pascual-Corrales E, Martínez San Millan J, Rebolleda G, Pian H, Ruz-Caracuel I, De Los Santos Granados G, Ley Urzaiz L, Escobar-Morreale HF, Rodríguez Berrocal V. Multidisciplinary protocol of preoperative and surgical management of patients with pituitary tumors candidates to pituitary surgery. Ann Endocrinol (Paris) 2020; 82:20-29. [PMID: 33278380 DOI: 10.1016/j.ando.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/05/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
The optimal planning of preoperative diagnosis, management and treatment of pituitary tumors (PT) candidates to pituitary surgery (PS) requires a multidisciplinary approach involving a team of endocrinologists, neurosurgeons, ENT, neuro-ophthalmologists and neuroradiologists with experience in pituitary diseases. Such teams improve surgical results, minimize complications and facilitate their correct treatment if occurring, and optimize the hormonal, ophthalmological and radiological preoperative and follow-up evaluation. We have developed a clinical practice protocol for patients with PT who are candidates to PS based on the most recent national and international guidelines and the relevant literature regarding PT published in the last years. The protocol has been elaborated by a multidisciplinary team of a Spanish Pituitary Tumor Center of Excellence (PTCE) that includes at least one neurosurgeon, ENT, neuroradiologist, neuro-ophthalmologist, endocrine pathologist and endocrinologist specialized in pituitary diseases. We elaborated this guideline with the aim of sharing our experience with other centers involved in the perioperative and surgical management of PT thereby facilitating the management of patients undergoing PS.
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Affiliation(s)
- Marta Araujo-Castro
- Neuroendocrinology unit, department of endocrinology and nutrition, hospital universitario Ramón y Cajal, M-607, km. 9, 100, 28034 Madrid, Spain; Instituto de investigación Sanitaria Ramón y Cajal (IRYCIS), Madrid, Spain.
| | - Eider Pascual-Corrales
- Neuroendocrinology unit, department of endocrinology and nutrition, hospital universitario Ramón y Cajal, M-607, km. 9, 100, 28034 Madrid, Spain
| | - Juan Martínez San Millan
- Neuroradiology unit, department of diagnostic imaging, hospital universitario Ramón y Cajal, Madrid, Spain
| | - Gema Rebolleda
- Neuro-ophthalmology unit, department of ophthalmology, hospital universitario Ramón y Cajal, Madrid, Spain; Universidad de Alcalá, Madrid, Spain
| | - Héctor Pian
- Endocrinology unit, department of pathology, hospital universitario Ramón y Cajal, Madrid, Spain
| | - Ignacio Ruz-Caracuel
- Endocrinology unit, department of pathology, hospital universitario Ramón y Cajal, Madrid, Spain
| | - Gonzalo De Los Santos Granados
- Rinology unit, department of otorhinolaryngology (ENT), hospital universitario Ramón y Cajal, Madrid, Spain; Universidad de Alcalá, Madrid, Spain; Instituto de investigación Sanitaria Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Luis Ley Urzaiz
- Pituitary surgery unit, department of neurosurgery, hospital universitario Ramón y Cajal, Madrid, Spain
| | - Héctor Francisco Escobar-Morreale
- Neuroendocrinology unit, department of endocrinology and nutrition, hospital universitario Ramón y Cajal, M-607, km. 9, 100, 28034 Madrid, Spain; Universidad de Alcalá, Madrid, Spain; Instituto de investigación Sanitaria Ramón y Cajal (IRYCIS), Madrid, Spain; Centro de investigación biomédica en red diabetes y enfermedades metabólicas asociadas (CIBERDEM), Madrid, Spain
| | - Victor Rodríguez Berrocal
- Pituitary surgery unit, department of neurosurgery, hospital universitario Ramón y Cajal, Madrid, Spain
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Gatto F, Arvigo M, Ferone D. Somatostatin receptor expression and patients' response to targeted medical treatment in pituitary tumors: evidences and controversies. J Endocrinol Invest 2020; 43:1543-1553. [PMID: 32557353 DOI: 10.1007/s40618-020-01335-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/19/2020] [Accepted: 06/11/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Somatostatin receptors (SSTs) are widely co-expressed in pituitary tumors. SST2 and SST5 are the most represented SST subtypes. First-generation somatostatin receptor ligands (SRLs) mainly target SST2, while pasireotide, a multi-receptor ligand, shows high binding affinity for both SST5 and SST2. Therefore, SRLs are routinely used as medical treatment for GH-, TSH-, and ACTH-secreting pituitary tumors. METHODS Critical revision of literature data correlating SST expression with patients' response to SRLs. RESULTS SST2 expression in somatroph tumors directly correlates with GH and IGF-1 decrease after first-generation SRL treatment. SST2 immunohistochemistry represents a valuable tool to predict biochemical response to first-generation SRLs in acromegalic patients. Pasireotide seems to exert its biological effects via SST2 in unselected patients. However, in those subjects resistant to first-generation SRLs, harbouring tumors with negligible SST2 expression, pasireotide can act throughout SST5. More than somatotroph tumors, TSH-omas represent the paradigm of tumors showing a satisfactory response to SRLs. This is probably due to the high SST2 expression observed in nearly 100% of cases, as well as to the balanced amount of SST5. In corticotroph tumors, pasireotide mainly act via SST5, although there is a need for translational studies correlating its efficacy with SST expression in this peculiar tumor histotype. CONCLUSIONS The assumption "more target receptor, more drug efficacy" is not straightforward for SRLs. The complex pathophysiology of SSTs, and the technical challenges faced to translate research findings into clinical practice, still need our full commitment to make receptor evaluation a worthwhile procedure for individualizing treatment decisions.
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Affiliation(s)
- F Gatto
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi, 10, 16132, Genoa, Italy.
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy.
| | - M Arvigo
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - D Ferone
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi, 10, 16132, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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Chumnanvej S, Pillai BM, Chalongwongse S, Suthakorn J. Endonasal endoscopic transsphenoidal approach robot prototype: A cadaveric trial. Asian J Surg 2020; 44:345-351. [PMID: 32951962 DOI: 10.1016/j.asjsur.2020.08.011] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Endonasal Endoscopic Transsphenoidal Surgery (EETS) is a minimally invasive procedure to approach and remove pituitary tumors and other sellar lesions. The process causes less pain, faster recovery, and provides further minimal invasive access in critical cases. However, a slight deviation of tools from the target area can be fatal to the patients. The aim of this study is to design and develop a prototype robot to demonstrate neurosurgical robot-assisted EET approach. METHODS The effectiveness of a prototype robot in executing a minimally invasive EET surgery was studied in 6 cadavers. The robot was associated with a multi-information integrated technique for surgery including QR code tracking. The robot was controlled and driven by the neurosurgeon. RESULTS The standard procedure of EET was followed and the robot carried out the first stage of EET under the supervision of neurosurgeon. Finally, the sellar was reached by the neurosurgeon. The result was determined by qualitative analysis and was confirmed by the neurosurgeon. The time for the entire EET surgical procedure showed marked reduction compared to the traditional EET approach. CONCLUSION The robot design was found to be technically feasible and hence can be used for assisting the EET procedure. The robot used was able to assist the neurosurgeon correctly to approach the sinus.
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Affiliation(s)
- Sorayouth Chumnanvej
- Neurosurgery Division, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Branesh M Pillai
- Center for Biomedical and Robotics Technology (BART LAB), Department of Biomedical Engineering, Faculty of Engineering Mahidol University, Salaya, Thailand.
| | - Suwiphat Chalongwongse
- Center for Biomedical and Robotics Technology (BART LAB), Department of Biomedical Engineering, Faculty of Engineering Mahidol University, Salaya, Thailand.
| | - Jackrit Suthakorn
- Center for Biomedical and Robotics Technology (BART LAB), Department of Biomedical Engineering, Faculty of Engineering Mahidol University, Salaya, Thailand.
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Zhu H, Fang Q, Huang Y, Xu K. Semi-supervised method for image texture classification of pituitary tumors via CycleGAN and optimized feature extraction. BMC Med Inform Decis Mak 2020; 20:215. [PMID: 32907561 PMCID: PMC7488038 DOI: 10.1186/s12911-020-01230-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/13/2019] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background Accurately determining the softness level of pituitary tumors preoperatively by using their image textures can provide a basis for surgical options and prognosis. Existing methods for this problem require manual intervention, which could hinder the efficiency and accuracy considerably. Methods We present an automatic method for diagnosing the texture of pituitary tumors using unbalanced sequence image data. Firstly, for the small sample problem in our pituitary tumor MRI image dataset where T1 and T2 sequence data are unbalanced (due to data missing) and under-sampled, our method uses a CycleGAN (Cycle-Consistent Adversarial Networks) model for domain conversion to obtain fully sampled MRI spatial sequence. Then, it uses a DenseNet (Densely Connected Convolutional Networks)-ResNet(Deep Residual Networks) based Autoencoder framework to optimize the feature extraction process for pituitary tumor image data. Finally, to take advantage of sequence data, it uses a CRNN (Convolutional Recurrent Neural Network) model to classify pituitary tumors based on their predicted softness levels. Results Experiments show that our method is the best in terms of efficiency and accuracy (91.78%) compared to other methods. Conclusions We propose a semi-supervised method for grading pituitary tumor texture. This method can accurately determine the softness level of pituitary tumors, which provides convenience for surgical selection and prognosis, and improves the diagnostic efficiency of pituitary tumors.
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Affiliation(s)
- Hong Zhu
- School of Medical Information, Xuzhou Medical University, Xuzhou, China. .,Department of Computer Science and Engineering, State University of New York at Buffalo, Buffalo, USA.
| | - Qianhao Fang
- School of Medical Information, Xuzhou Medical University, Xuzhou, China
| | - Yihe Huang
- School of Medical Information, Xuzhou Medical University, Xuzhou, China
| | - Kai Xu
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
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Ceraudo M, Criminelli Rossi D, Di Iorgi N, Cama A, Piatelli G, Consales A. Pediatric pituitary adenoma with mixed FSH and TSH immunostaining and FSH hypersecretion in a 6 year-old girl with precocious puberty: case report and multidisciplinary management. Int J Neurosci 2020; 132:362-369. [PMID: 32842843 DOI: 10.1080/00207454.2020.1815734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We describe a rare case of functioning gonadotropins-producing pediatric adenoma immunostaining positively for FSH and focally for TSH causing central precocious puberty associated to central hypothyroidism in a 6 year-old girl. MATERIALS AND METHODS Clinical evaluation revealed precocious puberty, as confirmed by hormonal determination with elevated FSH and estradiol, while central hypothyroidism was biochemically diagnosed by a low fT4 and normal TSH. Head MRI showed the presence of a hyperintense pituitary lesion. The patient successfully underwent transsphenoidal endoscopic resection of the pituitary macroadenoma. RESULTS Pathologic evaluation of the tissue resected at surgery confirmed the diagnosis of pituitary adenoma with positive immunohistochemistry for FSH and focally for TSH in a mixed pattern. Ten months after surgery, there were no neurological signs and symptoms. Postoperative head MRI showed no abnormalities and no evidence of tumor regrowth. CONCLUSIONS Early and accurate diagnosis, multidisciplinary approach and close follow up are crucial factors for the favorable outcome.
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Affiliation(s)
- Marco Ceraudo
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Policlinico San Martino-IRCCS Hospital, Genoa, Italy
| | - Diego Criminelli Rossi
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Policlinico San Martino-IRCCS Hospital, Genoa, Italy
| | - Natascia Di Iorgi
- Division of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Armando Cama
- Division of Neurosurgery, Department of Neurosciences, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Gianluca Piatelli
- Division of Neurosurgery, Department of Neurosciences, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Alessandro Consales
- Division of Neurosurgery, Department of Neurosciences, Giannina Gaslini Children's Hospital, Genoa, Italy
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Tulipano G, Paghera S, Missale C, Giustina A. Differential effects of metformin on reductive activity and energy production in pituitary tumor cells compared to myogenic precursors. Endocrine 2020; 69:604-614. [PMID: 32557328 DOI: 10.1007/s12020-020-02373-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/28/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Given the multiple targets of metformin within cells, the mechanism by which it may exert a growth-inhibitory action on pituitary tumor cells in vitro remains to be explored. Previous research stressed metformin-induced changes in the activity of signaling pathways regulating cell growth and cell death. In this work, we investigated the effects of metformin on cell viability markers related to cell metabolic activity in rat pituitary tumor cells versus rat myogenic precursors as a model of normal proliferating somatic cells. METHODS We designed our experiments in order to use the MTT reduction as a marker of cellular reductive activity and the total cellular ATP levels as a marker of energy supply during short incubations with different metabolic substrates (sodium pyruvate, D-glucose, L-glutamine, sodium citrate). Then, we extended the analysis to extracellular glucose consumption, extracellular medium acidification and pyruvate dehydrogenase (PDH) complex activity. RESULTS Metformin was found to be effective in both cell types at the same concentrations, although the outcome of the treatment was quite the opposite. Unexpectedly, metformin increased the viability of subconfluent rat myoblasts. Rat pituitary tumor cells and myoblasts differed in the utilization of distinct metabolic substrates and the PDH complex activity. Metformin actions on reductive activity and ATP production were substrate-dependent. CONCLUSIONS Overall, this work points out that metformin actions at the cellular level depend on metabolic features and metabolic requirements of cells. The pyruvate metabolic branch point is most likely to play a main role in the variability of cell response to metformin.
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Affiliation(s)
- Giovanni Tulipano
- Unit of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
| | - Simone Paghera
- Unit of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Cristina Missale
- Unit of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Andrea Giustina
- San Raffaele Vita- Salute University - Head, Division of Endocrinology, IRCCS San Raffaele Hospital, Segrate, Italy
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Abstract
BACKGROUND AND AIMS The novel coronavirus disease (COVID-19) pandemic and the resulting nationwide lockdowns have posed a major challenge to the management of pre-existing and newly diagnosed endocrine disorders. Herein, we have summarized the management approaches of common endocrine disorders amid the ongoing pandemic. METHODS We have performed an extensive literature search for articles in PubMed, EMBASE and Google Scholar databases till 25 May 2020, with the following keywords: "COVID-19", "diabetes mellitus", "thyroid disorders", "primary adrenal insufficiency", "Cushing's syndrome", "pituitary tumors", "vitamin D″", "osteoporosis", "primary hyperparathyroidism", "hypoparathyroidism", "management", "treatment" and "guidelines" with interposition of the Boolean operator "AND". RESULTS We have summarized the most feasible strategies for the management of diabetes mellitus, thyroid disorders, primary adrenal insufficiency (including congenital adrenal hyperplasia), Cushing's syndrome, pituitary tumors, osteoporosis, primary hyperparathyroidism and hypoparathyroidism amid the constraints laid down by the raging pandemic. In general, medical management should be encouraged and surgical interventions should be deferred whenever possible. Ongoing medications should be continued. Sick-day rules should be sincerely adhered to. Regular contact with physicians can be maintained through teleconsultations and virtual clinics. CONCLUSIONS Considering the burden of endocrine disorders in the general population, their management needs to be prioritized amid the ongoing COVID-19 pandemic.
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Affiliation(s)
- Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sanjay K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Wang Z, Guo X, Gao L, Deng K, Lian W, Bao X, Feng M, Duan L, Zhu H, Xing B. The Immune Profile of Pituitary Adenomas and a Novel Immune Classification for Predicting Immunotherapy Responsiveness. J Clin Endocrinol Metab 2020; 105:5870365. [PMID: 32652004 PMCID: PMC7413599 DOI: 10.1210/clinem/dgaa449] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/08/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT The tumor immune microenvironment is associated with clinical outcomes and immunotherapy responsiveness. OBJECTIVE To investigate the intratumoral immune profile of pituitary adenomas (PAs) and its clinical relevance and to explore a novel immune classification for predicting immunotherapy responsiveness. DESIGN, PATIENTS, AND METHODS The transcriptomic data from 259 PAs and 20 normal pituitaries were included for analysis. The ImmuCellAI algorithm was used to estimate the abundance of 24 types of tumor-infiltrating immune cells (TIICs) and the expression of immune checkpoint molecules (ICMs). RESULTS The distributions of TIICs differed between PAs and normal pituitaries and varied among PA subtypes. T cells dominated the immune microenvironment across all subtypes of PAs. The tumor size and patient age were correlated with the TIIC abundance, and the ubiquitin-specific protease 8 (USP8) mutation in corticotroph adenomas influenced the intratumoral TIIC distributions. Three immune clusters were identified across PAs based on the TIIC distributions. Each cluster of PAs showed unique features of ICM expression that were correlated with distinct pathways related to tumor development and progression. CTLA4/CD86 expression was upregulated in cluster 1, whereas programmed cell death protein 1/programmed cell death 1 ligand 2 (PD1/PD-L2) expression was upregulated in cluster 2. Clusters 1 and 2 exhibited a "hot" immune microenvironment and were predicted to exhibit higher immunotherapy responsiveness than cluster 3, which exhibited an overall "cold" immune microenvironment. CONCLUSIONS We summarized the immune profile of PAs and identified 3 novel immune clusters. These findings establish a foundation for further immune studies on PAs and provide new insights into immunotherapy strategies for PAs.
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Affiliation(s)
- Zihao Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- China Pituitary Disease Registry Center, Beijing, P. R. China
- China Pituitary Adenoma Specialist Council, Beijing, P. R. China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- China Pituitary Disease Registry Center, Beijing, P. R. China
- China Pituitary Adenoma Specialist Council, Beijing, P. R. China
| | - Lu Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- China Pituitary Disease Registry Center, Beijing, P. R. China
- China Pituitary Adenoma Specialist Council, Beijing, P. R. China
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- China Pituitary Disease Registry Center, Beijing, P. R. China
- China Pituitary Adenoma Specialist Council, Beijing, P. R. China
| | - Wei Lian
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- China Pituitary Disease Registry Center, Beijing, P. R. China
- China Pituitary Adenoma Specialist Council, Beijing, P. R. China
| | - Xinjie Bao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- China Pituitary Disease Registry Center, Beijing, P. R. China
- China Pituitary Adenoma Specialist Council, Beijing, P. R. China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- China Pituitary Disease Registry Center, Beijing, P. R. China
- China Pituitary Adenoma Specialist Council, Beijing, P. R. China
| | - Lian Duan
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- China Pituitary Disease Registry Center, Beijing, P. R. China
- China Pituitary Adenoma Specialist Council, Beijing, P. R. China
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- China Pituitary Disease Registry Center, Beijing, P. R. China
- China Pituitary Adenoma Specialist Council, Beijing, P. R. China
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
- China Pituitary Disease Registry Center, Beijing, P. R. China
- China Pituitary Adenoma Specialist Council, Beijing, P. R. China
- Correspondence and Reprint Requests: Bing Xing, Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing 100730, P. R. China. E-mail:
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Remón-Ruiz P, Venegas-Moreno E, Dios Fuentes E, Matias Kaen A, Cardenas Ruiz-Valdepeñas E, Martin-Schrader I, Roldán F, Fajardo E, Cano D, Soto-Moreno A. Our experience in prolactinomas larger than 60mm. ACTA ACUST UNITED AC 2020; 68:3-10. [PMID: 32861621 DOI: 10.1016/j.endinu.2020.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Giant prolactinomas (tumor size larger than 40mm) are a rare entity of benign nature. Prolactinomas larger than 60mm are usually underrepresented in published studies and their clinical presentation, outcomes and management might be different from smaller giant prolactinomas. PATIENTS AND METHODS We retrospective collected data from patients with prolactinomas larger than 60mm in maximum diameter and prolactin (PRL) serum levels higher than 21,200μIU/mL in our series of prolactinomas (283). Data were collected from January 2012 to December 2017. We included three patients with prolactinomas larger than 60mm. RESULTS At diagnosis, two patients presented neurological symptoms and one nasal protrusion. All patients received medical treatment with dopamine agonists. No surgical procedure was performed. Median prolactin levels at diagnosis was 108,180 [52,594-514,984]μIU/mL. Medical treatment achieved a marked reduction (>99%) in prolactin levels in all cases. Tumor size reduction (higher than 33%) was observed in all cases. In one patient cerebrospinal fluid (CSF) leak was observed after tumor shrinkage. CONCLUSIONS Dopamine agonists appear to be an effective and safe first-line treatment in prolactinomas larger than 60mm even in life-threatening situations. More studies with a higher number of patients are necessary to obtain enough data to make major recommendations.
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Affiliation(s)
- Pablo Remón-Ruiz
- Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Seville, Spain.
| | - Eva Venegas-Moreno
- Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Seville, Spain
| | - Elena Dios Fuentes
- Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Seville, Spain
| | - Ariel Matias Kaen
- Neurosurgery Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | | | | | - Florinda Roldán
- Unidad de Gestión de Radiodiagnóstico, Virgen del Rocio University Hospital, Spain
| | - Elena Fajardo
- Unidad de Gestión de Radiodiagnóstico, Virgen del Rocio University Hospital, Spain
| | - David Cano
- Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Seville, Spain
| | - Alfonso Soto-Moreno
- Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Seville, Spain
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Lizzul L, Lombardi G, Barbot M, Ceccato F, Gardiman MP, Regazzo D, Bellu L, Mazza E, Losa M, Scaroni C. Long-course temozolomide in aggressive pituitary adenoma: real-life experience in two tertiary care centers and review of the literature. Pituitary 2020; 23:359-366. [PMID: 32232709 DOI: 10.1007/s11102-020-01040-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Indexed: 12/20/2022]
Abstract
PURPOSE Aggressive pituitary adenomas (APAs) and pituitary carcinomas (PCs) are challenging for their invasive nature, resistance to treatment and recurrences. Temozolomide (TMZ) is used with benefit and well-tolerated toxicity profile in APAs and PCs. In most studies patients received ≤ 12 cycles but the best length of treatment is debated since other options after discontinuation are scarce and a second course is mainly unsuccessful. METHODS We report outcomes of 8 patients with APAs and PCs treated with TMZ for more than 12 continuous cycles with a literature review. Data were retrospectively collected from Padua and Milan University Hospitals. TMZ was used as a single agent (150-200 p.o. mg/m2 daily, 5/28 days) for 14 to 45 cycles. RESULTS Eight patients (7 M), 7 APAs and 1 PC. Previous treatments included neurosurgery and radiotherapy in all cases except two giant masses (ACTH-silent APA and prolactinoma). No patient had progression disease (PD) during long-term treatment nor toxicities. No one had complete response (CR) but four had partial response (PR). Four ACTH+ tumors maintained stable disease (SD) but the secretion pattern improved in all. After drug withdrawal, three had delayed PD (2 after 18 and one after 29 months, all ACTH+); two are still in SD. CONCLUSIONS TMZ may be useful and well-tolerated in APAs and PCs as a long-term therapy. PR appears within the first cycles with no escape throughout the treatment; most patients achieve SD. We suggest extended protocols particularly in responsive ACTH+ PAs and PCs, when further therapies may be unsuccessful.
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Affiliation(s)
- Laura Lizzul
- Endocrinology Unit, Department of Medicine (DIMED), Padua University Hospital, 35121, Padua, Italy
| | - Giuseppe Lombardi
- Neurooncology Unit, Venetian Oncologic Institute (IOV), 35121, Padua, Italy
| | - Mattia Barbot
- Endocrinology Unit, Department of Medicine (DIMED), Padua University Hospital, 35121, Padua, Italy
| | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine (DIMED), Padua University Hospital, 35121, Padua, Italy
| | - Marina Paola Gardiman
- Pathology Unit, Department of Medicine (DIMED), Padua University Hospital, 35121, Padua, Italy
| | - Daniela Regazzo
- Endocrinology Unit, Department of Medicine (DIMED), Padua University Hospital, 35121, Padua, Italy
| | - Luisa Bellu
- Neurooncology Unit, Venetian Oncologic Institute (IOV), 35121, Padua, Italy
| | - Elena Mazza
- Department of Oncology and Pathology Unit, San Raffaele University Hospital, 20132, Milan, Italy
| | - Marco Losa
- Pituitary Unit, Department of Neurosurgery, San Raffaele University Hospital, 20132, Milan, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine (DIMED), Padua University Hospital, 35121, Padua, Italy.
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Araujo-Castro M, Pascual-Corrales E, Martínez San Millan JS, Rebolleda G, Pian H, Ruz-Caracuel I, De Los Santos Granados G, Ley Urzaiz L, Escobar-Morreale HF, Rodríguez Berrocal V. Postoperative management of patients with pituitary tumors submitted to pituitary surgery. Experience of a Spanish Pituitary Tumor Center of Excellence. Endocrine 2020; 69:5-17. [PMID: 32170587 DOI: 10.1007/s12020-020-02247-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 12/10/2019] [Accepted: 02/26/2020] [Indexed: 12/13/2022]
Abstract
There is a lack of evidence on timing, frequency, and duration of postoperative endocrine, radiologic, and ophthalmologic assessments that should be performed after pituitary surgery (PS). However, it is known that careful optimization of treatment and follow-up strategies as well as a multidisciplinary approach may have a significant impact on long-term outcomes, improving surgical results, minimize complications and facilitate their correct treatment if occurring, and optimize the hormonal, ophthalmological, and radiological reassessment throughout the follow-up. Considering that there are no specific guidelines on the postoperative management of patients with pituitary tumors (PT), we present our protocol for the postoperative management of patients with PT. It has been elaborated by the multidisciplinary team of a Spanish Pituitary Tumor Center of Excellence (PTCE) that includes at least one neurosurgeon, ENT, neuroradiologist, neuro-ophthalmologist, endocrine pathologist and endocrinologist specialized in pituitary diseases. We elaborated this guideline with the aim of sharing our experience with other centers involved in the management of PT thereby facilitating the postoperative management of patients submitted to PS.
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Affiliation(s)
- M Araujo-Castro
- Neuroendocrinology Unit, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Hospital Universitario Ramón y Cajal, M-607, km. 9, 100, 28034, Madrid, Spain.
| | - E Pascual-Corrales
- Neuroendocrinology Unit, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J S Martínez San Millan
- Neuroradiology Unit, Department of Diagnostic Imaging, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - G Rebolleda
- Neuro-Ophthalmology Unit, Department of Ophthalmology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - H Pian
- Endocrinology Unit, Department of Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - I Ruz-Caracuel
- Endocrinology Unit, Department of Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - G De Los Santos Granados
- Universidad de Alcalá, Madrid, Spain
- Rinology Unit, Department of Otorhinolaryngology (ENT), Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Madrid, Spain
| | - L Ley Urzaiz
- Pituitary Surgery Unit, Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - H F Escobar-Morreale
- Neuroendocrinology Unit, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
- Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Madrid, Spain
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - V Rodríguez Berrocal
- Pituitary Surgery Unit, Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Abstract
Aggresssive pituitary tumors are defined as radiologically invasive, exhibiting a rapid growth and a poor response to the medical and surgical treatment options. The role of magnetic resonance imaging (MRI) is fundamental to assess tumor aggressiveness before surgical exploration. Distinction between cavernous sinus invasion and cavernous sinus compression is often challenging and cannot be solved always by using the Knosp criteria. Ideally, T2W images demonstrating the ruptured internal dural wall of cavernous sinus is the ultimate proof of cavernous sinus invasion. Subtle tumor volume increase in a short time can be shown when sequential MR images are rigorously replicable. A microcystic pattern observed on T2W images frequently reflects a potentially aggressive tumor as observed in silent corticotroph pituitary adenomas.
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Affiliation(s)
- J F Bonneville
- Department of Endocrinology and Medical Imaging CHU Sart Tilman, University of Liège, Liège, Belgium.
| | - J Potorac
- Department of Endocrinology CHU Sart Tilman, University of Liège, Liège, Belgium
| | - A Beckers
- Department of Endocrinology CHU Sart Tilman, University of Liège, Liège, Belgium
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Abstract
Pituitary tumors (PTs) are a heterogeneous group of lesions of the central nervous system that are usually benign. Most of them occur sporadically, but 5% can do so within family syndromes, usually at a young age. There are differences by sex, age, race, and genetic factors in the prevalence of different tumor cell types and clinical presentation. Functioning-PTs (FPTs) are usually diagnosed earlier than non-functioning PTs (NFPTs). However, this depends on the PT type. Headaches and visual disturbances are the most frequent mass-effect symptoms, but seizures or hydrocephalus may also occur. Pituitary apoplexy is another possible mode of presentation, and it requires special attention because of its potential severity. PTs in pregnancy, childhood, and old age present a series of clinical peculiarities that must be taken into account when evaluating these patients. Ectopic PTs (EPTs) are uncommon and share the same clinical-epidemiological data as eutopic PTs, but, depending on their location, other types of clinical manifestations may appear. Silent PTs are often detected as an incidentaloma or due to neurologic symptoms related to mass-effect. Aggressive PTs and pituitary carcinomas (PCs), which are very rare, are characterized by multiple local recurrences and metastases, respectively. This review addresses the epidemiology and clinical presentation of PTs, from the classical hormonal and mass-effect symptoms to the different rare presentations, such as pituitary apoplexy, hydrocephalus, or diabetes insipidus. Moreover, special situations of the presentation of PTs are discussed, namely, PTs in pregnancy, childhood, and the elderly, EPTs, silent and aggressive PTs, and PCs.
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Affiliation(s)
- Marta Araujo-Castro
- Neuroendocrinology Unit, Endocrinology Department, Ramón y Cajal University Hospital, Madrid, Spain.
| | | | - Eider Pascual-Corrales
- Neuroendocrinology Unit, Endocrinology Department, Ramón y Cajal University Hospital, Madrid, Spain
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Coopmans EC, Muhammad A, Daly AF, de Herder WW, van Kemenade FJ, Beckers A, de Haan M, van der Lely AJ, Korpershoek E, Neggers SJCMM. The role of AIP variants in pituitary adenomas and concomitant thyroid carcinomas in the Netherlands: a nationwide pathology registry (PALGA) study. Endocrine 2020; 68:640-649. [PMID: 32333269 PMCID: PMC7308253 DOI: 10.1007/s12020-020-02303-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/04/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Germline mutations in the aryl-hydrocarbon receptor interacting protein (AIP) have been identified often in the setting of familial isolated pituitary adenoma (FIPA). To date there is no strong evidence linking germline AIP mutations to other neoplasms apart from the pituitary. Our primary objective was to investigate the prevalence of AIP gene mutations and mutations in genes that have been associated with neuroendocrine tumors in series of tumors from patients presenting with both pituitary adenomas and differentiated thyroid carcinomas (DTCs). METHODS Pathology samples were retrieved from all pituitary adenomas in patients with concomitant DTCs, including one with a known germline AIP variant. Subsequently, two additional patients with known germline AIP variants were included, of which one presented only with a follicular thyroid carcinoma (FTC). RESULTS In total, 17 patients (14 DTCs and 15 pituitary adenomas) were investigated by targeted next generation sequencing (NGS). The pituitary tumor samples revealed no mutations, while among the thyroid tumor samples BRAF (6/14, 42.9%) was the most frequently mutated gene, followed by NRAS (3/11, 27.3%). In one AIP-mutated FIPA kindred, the AIP-variant c.853C>T; p.Q285* was confirmed in the FTC specimen, including evidence of loss of heterozygosity (LOH) at the AIP locus in the tumor DNA. CONCLUSION Although most observed variants in pituitary adenomas and DTCs were similar to those of sporadic DTCs, we confirmed in one AIP mutation-positive case the AIP-variant and LOH at this locus in an FTC specimen, which raises the potential role of the AIP mutation as a rare initiating event.
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Affiliation(s)
- E C Coopmans
- Department of Medicine, Endocrinology section, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - A Muhammad
- Department of Medicine, Endocrinology section, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A F Daly
- Department of Endocrinology, Centre Hospitalier Universitaire de Liege, University of Liege, 4000, Liege, Belgium
| | - W W de Herder
- Department of Medicine, Endocrinology section, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F J van Kemenade
- Department of Pathology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Beckers
- Department of Endocrinology, Centre Hospitalier Universitaire de Liege, University of Liege, 4000, Liege, Belgium
| | - M de Haan
- Department of Pathology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A J van der Lely
- Department of Medicine, Endocrinology section, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E Korpershoek
- Department of Pathology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S J C M M Neggers
- Department of Medicine, Endocrinology section, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands
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Barzaghi LR, Losa M, Capitanio JF, Albano L, Weber G, Mortini P. Pediatric Pituitary Adenomas: Early and Long-Term Surgical Outcome in a Series of 85 Consecutive Patients. Neurosurgery 2020; 85:65-74. [PMID: 29790934 DOI: 10.1093/neuros/nyy204] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 04/18/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Young age has been reported as a negative prognostic factor for pituitary adenomas (PAs). They are very uncommon in children and adolescents; therefore, surgical outcomes are poorly described. OBJECTIVE To report results of microsurgical transsphenoidal approach (MTSA) in pediatric PAs. METHODS The study retrospectively analyzed 3040 PAs treated in our institute, according to the adenoma subtype and then divided into pediatric (≤18 yr) and adult groups (>18 yr). The average follow-up after surgery was 58 mo (n = 2906). RESULTS In the pediatric group, the majority of adenomas were hormone-secreting (89.5%) with a female sex prevalence (78%) in prolactinomas and nonfunctioning pituitary adenomas (NFPAs); the maximum diameter of growth hormone (GH)-secreting adenomas was greater (28.1 ± 4.1 mm) than in adults (18 ± 0.3 mm, P = .002). Surgical remission rate at 6 mo was similar in both groups for all adenoma subtypes: 72.1% and 76% in pediatric and adult Cushing's disease, 69.3% and 59.3% in prolactinomas, 55.6% and 61% in gigantism or acromegaly, 55.6% and 61.5% in NFPAs. Recurrences after remission occurred more frequently in pediatric GH-secreting adenomas compared to adults (40.0% vs 5.3%, P = .028) despite similar follow-up (38 ± 17 and 48.1 ± 2.2 mo, P = .7). Mortality was zero in the pediatric and 0.2% in the adult group (P = .7); major morbidity was 2.4% and 2.2%, respectively (P = .8). CONCLUSION MTSA was safe and effective in children and adolescents as in adults, with the only exception of higher recurrence rate in pediatric GH-secreting adenomas. No complications related to young age appeared.
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Affiliation(s)
- Lina Raffaella Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute University, Scientific Institute San Raffaele, Milan, Italy
| | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute University, Scientific Institute San Raffaele, Milan, Italy
| | - Jody Filippo Capitanio
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute University, Scientific Institute San Raffaele, Milan, Italy
| | - Luigi Albano
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute University, Scientific Institute San Raffaele, Milan, Italy
| | - Giovanna Weber
- Department of Pediatrics, Vita-Salute University, Scientific Institute San Raffaele, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute University, Scientific Institute San Raffaele, Milan, Italy
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