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Sample records for pituitary adenomas experience

  1. Pituitary Adenoma Segmentation

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    Egger, Jan; Kuhnt, Daniela; Freisleben, Bernd; Nimsky, Christopher

    2011-01-01

    Sellar tumors are approximately 10-15% among all intracranial neoplasms. The most common sellar lesion is the pituitary adenoma. Manual segmentation is a time-consuming process that can be shortened by using adequate algorithms. In this contribution, we present a segmentation method for pituitary adenoma. The method is based on an algorithm we developed recently in previous work where the novel segmentation scheme was successfully used for segmentation of glioblastoma multiforme and provided an average Dice Similarity Coefficient (DSC) of 77%. This scheme is used for automatic adenoma segmentation. In our experimental evaluation, neurosurgeons with strong experiences in the treatment of pituitary adenoma performed manual slice-by-slice segmentation of 10 magnetic resonance imaging (MRI) cases. Afterwards, the segmentations were compared with the segmentation results of the proposed method via the DSC. The average DSC for all data sets was 77.49% +/- 4.52%. Compared with a manual segmentation that took, on the...

  2. Pituitary adenoma: a radiotherapeutic perspective.

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    Platta, Christopher S; Mackay, Christopher; Welsh, James S

    2010-08-01

    Pituitary adenomas comprise approximately 10% to 20% of all central nervous system neoplasms whereas autopsy series have suggested that the incidence of pituitary adenoma in the general population may approach 25%. Several treatment modalities are used in the treatment of pituitary adenomas, including observation, surgery, medical intervention, and radiotherapy. The treatment modality employed depends greatly on the type of pituitary adenoma and presenting symptoms. This review will discuss the biology of pituitary adenomas and the current management principles for the treatment of prolactinomas, Cushing disease, acromegaly, and nonsecretory adenomas, with an emphasis on the published radiotherapeutic literature.

  3. Familial pituitary adenomas.

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    Vandeva, S; Vasilev, V; Vroonen, L; Naves, L; Jaffrain-Rea, M-L; Daly, A F; Zacharieva, S; Beckers, A

    2010-12-01

    Pituitary adenomas are benign intracranial neoplasms that present a major clinical concern because of hormonal overproduction or compression symptoms of adjacent structures. Most arise in a sporadic setting with a small percentage developing as a part of familial syndromes such as multiple endocrine neoplasia type 1 (MEN1), Carney complex (CNC), and the recently described familial isolated pituitary adenomas (FIPA) and MEN-4. While the genetic alterations responsible for the formation of sporadic adenomas remain largely unknown, considerable advances have been made in defining culprit genes in these familial syndromes. Mutations in MEN1 and PRKAR1A genes are found in the majority of MEN1 and CNC patients, respectively. About 15% of FIPA kindreds present with mutations of the aryl hydrocarbon receptor-interacting protein (AIP) gene. Mutations in the CDKN1B gene, encoding p27(Kip)¹ were identified in MEN4 cases. Familial tumours appear to differ from their sporadic counterparts not only in genetic basis but also in clinical characteristics. Evidence suggests that, especially in MEN1 and FIPA, they are more aggressive and affect patients at younger age, therefore justifying the importance of early diagnosis. In this review, we summarize the genetic and clinical characteristics of these familial pituitary adenomas.

  4. Transcranial surgery for pituitary adenomas.

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    Youssef, A Samy; Agazzi, Siviero; van Loveren, Harry R

    2005-07-01

    Although the transsphenoidal approach is the preferred approach to the vast majority of pituitary tumors with or without suprasellar extension, the transcranial approach remains a vital part of the neurosurgical armamentarium for 1 to 4% of these tumors. The transcranial approach is effective when resection becomes necessary for a portion of a pituitary macroadenoma that is judged to be inaccessible from the transsphenoidal route because of isolation by a narrow waist at the diaphragma sellae, containment within the cavernous sinus lateral to the carotid artery, projection anteriorly onto the planum sphenoidale, or projection laterally into the middle fossa. The application of a transcranial approach in these circumstances may still be mitigated by response to prolactin inhibition of prolactinomas, the frequent lack of necessity to remove asymptomatic nonsecretory adenomas from the cavernous sinus, and the lack of evidence that sustained chemical cures can be reliably achieved by removal of secretory adenomas (adrenocorticotropic hormone, growth hormone) from the cavernous sinus. Cranial base surgical techniques have refined the surgical approach to pituitary adenomas but have had less effect on actual surgical indications than anticipated. Because application of the transcranial approach to pituitary adenomas is and should be rare in clinical practice, it is useful to standardize the technique to a default mode with which the surgical team is most experienced and, therefore, most comfortable. Our default mode for transcranial pituitary surgery is the frontotemporal-orbitozygomatic approach.

  5. MASEP gamma knife radiosurgery for secretory pituitary adenomas: experience in 347 consecutive cases

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    Yuan Shubin

    2009-03-01

    Full Text Available Abstract Background Secretory pituitary adenomas are very common brain tumors. Historically, the treatment armamentarium for secretory pituitary adenomas included neurosurgery, medical management, and fractionated radiotherapy. In recent years, MASEP gamma knife radiosurgery (MASEP GKRS has emerged as an important treatment modality in the management of secretory pituitary adenomas. The goal of this research is to define accurately the efficacy, safety, complications, and role of MASEP GKRS for treatment of secretory pituitary adenomas. Methods Between 1997 and 2007 a total of 347 patients with secretory pituitary adenomas treated with MASEP GKRS and with at least 60 months of follow-up data were identified. In 47 of these patients some form of prior treatment such as transsphenoidal resection, or craniotomy and resection had been conducted. The others were deemed ineligible for microsurgery because of body health or private choice, and MASEP GKRS served as the primary treatment modality. Endocrinological, ophthalmological, and neuroradiological responses were evaluated. Results MASEP GKRS was tolerated well in these patients under the follow-up period ranged from 60 to 90 months; acute radioreaction was rare and 17 patients had transient headaches with no clinical significance. Late radioreaction was noted in 1 patient and consisted of consistent headache. Of the 68 patients with adrenocorticotropic hormone-secreting(ACTH adenomas, 89.7% showed tumor volume decrease or remain unchanged and 27.9% experienced normalization of hormone level. Of the 176 patients with prolactinomas, 23.3% had normalization of hormone level and 90.3% showed tumor volume decrease or remain unchanged. Of the 103 patients with growth hormone-secreting(GH adenomas, 95.1% experienced tumor volume decrease or remain unchanged and 36.9% showed normalization of hormone level. Conclusion MASEP GKRS is safe and effective in treating secretory pituitary adenomas. None of the

  6. A clinicopathological and immunohistochemical study of clinically non-functioning pituitary adenomas: A single institutional experience

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    Rishi Arvind

    2010-01-01

    Full Text Available Background : Non-functioning pituitary adenomas (NFPA are characterized by the lack of clinical syndrome as compared to functioning adenomas (FA but not all functioning adenomas have clinical effects. Their exact incidence varies in different series. Materials and Methods : This study was undertaken to analyze the hormonal profile of NFPA at the immunohistochemical level in the Indian population and to see if any differences exist from the earlier studies. Their biological aggressiveness was also studied by MIB-1 labeling index (MIB-! LI and Epidermal Growth Factor Receptor (EGFR expression. These parameters along with their clinical behavior were correlated with radiological features of invasiveness and size. Results : Of the 151 pituitary adenomas diagnosed during a period of one and half years, 77 (51% were NFPA with a male predominance. There was increase in the incidence of NFPA with increase in age. Immunopositivity for various hormones was observed in 64 (83% cases, either singly or in various combinations. On the basis of immunohistochemistry, NFPA were classified into three subtypes; gonadotroph adenomas, silent adenomas, and null cell adenomas. Gonadotroph adenomas were the commonest subtype. In general, NFPA showed low MIB-1LI but invasive NFPA had LI on the higher side, however, this difference was not significant. We observed EGFR positivity in two cases only; therefore the tumorigenesis mechanism may be different in NFPA. Conclusion : Although non-functional at the clinical level immunohistochemistry showed reactivity for various hormones. If a battery of immunostains including seven hormones is studied, a significant number of cases are shifted to the functional group.

  7. The pathophysiology of pituitary adenomas.

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    Dworakowska, Dorota; Grossman, Ashley B

    2009-10-01

    The pathogenesis of tumour formation in the anterior pituitary has been intensively studied, but the causative mechanisms involved in pituitary cell transformation and tumourigenesis remain elusive. Most pituitary tumours are sporadic, but some arise as a component of genetic syndromes such as the McCune-Albright syndrome, multiple endocrine neoplasia type 1, Carney complex and, the most recently described, a MEN1-like phenotype (MEN4) and pituitary adenoma predisposition syndromes. Some specific genes have been identified that predispose to pituitary neoplasia (GNAS, MEN1, PRKAR1A, CDKN1B and AIP), but these are rarely involved in the pathogenesis of sporadic tumours. Mutations of tumour suppressor genes or oncogenes, as seen in more common cancers, do not seem to play an important role in the great majority of pituitary adenomas. The pituitary tumour transforming gene (PTTG; securin) was the first transforming gene found to be highly expressed in pituitary tumour cells, and seems to play an important role in the process of oncogenesis. Many tumour suppressor genes, especially those involved in the regulation of the cell cycle, are under-expressed, most often by epigenetic modulation - usually promoter hypermethylation - but the regulator of these co-ordinated series of methylations is also unclear. Cell signalling abnormalities have been identified in pituitary tumours, but their genetic basis is unknown. Both Raf/MEK/ERK and PI3K/Akt/mTOR pathways are over-expressed and/or over-activated in pituitary tumours: these pathways share a common root, including initial activation related to the tyrosine kinase receptor, and we speculate that a change to these receptors or their relationship to membrane matrix-related proteins may be an early event in pituitary tumourigenesis.

  8. Double pituitary adenomas: six surgical cases.

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    Sano, T; Horiguchi, H; Xu, B; Li, C; Hino, A; Sakaki, M; Kannuki, S; Yamada, S

    1999-05-01

    While double pituitary adenomas have been found in approximately 1% of autopsy pituitaries, those in surgically resected material have been only rarely reported. We report herein 6 cases of double pituitary adenomas, which consisted of two histologically and/or immunohistochemically different areas among approximately 450 surgical specimens. Five out of 6 patients were men and the age was ranged between 18 and 61 years old. All these 6 patients presented acromegaly or acrogigantism and hyperprolactinemia was noted in 3 patients. In 2 patients (cases 1 and 2) the two adenomas belonged to different adenoma groups (GH-PRL-TSH group and FSH/LH group), while in the remaining 4 patients (cases 3-6) the two adenomas belonged to the same group (GH-PRL-TSH group). Thus, in all patients at least one of the two adenomas was GH-producing adenoma. Reasons for a high incidence of GH-producing adenomas in surgically resected double pituitary adenomas may include the presence of a variety of histologic subtypes among GH-producing adenomas and the advantage of cytokeratin immunostaining to distinguish these subtypes. In regard to pathogenesis of double pituitary adenomas, adenomas in cases 1 and 2 may be of multicentric occurrence, while those in cases 3-6 may occur through different clonal proliferation within originally one adenoma, resulting in diverse phenotypic expressions. Since there were patients with familial MEN 1 (case 2) and familial pituitary adenoma unrelated MEN 1 (case 3), genetic background should be also considered. Double pituitary adenomas in surgically resected material may not be so infrequent. Further molecular analysis will provide new insights into understanding the pathogenesis of pituitary adenomas and their mechanisms of multidirectional phenotypic diffrentiation.

  9. [Old phenotype and new genotypes. Pituitary adenomas].

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    Gérard, C; Jedidi, H; Petrossians, P; Krzesinski, F; Daly, A; Beckers, A

    2015-11-01

    Gigantism and acromegaly, usually caused by a pituitary adenoma linked inappropriate secretion of growth hormone (GH), are generally considered as very rare diseases, even if, according to some authors, their cumulative prevalence is about 1/5000. Starting from the historical case of a giant from Liège we shall describe the different types of GH pituitary adenomas and their pathophysiology. We shall particularly discuss rare forms of inherited GH secreting pituitary adenomas like the FIPA (familial inherited isolated pituitary adenomas) and the X-LAG (X linked acrogigantism), both described for the first time in Liège, in 2000 and 2014, respectively.

  10. The endonasal microscopic approach for pituitary adenomas and other parasellar tumors: a 10-year experience.

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    Fatemi, Nasrin; Dusick, Joshua R; de Paiva Neto, Manoel A; Kelly, Daniel F

    2008-10-01

    THE DIRECT ENDONASAL transsphenoidal approach to the sella with the operating microscope was initially described more than 20 years ago. Herein, we describe the technique, its evolution, and lessons learned over a 10-year period for treating pituitary adenomas and other parasellar pathology. From July 1998 to January 2008, 812 patients underwent a total of 881 operations for a pituitary adenoma (n = 605), Rathke's cleft cyst (n = 59), craniopharyngioma (n = 26), parasellar meningioma (n = 23), chordoma (n = 18), or other pathological condition (n = 81). Of these, 118 operations (13%) included an extended approach to the suprasellar, infrasellar/clival, or cavernous sinus regions. Endoscopic assistance was used in 163 cases (19%) overall, including 36% of the last 200 cases in the series and 18 (72%) of the last 25 extended endonasal cases. Surgical complications included 19 postoperative cerebrospinal fluid leaks (2%), 6 postoperative hematomas (0.7%), 4 carotid artery injuries (0.4%), 4 new permanent neurological deficits (0.4%), 3 cases of bacterial meningitis (0.3%), and 2 deaths (0.2%). The overall complication rate was higher in the first 500 cases in the series and in extended approach cases. Major technical modifications over the 10-year period included increased use of shorter (60-70 mm) endonasal speculums for greater instrument maneuverability and visualization, the micro-Doppler probe for cavernous carotid artery localization, endoscopy for more panoramic visualization, and a graded cerebrospinal fluid leak repair protocol. These changes appear to have collectively and incrementally made the approach safer and more effective. In summary, the endonasal approach provides a minimally invasive route for removal of pituitary adenomas and other parasellar tumors.

  11. Magnetic resonance imaging of pituitary adenomas

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    Bonneville, Jean-Francois; Bonneville, Fabrice; Cattin, Francoise [University Hospital, Department of Neuroradiology, Besancon (France)

    2005-03-01

    Today, MR is the only method needed for the morphological investigation of endocrine-active pituitary adenomas. In acromegaly and Cushing's syndrome, the therapeutic attitude is directly dictated by MR data. We present the MR aspect of pituitary adenomas according to size, sex, age, endocrine activity and a few particular conditions such as hemorrhagic pituitary adenomas, pituitary adenomas during pregnancy, cavernous sinus invasion and postsurgical changes. When an intrasellar mass extending out of the sella turcica is detected, the goal of the MR examination is to indicate precisely the origin of the tumor, its extension in relation to the various surrounding structures, its structure and its enhancement in order to help in the differential diagnosis. Demonstration of very small pituitary adenomas remains a challenge. When SE T1- and Turbo SE T2-weighted sequences are non-diagnostic, enhanced imaging becomes mandatory; half-dose gadolinium injection, delayed sequence, dynamic imaging can be of some help. (orig.)

  12. MRI of pituitary adenomas in acromegaly

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    Marro, B. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Zouaoui, A. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Sahel, M. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Crozat, N. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Gerber, S. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Sourour, N. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Sag, K. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Marsault, C. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France)

    1997-06-01

    Adenomas causing acromegaly represent at least a quarter of pituitary adenomas. We studied 12 patients presenting with active acromegaly due to a pituitary adenoma with a 1.5 T superconductive MRI unit. All had T1-weighted sagittal and coronal sections before and after Gd-DTPA; six had coronal T2-weighted images. Surgical correlation was obtained in seven patients. Histologically, there were eight growth hormone (GH)-secreting and three mixed [GH and prolactin (PRL) secreting] adenomas, and one secreting GH, PRL and follicle-stimulating hormone. Macroadenomas (10) were more frequent than microadenomas (2). No correlation was found between serum GH and tumour size. There were nine adenomas in the lateral part of the pituitary gland; seven showed lateral or infrasellar invasion. Homogeneous, isointense signal on T1- and T2-weighted images was observed in six cases. Heterogeneous adenomas had cystic or necrotic components. (orig.). With 5 figs., 3 tabs.

  13. Pituitary prolactin adenoma with Toxoplasma gondii infection

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    张晓晖; 李青; 程虹; 阎庆国; 黄高昇

    2003-01-01

    Objective: To report two recent cases of pituitary adenoma associated with Toxoplasma gondii (T.Gondii) infection.Methods: Histological changes were observed in H & E and PAS staining sections microscopically.Immunohistochemistry was performed to classify the pituitary tumors and to confirm the diagnosis of T.gondii.Results: The cases were 43- and 19-year-old females, in which the latter one was a recurring case, and radiology examination showed that tumors existed in sellar region.Microscopically, the tumors consisted of small homogenous polygonal or round cells with abundant eosinophilic granular cytoplasm.Immunohistochemistry revealed they were prolactin-producing adenomas.Interestingly, we found toxoplasma infection in the tumor tissues, being confirmed by T.gondii sepicific antibody immunohistochemistry.Conclusion: The association of pituitary adenoma with toxoplasma raises the possibility that T.gondii may be involved in the development of certain cases of pituitary adenoma.

  14. MicroRNAs in Human Pituitary Adenomas

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    Xu-Hui Li

    2014-01-01

    Full Text Available MicroRNAs (miRNAs are a class of recently identified noncoding RNAs that regulate gene expression at posttranscriptional level. Due to the large number of genes regulated by miRNAs, miRNAs play important roles in many cellular processes. Emerging evidence indicates that miRNAs are dysregulated in pituitary adenomas, a class of intracranial neoplasms which account for 10–15% of diagnosed brain tumors. Deregulated miRNAs and their targets contribute to pituitary adenomas progression and are associated with cell cycle control, apoptosis, invasion, and pharmacological treatment of pituitary adenomas. To provide an overview of miRNAs dysregulation and functions of these miRNAs in pituitary adenoma progression, we summarize the deregulated miRNAs and their targets to shed more light on their potential as therapeutic targets and novel biomarkers.

  15. Light bodies in human pituitary adenomas

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    Holck, S; Wewer, U M; Albrechtsen, R

    1987-01-01

    Light bodies are large cytoplasmic granules originally described in the gonadotrophic cells of the rat pituitary gland. In order to determine whether similar bodies occur in the human anterior pituitary gland, 89 pituitary adenomas and periadenomatous tissue from 20 cases were examined by transmi......Light bodies are large cytoplasmic granules originally described in the gonadotrophic cells of the rat pituitary gland. In order to determine whether similar bodies occur in the human anterior pituitary gland, 89 pituitary adenomas and periadenomatous tissue from 20 cases were examined...... by transmission electron microscopy. Double membrane bound bodies with filamentous internal structure identical to rodent light bodies were identified in 10 hormone-producing adenomas: 5 PRL, 1 PRL-GH, 2 GH, and 2 ACTH-producing tumours. No light bodies were found in the remaining 79 tumours nor in the pituitary...... cells in periadenomatous tissue from 20 cases. These results show that some human pituitary adenomas may contain light bodies identical to those seen in gonadotrophs of rat pituitary....

  16. Angioscan exploration of morphology of pituitary adenoma

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    Tabarin, A.; David, J.P.; Drouillard, J. and others

    1987-01-01

    Considerable progress has been made in the morphologic study of pituitary due to the availability of angioscan programs. An exceptional case is presented of a persistent intrasellar trigeminal artery associated with prolactinoma. Based on technological progress in CT scan imaging the place of angiographic explorations in the investigation of pituitary adenoma is reconsidered.

  17. ENDOSCOPIC ENDONASAL TRANS-SPHENOIDAL SURGERY: OUR EXPERIENCE OF 40 PITUITARY ADENOMAS TREATED AT A TERTIARY CENTRE

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    Pankaj

    2015-12-01

    Full Text Available Introduction of Endoscope has revolutionized the surgical management of Pituitary tumors. Endoscopic endonasal approach has now become the most acceptable and routinely done procedure. In our tertiary center, we have analysed the data of 40 patients, who underwent endoscopic endonasal surgery over a period of one year. Clinical parameters, tumor excision, endocrinological status, complication rates were retrospectively analysed. One month follow up with repeat MRI and hormonal status was compared with pre-operative findings. There were 15 functioning and 25 non-functioning pituitary adenomas. There were 6 prolactinomas, 4 acromegaly, 4 Cushing and 1 FSH secreting pituitary adenoma. 25 were non-functioning adenomas. There was one microadenoma with Cushing syndrome. Subtotal excision was done in 76% of non-functioning and 66% of functioning adenomas. The remission rates were 80% in non-functional and almost 75% in functional pituitary adenoma. In our series, endoscopic approach proved to be less invasive, excellent tumors removal rate and better post-operative results. The complications were also less and comparable to other conventional methods. But it has steep learning curve and needs technical skills.

  18. Growth hormone receptor expression and function in pituitary adenomas

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    Clausen, Lene R; Kristiansen, Mikkel T; Rasmussen, Lars M

    2004-01-01

    OBJECTIVE AND DESIGN: Hypopituitarism, in particular GH deficiency, is prevalent in patients with clinically nonfunctioning pituitary adenomas (NFPAs) both before and after surgery. The factors regulating the growth of pituitary adenomas in general and residual tumour tissue in particular...

  19. Radiotherapy for pituitary adenomas: an endocrinologist`s perspective

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    O`Halloran, D.J.; Shalet, S.M. [Christie Hospital and Holt Radium Inst., Manchester (United Kingdom)

    1996-10-01

    A brief review is given of the clinical management of patients with pituitary adenomas such as prolactinomas, adenomasin acromegoly and Leushin`s disease, and non-functioning pituitary adenomas. In particular the complications of radiotherapy are explored. (UK).

  20. Radiosurgery for pituitary adenomas; Radiocirurgia nos adenomas hipofisarios

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    Castro, Douglas Guedes de; Salvajoli, Joao Victor; Canteras, Miguel Montes; Cecilio, Soraya A. Jorge [Instituto de Radiocirurgia Neurologica, Sao Paulo, SP (Brazil)]. E-mail: dougguedes@uol.com.br

    2006-12-15

    Pituitary adenomas represent nearly 15% of all intracranial tumors. Multimodal treatment includes microsurgery, medical management and radiotherapy. Microsurgery is the primary recommendation for nonfunctioning and most of functioning adenomas, except for prolactinomas that are usually managed with dopamine agonist drugs. However, about 30% of patients require additional treatment after microsurgery for recurrent or residual tumors. In these cases, fractionated radiation therapy has been the traditional treatment. More recently, radiosurgery has been established as a treatment option. Radiosurgery allows the delivery of prescribed dose with high precision strictly to the target and spares the surrounding tissues. Therefore, the risks of hypopituitarism, visual damage and vasculopathy are significantly lower. Furthermore, the latency of the radiation response after radiosurgery is substantially shorter than that of fractionated radiotherapy. The goal of this review is to define the efficacy, safety and role of radiosurgery for treatment of pituitary adenomas and to present the preliminary results of our institution. (author)

  1. Diagnostic criteria in invasive pituitary adenomas

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    Moldovan Ioana-Maria

    2016-09-01

    Full Text Available Pituitary adenomas are benign pituitary primary tumors, the most frequent type of tumor in the pituitary fossa. An important part, around 1/3 of the pituitary adenomas manifests an aggressive behavior, growing faster and invading into parasellar areas (cavernous sinus, neural tissues and bones. Objectives: the first aim of this paper is to review the last findings about invasiveness diagnostic criteria, imagistic and biomarkers, which can be used in the classification of pituitary tumors and also to predict the probability of invasiveness, tumor recurrence and suspicion of malignancy. The second aim is to highlight the morphological and clinic types of invasive pituitary adenomas. Materials and methods: we performed a systematic review and analysis of the published articles, searching PubMed between January 1985 and December 2015. There were selected articles published in English, reviews and abstracts. During the advanced search type in PubMed, combinations of the following keywords were used: “pituitary adenoma”, “invasive”, “aggressive”, “biomarkers”, “classification”, “histological subtypes”, ‘”immunohistochemical markers”. Results: 215 articles were selected, regarding diagnostic, prognostic and therapeutic aspects. There were some histological subtypes of pituitary adenomas known as having an aggressive clinical behavior. Several biomarkers were identified as being associated with the invasive feature: proliferation markers (Ki-67 index, number of mitoses, p53 & p27 expression, microvascularization density, telomerase, topoisomerase 2 Alpha, matrix metalloproteinases, protein kinase C, cyclooxygenase-2, E-cadherin, transcription Factors, genetic alterations (PTTG gene, Galectin-3 protein/ LGALS3 gene, apoptosis markers. Based on their invasion and proliferation characteristics, pituitary tumors are proposed to be classified into five grades (1a, 1b, 2a, 2b, 3, the grade 2b tumor with high risk of recurrence

  2. HYPONATREMIA AFTER TRANSSPHENIODAL SURGERY OF PITUITARY ADENOMA

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    陶蔚; 任祖渊; 苏长保; 王任直; 杨义; 马文斌

    2003-01-01

    Objective. To clarify the frequency, presentation, associated factors, treatment and outcome of hy-ponatremia after transsphenoidal surgery of pituitary adenomas.Methods. Retrospectively reviewed the database of 183 patients who underwent transsphenoidal surgeryof pituitary adenomas between January 1999 and June 2000 in our department.Result.s. 38.8% (71/183) had postoperative hyponatremia. Among them, 59.2% (42/71) appeared onthe 4th to 7th day postoperatively. 59.2% (42/71) presented with nausea, vomiting, headache, dizzi-ness, confusion and weakness. Hyponatremia was related to age, tumor size and adenoma type, but notrelated to sex and degree of resection. Treatment consisted of salt replacement and mild fluid restrictionin 4 patients and salt and fluid replacement in 67 patients. Hyponatremia resolved within 16 days in allthe patients.Conclusions. Hyponatremia often appeared about 7 days after transsphenoidal surgery of pituitary ade-nomas, especially in elderly and patients with macroadenomas and huge pituitary adenomas. The principleof treatment was salt and fluid replacement.

  3. Shift of the pituitary stalk in intrasellar pituitary adenomas

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    Ito, Jusuke; Tokiguchi, Susumu; Nakamori, Akitoshi (Niigata Univ. (Japan). School of Medicine); Watanabe, Akira; Yokoyama, Motoharu

    1982-08-01

    Fifty-one patients from a group of 344 patients undergoing the evaluation of intrasellar or parasellar tumors were diagnosed on CT as having an intrasellar pituitary adenoma. Axial transverse sections were performed at -10/sup 0/ to Reid's basal line, using 1.5-mm-thick slices and sagittal and coronal reformation. Of these 51 patients, 17 showed a shift of the pituitary stalk. The area where a tumor was thought to be located within the sella turcica on preoperative CT became defective on CT after transsphenoidal surgery in all cases. Histological verification was obtained in all cases. Also, the shift of the pituitary stalk was normalized or markedly improved after surgery in all cases. In functioning tumors, all cases except two showed an endocrinologically normal state or a marked improvement after transsphenoidal surgery. On the basis of the above-mentioned facts, it was concluded that the shift of the pituitary stalk in intrasellar pituitary adenomas indicated the evidence of a mass and its location in the sella turcica. However, a shift of the pituitary stalk was also observed under other conditions, such as empty sella and tuberculum sellae meningioma, and so it is not a pathognomonic finding in intrasellar pituitary adenomas.

  4. Temozolomide in aggressive pituitary adenomas and carcinomas

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    Leon D. Ortiz; Luis V. Syro; Scheithauer, Bernd W.; Fabio Rotondo; Humberto Uribe; Camilo E Fadul; Eva Horvath; Kalman Kovacs

    2012-01-01

    Temozolomide is an alkylating agent used in the treatment of gliomas and, more recently, aggressive pituitary adenomas and carcinomas. Temozolomide methylates DNA and, thereby, has antitumor effects. O 6-methylguanine-DNA methyltransferase, a DNA repair enzyme, removes the alkylating adducts that are induced by temozolomide, thereby counteracting its effects. A Medline search for all of the available publications regarding the use of temozolomide for the treatment of pituitary tumors was perf...

  5. Sellar lesion: Not always a pituitary adenoma

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    Rao Shalinee

    2008-04-01

    Full Text Available Inflammatory lesions of the hypophysis account for 0.5% of all symptomatic diseases of the pituitary, which include lymphocytic hypophysitis, granulomatous hypophysitis with or without specific etiology and pituitary abscess. Sellar tuberculoma is a rare type of granulomatous hypophysitis. We document a case of a postmenopausal lady who presented with galactorrhea, headache and blurring of vision. Based on preliminary investigations, a clinical diagnosis of pituitary adenoma was made and the pituitary gland was surgically excised. Histopathological examination showed caseating granulomas, along with normal areas of preserved pituitary gland and a final diagnosis of tuberculous hypophysitis was made. This case is being documented due to the extremely rare involvement of the pituitary gland by granulomatous lesions such as tuberculosis and to emphasize the role of intraoperative consultation to obviate the need for radical surgery in such lesions.

  6. Temozolomide in aggressive pituitary adenomas and carcinomas

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    Leon D. Ortiz

    2012-01-01

    Full Text Available Temozolomide is an alkylating agent used in the treatment of gliomas and, more recently, aggressive pituitary adenomas and carcinomas. Temozolomide methylates DNA and, thereby, has antitumor effects. O6-methylguanine-DNA methyltransferase, a DNA repair enzyme, removes the alkylating adducts that are induced by temozolomide, thereby counteracting its effects. A Medline search for all of the available publications regarding the use of temozolomide for the treatment of pituitary tumors was performed. To date, 46 cases of adenohypophysial tumors that were treated with temozolomide, including 30 adenomas and 16 carcinomas, have been reported. Eighteen of the 30 (60% adenomas and 11 of the 16 (69% carcinomas responded favorably to treatment. One patient with multiple endocrine neoplasia type 1 and an aggressive prolactin-producing adenoma was also treated and demonstrated a good response. No significant complications have been attributed to temozolomide therapy. Thus, temozolomide is an effective treatment for the majority of aggressive adenomas and carcinomas. Evidence indicates that there is an inverse correlation between levels of O6-methylguanine-DNA methyltransferase immunoexpression and therapeutic response. Alternatively, high-level O6-methylguanine-DNA methyltransferase immunoexpression correlates with an unfavorable response. Here, we review the use of temozolomide for treating pituitary neoplasms.

  7. Pathobiology and oncogenesis of pituitary corticotroph adenomas in dogs

    NARCIS (Netherlands)

    Hanson, J.M.

    2007-01-01

    Pituitary-dependent hyperadrenocorticism (PDH) or Cushing's disease is a common endocrinopathy in the elderly dog caused by a pituitary adrenocorticotrophic hormone (ACTH) producing tumor (corticotroph adenoma) of unknown pathogenesis. Surgical removal of the pituitary tumor is applied as routine

  8. MRI of pituitary adenomas following treatment

    Energy Technology Data Exchange (ETDEWEB)

    Gouliamos, A. [Dept. of Radiology, CT and MRI Section, Areteion Hospital, Univ. of Athens (Greece); Athanassopoulou, A. [Dept. of Radiology, CT and MRI Section, Areteion Hospital, Univ. of Athens (Greece); Rologis, D. [Neurosurgical Clinic, Athens General Hospital (Greece); Kalovidouris, A. [Dept. of Radiology, CT and MRI Section, Areteion Hospital, Univ. of Athens (Greece); Kotoulas, G. [Dept. of Radiology, CT and MRI Section, Areteion Hospital, Univ. of Athens (Greece); Vlahos, L. [Dept. of Radiology, CT and MRI Section, Areteion Hospital, Univ. of Athens (Greece); Papavassiliou, C. [Dept. of Radiology, CT and MRI Section, Areteion Hospital, Univ. of Athens (Greece)

    1993-10-01

    The purpose of this study was to assess pituitary adenomas following surgical and/or medical treatment in 28 patients. All patients were evaluated with both computed tomography (CT) and magnetic resonance imaging (MRI). The results were correlated with the clinical findings. Apart from the visualization of the adenoma itself (either residual or recurrent) other findings and in particular, morphological changes of the optic chiasm, the pituitary stalk and the sellar floor were evaluated with both imaging modalities. By comparing the two imaging modalities it was found that MRI was superior to CT in demonstrating residual/recurrent adenoma as well as evaluating the morphological changes of the optic chiasm and optic nerves. CT was superior or equal to MR in demonstrating the sellar floor changes. The intra-operatively implanted fat was equally seen by CT and MR. In conclusion, the anatomical variations of the optic chiasm and pituitary stalk are better visualized by MRI and allow a more precise evaluation of changes attributed to surgical or medical treatment of pituitary adenomas. (orig.)

  9. Contemporary issues in the evaluation and management of pituitary adenomas.

    Science.gov (United States)

    Pekic, S; Stojanovic, M; Popovic, V

    2015-12-01

    Pituitary adenomas are common benign monoclonal neoplasms accounting for about 15% of intracranial neoplasms. Data from postmortem studies and imaging studies suggest that 1 of 5 individuals in the general population may have pituitary adenoma. Some pituitary adenomas (mainly microadenomas which have a diameter of less than 1 cm) are exceedingly common and are incidentally diagnosed on magnetic resonance imaging (MRI) performed for an unrelated reason (headache, vertigo, head trauma). Most microadenomas remain clinically occult and stable in size, without an increase in tumor cells and without local mass effects. However, some pituitary adenomas grow slowly, enlarge by expansion and become demarcated from normal pituitary (macroadenomas have a diameter greater than 1 cm). They may be clinically silent or secrete anterior pituitary hormones in excess such as prolactin, growth hormone (GH), or adrenocorticotropic hormone (ACTH) causing diseases like prolactinoma, acromegaly, Cushing's disease or rarely thyroid-stimulating hormone (TSH) or gonadotropins (LH, FSH). The incidence of the various subtypes of pituitary adenoma varies but the most common is prolactinoma. Clinically non-functioning pituitary adenomas (NFPAs), which do not secrete hormones often cause local mass symptoms and represent one-third of pituitary adenomas. Given the high prevalence of pituitary adenomas and their heterogeneity (different tumor subtypes), it is critical that clinicians have a thorough understanding of the potential abnormalities in pituitary function and prognostic factors for behavior of pituitary adenomas in order to timely implement specific treatment modalities. Regarding pathogenesis of these tumors genetics, epigenetics and signaling pathways are the focus of current research yet our understanding of pituitary tumorigenesis remains incomplete. Although several genes and signaling pathways have been identified as important factors in the development of pituitary tumors, current

  10. Relationship Between Histopathology and Clinical Prognosis of Invasive Pituitary Adenoma

    Institute of Scientific and Technical Information of China (English)

    LIYong; SHUKai; DONGFangyong; WANFeng; LEITing; LILing

    2005-01-01

    Objective: To study the relationship between histopathology and clinical prognosis of invasive pituitary adenoma subjected to transsphenoidal surgery. Methods: The enrolled were 82 patients with invasive pituitary adenomas undergoing transsphenoidal surgery during Jan. 2000 May 2003 in our department with full MR imaging findings, pathology data and follow-up information. The follow-up duration was 5-30 months. Results: MR imaging findings of invasive pituitary adenoma included: depression of the sellar floor, involvement of sphenoid sinus and cavernous sinus, breakthrough of diaphragma sellae,encasement of internal carotid artery, etc. Pathological examination revealed that the invasion rate of dura in sella turcica was the highest among the structures around tumor. Pituitary adenoma apoplexy was found in 20 cases (24.4%). The total removal rate for PRL-secreting adenomas was significantly lower than that for non-secreting adenomas (P<0.01), but non-, GH-, ACTH-secreting adenomas had no significant differences. The recurrence rate of PRL-secreting adenornas was higher than that of non- and GH-secreting adenomas (P<0.05). Conclusion: Among invasive pituitary adenomas, the therapeutic effects of nonand GH-secreting pituitary adenomas are better than that of PRL-secreting adenomas. Invasive biological behaviors of invasive pituitary adenomas result in radical operation failure and postoperative recurrence.

  11. Diagnosis and treatment of pituitary adenomas.

    Science.gov (United States)

    Chanson, P; Salenave, S

    2004-12-01

    Pituitary tumors cause symptoms by secreting hormones (prolactin, PRL, responsible for amenorrhea-galactorrhea in women and decreased libido in men; growth hormone, GH, responsible for acromegaly; adrenocorticotropic hormone, ACTH, responsible for Cushing's syndrome; thyroid-stimulating hormone, TSH, responsible for hyperthyroidism), depressing the secretion of hormones (hypopituitarism), or by mass-related effects (headaches, visual field abnormalities...). All patients with pituitary tumors should be evaluated for gonadal, thyroid and adrenal function as well as PRL and GH secretion. Specific stimulation and suppression tests for pituitary hormones are performed in selected situations for detecting the type of hypersecretion or the response to treatment. Imaging procedures (mainly magnetic resonance imaging, MRI, nowadays) determine the presence, size and extent of the lesion. The classification of pituitary tumors is based on the staining properties of the cell cytoplasm viewed by light microscopy and immunocytochemistry revealing the secretory pattern of the adenoma. Treatment of pituitary adenomas consists of surgery (performed in more than 99% of cases via a transphenoidal route) and radiotherapy, generally fractionated or, in selected cases, using stereotactic techniques such as gamma-knife. The availability of medical treatment (dopamine, DA, agonists, somatostatin analogs, GH-receptor antagonists...) has profoundly modified the indications of radiotherapy, drugs being now generally used as a second-line treatment, after surgery (or even as first-line treatment). Based on the results of the different treatment modalities for each type of pituitary adenoma, recommendations will be proposed. They may be summarized as follows. For treatment of GH-secreting adenomas, trans-sphenoidal surgery is the first-line therapy except when the macroadenoma is giant or if surgery is contra-indicated; postoperative radiation therapy (fractionated, or by gamma-knife) is

  12. Lymphocitic infundibuloneurohypophysitis mimicking a pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Hubertus Maximilian Mehdorn

    2011-04-01

    Full Text Available A rare case of infundibulo-neurohypophysitis mimicking a pituitary adenoma is presented. A 69-years-old female patient developed polyuria and polydipsia. Laboratory analysis revealed central diabetes insipidus. No hormonal abnormalities. Cranial-magnetic resonance imaging (MRI showed a left sided mass in the adenohypophysis presuming a pituitary adenoma. The mass had contact to both internal carotids. Admission to our department for neurosurgical treatment followed. Ophthalmo - logic examination and neurological examination yielded normal findings. A second MRI focussing on the sellar-region showed a leftsided (T2-MRI.hyperintense, distended adenohypophysis, without contrast enhancement in T1. The stalk appeared thickened. T1- weighted sequences of the neurohypophysis showed loss of signal intensity. We diagnosed an infundibulo-neurohypophysitis and abstai - ned from surgical removal. The patient was discharged under treatment with corticosteroids and desmopressin. Hypophysitis is rare and shows special clinical characteristics. Despite defined radiological features to differentiate between hypophysitis and adenoma the possibility of misdiagnosis, and unnecessary surgical procedures, should always kept in mind.

  13. Radiation therapy alone for growth hormone-producing pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Plataniotis, G.A.; Kouvaris, J.R.; Vlahos, L.; Papavasiliou, C. [Athens Univ. (Greece). Dept. of Radiology

    1998-09-01

    We present our experience in the treatment of growth hormone (GH)-producing pituitary adenomas using irradiation alone. Between 1983 and 1991, 21 patients suffering from GH-secreting pituitary adenomas were treated with radiotherapy alone. Two bilateral opposing coaxial fields were used in 10 patients and in the remaining 11 a third frontovertex field was added. Treatment was given in 1.8-2 Gy daily fractions and total dose ranged between 45 and 54 Gy. Treatment was given using a cobalt unit. Four patients treated with somatostatin prior to and 14 patients treated after the end of radiotherapy experienced symptom relief for 6-28 weeks. The 5-year actuarial rate of disease control was 72%. Five out of six failed patients had macroadenomas. Hypopituitarism was observed in 5/21 (24%) patients. Whereas RT alone is effective in the treatment of microadenomas, this is not true for large infiltrative macroadenomas. (orig.)

  14. Expression of Neuropeptide Y in Human Pituitary Adenoma

    Institute of Scientific and Technical Information of China (English)

    Laizhao Chen; Jingjian Ma; Anchao Zheng; Honggang Zheng

    2006-01-01

    OBJECTIVE Neuropeptid e Y (NPY) acts as a neuroendocrine modulator in the anterior pituitary, and NPY mRNA and NPY-immunoreactivity have been detected in normal human anterior pituitaries. However, only a few studies of NPY expression in human pituitary adenomas have been published. Our study was conducted to determine whether or not adenomatous cells express NPY, to investigate the relationship between NPY expression and the subtypes of pituitary adenoma and to explore the clinical significance of NPY.METHODS The study included tissues from 58 patients with pituitary adenomas who underwent surgery because of their clinical diagnosis.Using a highly specific anti-NPY polyclonal antibody, immunohistochemical analysis was performed on the surgically removed pituitary adenomas. Six fresh specimens also were examined using immuno-electron microscopy. NPY was labeled with colloidal gold in order to study the distribution of NPY at the subcellular level.RESULTS The NPY expression level was significantly different among subgroups of pituitary adenomas (P<0.05). NPY was immuno-detected in 58.6% of all adenomas, in 91.7% of gonadotrophic adenomas and in 14.3% of prolactinomas. NPY expression was slightly lower in invasive pituitary adenomas compared to noninvasive adenomas, but the difference was not significant (t=1.81, P>0.05). Of particular interest was the finding that vascular endothelial cells showed positive NPY expression in some pituitary adenomas. Parts of strongly positive tumor cells were seen in channels formed without endothelial cells, but which contained some red blood cells in a formation similar to so-called vasculogenic mimicry. Immuno-electron microscopy demonstrated that 4 of the 6 fresh specimens displayed positive NPY staining with a high density of gold particles located mainly in the secretory granulas. In addition, gold particles were sparsely detected in the rough endoplasmic reticulum and cell matrix.CONCLUSION NPY exists in pituitary adenomas

  15. Ectopic pituitary adenoma presenting as midline nasopharyngeal mass.

    LENUS (Irish Health Repository)

    Ali, R

    2012-02-01

    INTRODUCTION: Ectopic pituitary adenomas are extremely rare. We report a case of ectopic pituitary adenoma in the midline of the nasopharynx. This adenoma probably arose from the pharyngeal remnant of Rathke\\'s pouch. METHODS: We discuss a case of a lady who presented to our unit with 2 months history of dryness and sensation of lump in her throat and a long standing history of hypothyroidism. Examination of nasopharynx revealed a smooth and fluctuant midline mass. CT scan of nose and paranasal sinuses confirmed the midline mass with small defect communicating with the sphenoid sinus. An initial diagnosis of Thornwaldt\\'s cyst was made and she underwent upper aerodigestive tract endoscopy and marsupialization of the mass. Histopathological examination revealed ectopic pituitary adenoma. CONCLUSION: Ectopic pituitary adenoma is an important differential diagnosis for a midline nasopharyngeal mass. It is recommended that prior to surgical resection of midline nasopharyngeal mass biopsy is taken and MRI is performed.

  16. Heterogeneity of secretory granules of silent pituitary adenomas

    DEFF Research Database (Denmark)

    Holck, S; Wewer, U M; Albrechtsen, R

    1988-01-01

    Silent pituitary adenomas were compared with hormonally active tumors taking into account the size, number, and ultrastructural characteristics of secretory granules (SG). The study group (a total of 79 primary pituitary adenomas) comprised 27 silent, 21 growth hormone (GH)-producing-, 16 prolactin...... (PRL)-producing-, 5 GH-PRL-producing- and 10 adrenocorticotropic hormone (ACTH)-producing adenomas. The SG of silent adenomas were significantly smaller than SG in endocrine active adenomas. All hormonally inactive tumors also contained small (mean, 94 nm) specific cytoplasmic granules, designated...... approximately 10 to 50% of the granules in each cell. These granules were not seen in hormonally active tumors and considered therefore diagnostic of silent pituitary adenomas....

  17. Ectopic Adrenocorticotropic Hormone-Secreting Pituitary Adenomas: An Underestimated Entity.

    Science.gov (United States)

    Knappe, Ulrich J; Jaspers, Christian; Buschsieweke, Desirée; Reinbold, Wolf-Dieter; Alomari, Ali; Saeger, Wolfgang; Ehlenz, Klaus; Mann, W Alexander; Kann, Peter Herbert; Feldkamp, Joachim

    2017-04-01

    The diagnosis of Cushing disease is based on endocrinological pa-rameters, with no single test being specific. In some patients, dynamic thin-slice sellar magnetic resonance imaging fails to detect a pituitary tumor. The purpose of this study is to investigate the role of ectopic pituitary adenoma in this situation. In a retrospective chart review, 5 patients (6%) with ectopic adenomas were identified in 83 consecutive patients undergoing transsphenoidal surgery for adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas by 1 surgeon. In all 5 patients (all female, 32-41 years of age), an exclusively extrasellar ACTH-secreting adenoma was excised. Three adenomas were located in the cavernous sinus, 1 in the sphenoid sinus, and 1 in the ethmoidal cells. Histologically, none of the tumors showed signs of aggressiveness. Three of the 5 adenomas specifically expressed somatostatin receptor 5. In 4 patients with Cushing disease, postoperative remission was obtained, with 1 recurrence after 14 months. In the patient with Nelson syndrome, ACTH decreased from >800 to ectopic adenoma (positive for somatostatin receptor 5) in the ethmoidal cells turned out to be positive on gallium 68 DOTATATE positron emission tomography/computed tomography. The incidence of primarily ectopic ACTH-secreting adenomas in this series was 6%. In cases of negative MRI findings, an ectopic ACTH-secreting adenoma should be taken into account. 68 Ga DOTATATE positron emission tomography/computed tomography may identify ectopic pituitary adenomas. Hypophysectomy should always be avoided in primary surgery for CD.

  18. Serotonin, ATRX, and DAXX Expression in Pituitary Adenomas

    DEFF Research Database (Denmark)

    Casar-Borota, Olivera; Botling, Johan; Granberg, Dan

    2017-01-01

    Differential diagnosis based on morphology and immunohistochemistry between a clinically nonfunctioning pituitary neuroendocrine tumor (NET)/pituitary adenoma and a primary or secondary NET of nonpituitary origin in the sellar region may be difficult. Serotonin, a frequently expressed marker...... of the pituitary tumors expressed serotonin, suggesting that serotonin immunoreactive sellar tumors represent primary or secondary NETs of nonpituitary origin. Normal expression of ATRX and DAXX in pituitary tumors suggests that ATRX and DAXX do not play a role in the pathogenesis of pituitary endocrine tumors...... on a larger cohort of pituitary carcinomas are needed to clarify whether ATRX mutations may contribute to the metastatic potential in a subset of pituitary NETs....

  19. Follicle stimulating hormone secreting pituitary adenoma: a challenging diagnosis

    Directory of Open Access Journals (Sweden)

    Madhuri Alap Mehendale

    2015-04-01

    Full Text Available FSH secreting pituitary adenomas are relatively uncommon brain tumours and usually non-functioning. But in rare cases they produce ovarian hyperstimulation. We report a case of a 32 year old female P2L2, with amenorrhoea of 1 year, pain in abdomen and galactorrhoea since 6 months. Initially thought to be a simple prolactinoma with multicystic ovaries, but after thorough investigations to our surprise diagnosed to be a rare case of gonadotropin secreting pituitary adenoma. Patient was successfully managed by excision of the pituitary adenoma. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 493-496

  20. [Image-guided endoscopic transsphenoidal removal of pituitary adenoma].

    Science.gov (United States)

    Zhang, Qui-Hang; Liu, Hai-Sheng; Yang, Da-Zhang; Cheng, Jing-Yu

    2005-01-01

    To assess the role of neuronavigation in assisting endoscopic transsphenoidal surgery for pituitary adenomas. Ten endoscopic endonasal transsphenoidal reoperations for pituitary adenomas were selected. Clinical records were reviewed retrospectively. Five of 10 patients had gigantic adenoma, 3 microadenoma, 2 large adenoma. The mean setup time was 5 minutes, and the operative time was 50 minutes in image-guided procedures. In all cases, the system worked well without malfunction. Continuous information regarding instrument location and trajectory was provided to the surgeon. Measurements of intraoperative accuracy in the axial, coronal, and.sagittal planes indicated a mean verified system error of 1.5 mm. for pituitary adenomas. After operation, the symptoms relieved in all patients. Neuronavigation can be applied during endonasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It makes reoperation easier, faster, and safer.

  1. Simple numerical chromosome aberrations in two pituitary adenomas

    DEFF Research Database (Denmark)

    Dietrich, C U; Pandis, N; Bjerre, P

    1993-01-01

    Cytogenetic analysis of short-term cultures of one non-secreting and one prolactin-producing pituitary adenoma revealed simple clonal numerical abnormalities in both tumors. The karyotype of the non-secreting adenoma was 48,XX, +4, +9[42]/49,XX, +4, +9, +20[2]/46,XX[6]. In the prolactin-secreting...

  2. Cushing-type ectopic pituitary adenoma with unusual pathologic features

    Directory of Open Access Journals (Sweden)

    Kristopher T. Kimmell, MD

    2014-06-01

    Full Text Available Ectopic pituitary adenomas comprise, by varying reports, approximately 1-2% of all pituitary adenomas. They are often located in the nasopharyngeal region associated with the pharyngeal pituitary. The location and pathologic features of these masses make them atypical when compared with intrasellar pituitary adenomas. A 54-year-old man presented with vertebral compression fracture and physical stigmata of Cushing’s disease. Biochemical testing confirmed hypercortisolemia responsive to high dose dexamethasone suppression. MRI of the head demonstrated an enhancing mass in the posterior aspect of the sphenoid sinus not involving the sella turcica. Endoscopic biopsy followed by resection confirmed this mass to be a pituitary adenoma with unusual pathologic features. Most notably, the tumor cells demonstrated large, eosinophilic, vacuolated cytoplasm. Immunohistochemical profile of the tumor was typical of an ACTH secreting tumor, notably with positivity for ACTH. The patient did well from his surgery. Post-operatively his serum cortisol level normalized and he remains in chemical remission one year after surgery. Ectopic pituitary adenomas are an unusual manifestation of hormonally active pituitary neoplastic disease. Their atypical clinical presentations, location, and pathologic features can make them a diagnostic challenge. Clinicians should be aware of these entities, especially when considering differential diagnosis for a mass in the sphenoid sinus and nasopharyngeal region.

  3. MR of pituitary micro-adenomas; IRM des microadenomes hypophysaires

    Energy Technology Data Exchange (ETDEWEB)

    Le Marec, E.; Ait Ameur, A.; David, H.; Pharaboz, C. [Hopital d`Instruction des Armees Begin, 94 - Saint-Mande (France)

    1997-12-31

    Most of the time, rationales to look for pituitary micro-adenomas are based on endocrinal disorder. MRI is often helpful to confirm diagnosis. It gives information about micro-adenomas size and localisation. If conventional sequence are inadequate, a dynamic sequence has then to be performed after Gadolinium injection. Any disorder observed from the pituitary gland must be correlated with the clinical observation and results from biochemistry analysis. False positive happens quite open because of gland morphological variation, incidentalomas and partial volumes. MRI offers the possibility to follow-up treated micro-adenomas evolution especially to detect recurrence. (author)

  4. Coexisting intracranial tumors with pituitary adenomas: Genetic association or coincidence?

    Directory of Open Access Journals (Sweden)

    Furtado Sunil

    2010-01-01

    Full Text Available The co-occurrence of two or more brain tumors with different histological features is rare. The authors report three rare cases of intracranial tumors associated with pituitary adenomas. Two of the pituitary tumors were functioning adenomas: a prolactinoma and a thyrotropin secreting adenoma. Two of the associated intracranial neoplasms were gliomas and one was a meningioma. Radiological and clinical examination for syndromal association was negative in all cases. We briefly discuss the presentation and treatment options of these cases and review the 19 previous publications in the literature of pituitary tumors occurring in association with other neoplasms and explore the possible links underlying these co-occurring neoplasms. Our three cases represent 0.86% of all pituitary tumors operated at our institute over a 9-year period.

  5. The pathology of pituitary adenomas from a clinical perspective.

    Science.gov (United States)

    Dworakowska, Dorota; Korbonits, Marta; Aylwin, Simon; McGregor, Alan; Grossman, Ashley B

    2011-01-01

    Pituitary adenomas present with a variety of clinical endocrine manifestations and arise in a sporadic setting or rarely as part of hereditary genetic syndromes. Molecular analysis of familial pituitary adenomas has provided significant insight into pituitary tumorigenesis. Some specific genes have been identified that predispose to pituitary neoplasia, but these are rarely involved in the pathogenesis of sporadic tumors. The number of identified genes involved in pituitary tumorigenesis is progressively increasing. The possible resulting mechanisms of action involve abnormalities in signal transduction pathways, cell cycle regulators, growth factors, chromosome stability and others. Further studies are needed to evaluate the clinical significance of genetic alterations and their implications for patient prognosis, as well as to identify targets for existing and new therapeutic options. The aim of this review is to focus on the molecular pathology of pituitary adenomas from a practical perspective and discuss the possible clinical implications which may relate to particular molecular alterations. We have summarised familial syndromes related to pituitary adenomas and considered the prognostic value of selected molecular alterations in these tumors.

  6. Signaling pathway networks mined from human pituitary adenoma proteomics data

    Directory of Open Access Journals (Sweden)

    Zhan Xianquan

    2010-04-01

    Full Text Available Abstract Background We obtained a series of pituitary adenoma proteomic expression data, including protein-mapping data (111 proteins, comparative proteomic data (56 differentially expressed proteins, and nitroproteomic data (17 nitroproteins. There is a pressing need to clarify the significant signaling pathway networks that derive from those proteins in order to clarify and to better understand the molecular basis of pituitary adenoma pathogenesis and to discover biomarkers. Here, we describe the significant signaling pathway networks that were mined from human pituitary adenoma proteomic data with the Ingenuity pathway analysis system. Methods The Ingenuity pathway analysis system was used to analyze signal pathway networks and canonical pathways from protein-mapping data, comparative proteomic data, adenoma nitroproteomic data, and control nitroproteomic data. A Fisher's exact test was used to test the statistical significance with a significance level of 0.05. Statistical significant results were rationalized within the pituitary adenoma biological system with literature-based bioinformatics analyses. Results For the protein-mapping data, the top pathway networks were related to cancer, cell death, and lipid metabolism; the top canonical toxicity pathways included acute-phase response, oxidative-stress response, oxidative stress, and cell-cycle G2/M transition regulation. For the comparative proteomic data, top pathway networks were related to cancer, endocrine system development and function, and lipid metabolism; the top canonical toxicity pathways included mitochondrial dysfunction, oxidative phosphorylation, oxidative-stress response, and ERK/MAPK signaling. The nitroproteomic data from a pituitary adenoma were related to cancer, cell death, lipid metabolism, and reproductive system disease, and the top canonical toxicity pathways mainly related to p38 MAPK signaling and cell-cycle G2/M transition regulation. Nitroproteins from a

  7. Familial isolated pituitary adenomas (FIPA) and the pituitary adenoma predisposition due to mutations in the aryl hydrocarbon receptor interacting protein (AIP) gene.

    Science.gov (United States)

    Beckers, Albert; Aaltonen, Lauri A; Daly, Adrian F; Karhu, Auli

    2013-04-01

    Pituitary adenomas are one of the most frequent intracranial tumors and occur with a prevalence of approximately 1:1000 in the developed world. Pituitary adenomas have a serious disease burden, and their management involves neurosurgery, biological therapies, and radiotherapy. Early diagnosis of pituitary tumors while they are smaller may help increase cure rates. Few genetic predictors of pituitary adenoma development exist. Recent years have seen two separate, complimentary advances in inherited pituitary tumor research. The clinical condition of familial isolated pituitary adenomas (FIPA) has been described, which encompasses the familial occurrence of isolated pituitary adenomas outside of the setting of syndromic conditions like multiple endocrine neoplasia type 1 and Carney complex. FIPA families comprise approximately 2% of pituitary adenomas and represent a clinical entity with homogeneous or heterogeneous pituitary adenoma types occurring within the same kindred. The aryl hydrocarbon receptor interacting protein (AIP) gene has been identified as causing a pituitary adenoma predisposition of variable penetrance that accounts for 20% of FIPA families. Germline AIP mutations have been shown to associate with the occurrence of large pituitary adenomas that occur at a young age, predominantly in children/adolescents and young adults. AIP mutations are usually associated with somatotropinomas, but prolactinomas, nonfunctioning pituitary adenomas, Cushing disease, and other infrequent clinical adenoma types can also occur. Gigantism is a particular feature of AIP mutations and occurs in more than one third of affected somatotropinoma patients. Study of pituitary adenoma patients with AIP mutations has demonstrated that these cases raise clinical challenges to successful treatment. Extensive research on the biology of AIP and new advances in mouse Aip knockout models demonstrate multiple pathways by which AIP may contribute to tumorigenesis. This review assesses

  8. Gigantism caused by growth hormone secreting pituitary adenoma.

    Science.gov (United States)

    Rhee, Noorisaem; Jeong, Kumi; Yang, Eun Mi; Kim, Chan Jong

    2014-06-01

    Gigantism indicates excessive secretion of growth hormones (GH) during childhood when open epiphyseal growth plates allow for excessive linear growth. Case one involved a 14.7-year-old boy presented with extreme tall stature. His random serum GH level was 38.4 ng/mL, and failure of GH suppression was noted during an oral glucose tolerance test (OGTT; nadir serum GH, 22.7 ng/mL). Magnetic resonance imaging (MRI) of the brain revealed a 12-mm-sized pituitary adenoma. Transsphenoidal surgery was performed and a pituitary adenoma displaying positive immunohistochemical staining for GH was reported. Pituitary MRI scan was performed 4 months after surgery and showed recurrence/residual tumor. Medical treatment with a long-acting somatostatin analogue for six months was unsuccessful. As a result, secondary surgery was performed. Three months after reoperation, the GH level was 0.2 ng/mL and insulin-like growth factor 1 was 205 ng/mL. Case two involved a 14.9-year-old boy, who was referred to our department for his tall stature. His basal GH level was 9.3 ng/mL, and failure of GH suppression was reported during OGTT (nadir GH, 9.0 ng/mL). Pituitary MRI showed a 6-mm-sized pituitary adenoma. Surgery was done and histopathological examination demonstrated a pituitary adenoma with positive staining for GH. Three months after surgery, the GH level was 0.2 ng/mL and nadir GH during OGTT was less than 0.1 ng/mL. Pituitary MRI scans showed no residual tumor. We present two cases of gigantism caused by a GH-secreting pituitary adenoma with clinical and microscopic findings.

  9. Chondroid chordoma of the sella turcica mimicking a pituitary adenoma.

    Science.gov (United States)

    Wu, Arthur W; Bhuta, Sunita; Salamon, Noriko; Martin, Neil; Wang, Marilene B

    2015-01-01

    We report an unusual case of a chondroid chordoma of the sella turcica that mimicked the clinical and radiologic presentation of the more common pituitary adenoma. A 50-year-old man presented with bitemporal visual field deficits. Magnetic resonance imaging (MRI) detected a sellar mass that was suggestive of a pituitary adenoma. However, the intraoperative appearance of the mass was not consistent with an adenoma, and frozen-section pathology was obtained. Pathology identified the mass as a malignant lesion. Based on this finding, the mass was treated more aggressively. Chondroid chordomas are rare and slowly growing but locally aggressive tumors. The prognosis depends on the ability to totally resect the mass, so differentiating this tumor from a benign lesion is critical. An intrasellar chordoma can be confused clinically and radiologically with a pituitary adenoma. These two lesions are nearly identical on MRI, although T2-weighted imaging sometimes demonstrates higher intensity with a chondroid chordoma. Computed tomography may be helpful in demonstrating bony destruction by these lesions, as can the presence of intralesional calcifications. Intraoperative findings of bony invasion or a purple-red color may also lead the surgeon to suspect a diagnosis other than pituitary adenoma.

  10. Expression pattern of the Hedgehog signaling pathway in pituitary adenomas.

    Science.gov (United States)

    Yavropoulou, Maria P; Maladaki, Anna; Topouridou, Konstantina; Kotoula, Vasiliki; Poulios, Chris; Daskalaki, Emily; Foroglou, Nikolaos; Karkavelas, George; Yovos, John G

    2016-01-12

    Several studies have demonstrated the role of Wnt and Notch signaling in the pathogenesis of pituitary adenomas, but data are scarce regarding the role of Hedgehog signaling. In this study we investigated the differential expression of gene targets of the Hedgehog signaling pathway. Formalin-fixed, paraffin-embedded specimens from adult patients who underwent transphenoidal resection and normal human pituitary tissues that were obtained from autopsies were used. Clinical information and data from pre-operative MRI scan (extracellular tumor extension, tumor size, displacement of the optic chiasm) were retrieved from the Hospital's database. We used a customized RT(2) Profiler PCR Array, to investigate the expression of genes related to Notch and Hedgehog signaling pathways (PTCH1, PTCH2, GLI1, GLI3, NOTCH3, JAG1, HES1, and HIP). A total of 52 pituitary adenomas (32 non-functioning adenomas, 15 somatotropinomas and 5 prolactinomas) were used in the final analysis. In non-functioning pituitary adenomas there was a significant decrease (approximately 75%) in expression of all Hedgehog related genes that were tested, while Notch3 and Jagged-1 expression was found significantly increased, compared with normal pituitary tissue controls. In contrast, somatotropinomas demonstrated a significant increase in expression of all Hedgehog related genes and a decrease in the expression of Notch3 and Jagged-1. There was no significant difference in the expression of Hedgehog and Notch related genes between prolactinomas and healthy pituitary tissues. Hedgehog signalling appears to be activated in somatotropinomas but not in non-functioning pituitary adenomas in contrast to the expression pattern of Notch signalling pathway.

  11. Fractionated stereotactic radiotherapy in the treatment of pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Kopp, C.; Theodorou, M.; Poullos, N.; Astner, S.T.; Geinitz, H.; Molls, M. [Technische Univ. Muenchen, Klinikum rechts der Isar (Germany). Klinik und Poliklinik fuer Strahlentherapie und Radiologische Onkologie; Stalla, G.K. [Max-Planck-Institut fuer Psychiatrie, Muenchen (Germany). Klinische Neuroendokrinologie; Meyer, B. [Technische Univ. Muenchen, Klinikum rechts der Isar (Germany). Neurochirurgische Klinik und Poliklinik; Nieder, C. [Nordland Hospital, Bodoe (Norway). Dept. of Oncology and Palliative Medicine; Tromsoe Univ. (Norway). Inst. of Clinical Medicine; Grosu, A.L [Freiburg Univ. (Germany). Klinik fuer Strahlenheilkunde

    2013-11-15

    Purpose: The purpose of this work was to evaluate tumor control and side effects associated with fractionated stereotactic radiotherapy (FSRT) in the management of residual or recurrent pituitary adenomas. Patients and methods: We report on 37 consecutive patients with pituitary adenomas treated with FSRT at our department. All patients had previously undergone surgery. Twenty-nine patients had nonfunctioning, 8 had hormone-producing adenoma. The mean total dose delivered by a linear accelerator was 49.4 Gy (range 45-52.2 Gy), 5 x 1.8 Gy weekly. The mean PTV was 22.8 ccm (range 2.0-78.3 ccm). Evaluation included serial imaging tests, endocrinologic and ophthalmologic examination. Results: Tumor control was 91.9 % for a median follow-up time of 57 months (range 2-111 months). Before FSRT partial hypopituitarism was present in 41 % of patients, while 35 % had anterior panhypopituitarism. After FSRT pituitary function remained normal in 22 %, 43 % had partial pituitary dysfunction, and 35 % had anterior panhypopituitarism. Visual acuity was stable in 76 % of patients, improved in 19 %, and deteriorated in 5 %. Visual fields remained stable in 35 patients (95 %), improved in one and worsened in 1 patient (2.7 %). Conclusion: FSRT is an effective and safe treatment for recurrent or residual pituitary adenoma. Good local tumor control and preservation of adjacent structures can be reached, even for large tumors. (orig.)

  12. Expression for peroxisome proliferator-activated receptor gamma in pituitary adenomas 38 cases for semi-quantitative immunohistochemical analysis

    Institute of Scientific and Technical Information of China (English)

    Xiaojie Lu; Kailai Chen; Weiyang Ji; Qing Wang; Bing Li; Jiang'an Li; Jiyong Sun

    2008-01-01

    BACKGROUND:It has been reposed that peroxisome proliferator-activated receptor γ(PPAR γ)is highly expressed in lung cancer,colon cancer,and gastric cancer,as well as other tumors.OBJECTIVE:To study expression of PPAR γ in pituitary adenomas and analyze the role of PPAR γ in hormonal typing of pituitary adenomas.DESIGN,TIME AND SETTING:Semi-quantitative immunohistochemistry of pathological specimens.The experiment was conducted at the Department of Neurosurgery,Wuxi Second Hospital Affiliated to Nanjing Medical University between January 2002 and May 2005.MATERIALS:Surgical resection samples of pituitary adenomas from 38 cases(18 male and 20 female)were analyzed.Eight cases were determined to be invasive pituitary adenomas and 30 cases were non-invasive pituitary adenomas.Hormonal classification of the types of pituitary adenomas revealed somatotrophic adenomas in six cases,corticotrophic adenoma in five cases,prolactinomas in 13 cases,multi-hormone secreting adenomas in six cases,and eight cases of adenoma without altered endocrine function.Five autopsy specimens were collected dunng the same period from patients of matching age that died from unrelated diseases and were included as normal anterior pituitary controls.METHODS:Cell counts for positive immunohistochemical signals were recorded from histopathological sections.The percentage of positive cells was reported as a semi-quantitative analysis.MAIN OUTCOME MEASURES:The rate of PPAR γ positive cells in different types of adenoma was based on hormonal levels and invasiveness of pituitary tumor cells.RESULTS:All tumor biopsies were determined to express PPAR γ.T1le rate of PPAR γ-positive cells ranged between 8%-65% in the pituitary adenomas.According to hormonal type,PPAR γ expression did not vary between the groups.In addition.there was no significant difference in PPAR γ expression between the non-invasive and invasive pituitary adenomas.CONCLUSIONS:Human pituitary adenomas express PPAR γ,and this

  13. Expression of growth hormone (GH)-releasing factor gene in GH-producing pituitary adenoma.

    Science.gov (United States)

    Wakabayashi, I; Inokuchi, K; Hasegawa, O; Sugihara, H; Minami, S

    1992-02-01

    Pituitary cells synthesize various neuropeptides that influence pituitary hormone secretion. GH-releasing factor (GRF) may also be produced by normal or pituitary tumor cells. We examined GRF gene expression in pituitary tumors. Standard techniques for the analysis of GRF gene expression did not appear to be suitable. Highly sensitive reverse transcription coupled to polymerase chain reaction was used. Specimens of pituitary adenoma were obtained by transsphenoidal adenomectomy from six patients with acromegaly and three patients with no clinical evidence of pituitary hormone overproduction; non-functioning adenoma. Pituitary glands were collected at autopsy from three patients who died from nonendocrine disorders. A specific GRF gene transcript was detected in five out of six GH-producing pituitary adenomas, whereas this was not found in three separate specimens of nonfunctioning pituitary adenoma or anterior and posterior pituitary tissue. The data suggest that GRF is synthesized as an intrinsic product in human GH-producing pituitary adenoma.

  14. Molecular cytogenetics of pituitary adenomas, assessed by FISH technique.

    Science.gov (United States)

    Kontogeorgos, George

    2004-01-01

    Fluorescent in situ hybridization (FISH) represents a moden molecular pathology technique, alternative to conventional cytogenetics (karyotyping). In addition to metaphase spreads, it can be applied directly to interphase nuclei. The latter makes the FISH technique powerful for pathologists for it integrates molecular genetics and classic cytogenetics and brings them together to a single framework for morphologic evaluation. Interphase FISH can be applied to imprints from fresh tissue or to paraffin sections after proteinase K digestion. Centromeric, telomeric and locus DNA-sequence specific probes can be used to identify aneuploidy or gene mutations. Several protocols combine molecular cytogenetics with classic karyotyping. Other sophisticated, FISH-based protocols have been introduced. Among them, comparative genomic hybridization is very important for it can detect non-balanced chromosomal aberrations of uncultured tumor cells and provide overall genomic information in a single experiment. This review presents the principles and applications of FISH technique for the investigation of the cytogenetic background of pituitary adenomas.

  15. RT-01FRACTIONATED STEREOTACTIC RADIOTHERAPY FOR PITUITARY ADENOMA WITH NOVALIS

    Science.gov (United States)

    Arakawa, Yoshiki; Mizowaki, Takashi; Ogura, Kengo; Sakanaka, Katsuyuki; Hojo, Masato; Hiraoka, Masahiro; Miyamoto, Susumu; Murata, Daiki

    2014-01-01

    BACKGROUND: Radiation therapy is an available treatment modality for pituitary adenoma. In particular, it is effective for the case unable to be removed with surgery or repeating recurrence. However, hypopituitarism and optic nerve injury associated with radiation therapy become a problem. Novalis® (Brain Lab) is an equipment of radiation to establish the detailed irradiation area, fractionated stereotactic radiotherapy (fSRT) and intensity-modulated radiation therapy (IMRT). Retrospectively, we review local control and morbidity following fSRT with Novalis in pituitary adenoma. PATIENTS AND METHODS: Between 2007 and 2012, 29 patients with pituitary adenoma (9 functioning, 20 non-functioning) received fSRT with Novalis in our institute. Total radiation dose was 50.4-54Gy (1.8 Gy per fraction) and prescribed to the gross target volume + 2 mm. The effectiveness of fSRT was evaluated by tumor volume and clinical symptoms on pre- fSRT, and every 1-year. RESULTS: The median follow-up time was 59.1 months (20 to 83 months). Tumor regrowth was observed in 2 cases. Progression free survival rate was 93%. New visual field deficit was observed in 1 case, and new pituitary dysfunction were not observed in all patients. CONCLUSION: fSRT with Novalis is safe and effective in the treatment for pituitary adenoma. Although follow-up time is short, any problematic complications were not observed. In the future, fSRT is expected to make for safe and effective treatment in pituitary adenoma impossible to cure surgically.

  16. Inflammatory Pseudotumor of the Pituitary Gland Mimicking a Pituitary Adenoma: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Da Mi; Yu, In Kyu [Dept. of Radiology, Eulji University Hospital, Daejeon (Korea, Republic of); Kim, Han Kyu [Dept. of Neurosurgery, Eulji University Hospital, Daejeon (Korea, Republic of); Son Hyun Jin [Dept. of Pathology, Eulji University Hospital, Daejeon (Korea, Republic of)

    2011-04-15

    A 38-year-old man was admitted to our hospital with diplopia. The patient had a relatively well-defined pituitary mass with high cellularity as well as weaker enhancement on imaging modalities including computed tomography (CT) and magnetic resonance imaging (MRI), than a typical pituitary adenoma. The distinction between a pseudotumor and an invasive neoplasm is very difficult before biopsy. In this case report, we discuss the characteristic imaging features of a fibrosing inflammatory pseudotumor of the pituitary gland

  17. Genetics Home Reference: familial isolated pituitary adenoma

    Science.gov (United States)

    ... named? Additional Information & Resources MedlinePlus (6 links) Encyclopedia: Acromegaly Encyclopedia: Gigantism Encyclopedia: Pituitary Tumor Encyclopedia: Prolactinoma Health Topic: Endocrine ...

  18. The Spectrum of Hormone Immunoreactivity in Typical and Atypical Pituitary Adenomas

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    Yeşim ERTAN

    2009-09-01

    Full Text Available Objective: We aimed to assess the spectrum of hormone immunoreactivity in our pituitary adenoma cases and discuss the diagnostic parameters of atypical pituitary adenomas.Material and Methods: A total of 166 pituitary adenoma cases diagnosed from 2005 to 2008 in our department were included in the present study. Hematoxylin-eosin stained and immunohistochemistry performed slides (ACTH, PRL, GH, TSH, FSH, LH, Ki-67, and p53 were evaluated. Cases having more than two mitoses on 10 high power fields besides more than 3% Ki-67 index were accepted in the atypical group.Results: Histologically, 159 cases were typical pituitary adenoma and 7 were atypical pituitary adenoma. Of the atypical pituitary adenoma cases, one case was ACTH, one GH and one both GH and prolactin hormone immunoreactive pituitary adenomas. Four cases were hormone immunonegative adenomas. Of the typical pituitary adenoma cases, 39 cases were GH, 19 ACTH, 17 prolactin, 10 FSH, 8 LH and one TSH immunreactive pituitary adenomas. Fourty-seven cases were hormone immunonegative adenomas.Twenty-two of the all pitutary adenoma cases had recurrence. Of these cases, 18 were typical adenoma and four were atypical adenoma.Conclusion: The ratio of prolactin immunoreactive pituitary adenoma cases in the surgical material of neuropathology is decreasing due to medical therapy. Atypical pituitary adenomas are not the sole factor affecting the recurrence mechanism but these tumors have higher recurrence rate compared with typical pituitary adenomas and we think the proliferation index might be the principal approach in the diagnosis of these lesions.

  19. Unusual mixed gangliocytoma-pituitary adenoma in sellar region

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    Jie-tian JIN

    2016-10-01

    Full Text Available Background The presence of ganglion cells within an endocrine pituitary adenoma in sellar region is rare, and is usually diagnosed as "mixed gangliocytoma-pituitary adenoma". Due to lack of radiological characteristics, it is very difficult to make an accurate diagnosis preoperatively. Herein we describe one case of unusual mixed gangliocytoma - growth hormone (GH secreting pituitary adenoma in sellar region and review related literatures, so as to summarize the clinicopathological characteristics and improve the diagnosis and differential diagnosis of this tumor. Methods and Results A 28 - year - old female presented with headache and blurred vision for 8 months. She also complained of acromegaly and amenorrhea. Head CT and MRI examinations showed a sellar and suprasellar mass with clear boundary compressing the optic chiasm and buttom of the third ventricle. The mass exhibited isointense signal or mild hypointensity on T1WI and mild hyperintensity on T2WI with heterogeneous enhancement on the contrast MRI. The tumor was removed totally. The histological sections demonstrated two parts of intermixed areas. One part of areas was marked by a proliferation of scattered gangliocyte - like cells arranged in a fibrillary background. Other areas were marked by a sheet - like or locally papillary proliferation of round and oval cells. Immunohistochemically, cytoplasm of gangliocyte-cells were diffusely positive for synaptophysin (Syn, and negative for adenohypophysial hormones; cytoplasm of round and oval cells were diffusely positive for Syn, and almost 30% cells were positive for GH, and negative for other neurohypophysial hormones. A final diagnosis of mixed gangliocytoma-GH secreting pituitary adenoma in sellar region (WHO grade Ⅰ was made. The patient did not receive postoperatively adjuvant therapy and was followed-up for one year, without any neurological deficit or signs of recurrence. Conclusions Mixed gangliocytoma - pituitary

  20. Pituitary null cell adenoma in a domestic llama (Lama glama).

    Science.gov (United States)

    Chalkley, M D; Kiupel, M; Draper, A C E

    2014-07-01

    Pituitary gland neoplasia has been reported rarely in camelids. A 12-year-old neutered male llama (Lama glama) presented with lethargy, inappetence and neurological signs. On physical examination, the llama was mentally dull and exhibited compulsive pacing and circling to the left. Complete blood count and serum biochemistry revealed haemoconcentration, mild hypophosphataemia, hyperglycaemia, hypercreatininaemia and hyperalbuminaemia. Humane destruction was elected due to rapid clinical deterioration and poor prognosis. Post-mortem examination revealed a pituitary macroadenoma and bilateral internal hydrocephalus. Microscopically, the pituitary tumour was composed of neoplastic chromophobic pituitary cells. Ultrastructural studies revealed similar neoplastic cells to those previously described in human null cell adenomas. Immunohistochemically, the neoplastic cells were strongly immunoreactive for neuroendocrine markers (synaptophysin and chromogranin A), but did not exhibit immunoreactivity for epithelial, mesenchymal, neuronal and all major pituitary hormone markers (adrenocorticotropic hormone, follicle stimulating hormone, growth hormone, luteinizing hormone, melanocyte-stimulating hormone, prolactin and thyroid stimulating hormone), consistent with the diagnosis of a pituitary null cell adenoma. This is the first report of pituitary neoplasia in a llama.

  1. Molecular screening of pituitary adenomas for gene mutations and rearrangements

    Energy Technology Data Exchange (ETDEWEB)

    Herman, V.; Drazin, N.Z.; Gonskey, R.; Melmed, S. (Cedars-Sinai Medical Center, Los Angeles, CA (United States))

    1993-07-01

    Although pituitary tumors arise as benign monoclonal neoplasms, genetic alterations have not readily been identified in these adenomas. The authors studied restriction fragment abnormalities involving the GH gene locus, and mutations in the p53 and H-, K-, and N-ras genes in 22 human GH cell adenomas. Twenty two nonsecretory adenomas were also examined for p53 and ras gene mutations. Seven prolactinoma DNA samples were tested for deletions in the multiple endocrine neoplasia-1 (MEN-1) locus, as well as for rearrangements in the hst gene, a member of the fibroblast growth factor family. In DNA from GH-cell adenomas, identical GH restriction patterns were detected in both pituitary and lymphocyte DNA in all patients and in one patient with a mixed GH-TSH cell adenoma. Using polymerase chain reaction (PCR)-single stranded conformation polymorphism analysis, no mutations were detected in exons 5, 6, 7 and 8 of the p53 gene in GH cell adenomas nor in 22 nonsecretory adenomas. Codons 12/13 and 61 of H-ras, K-ras, and N-ras genes were also intact on GH cell adenomas and in nonsecretory adenomas. Site-specific probes for chromosome 11q13 including, PYGM, D11S146, and INT2 were used in 7 sporadic PRL-secreting adenomas to detect deletions of the MEN-1 locus on chromosome 11. One patient was identified with a loss of 11p, and the remaining 6 patients did not demonstrate loss of heterozygosity in the pituitary 11q13 locus, compared to lymphocyte DNA. None of these patients demonstrated hst gene rearrangements which also maps to this locus. These results show that p53 and ras gene mutations are not common events in the pathogenesis of acromegaly and nonsecretory tumors. Although hst gene rearrangements and deletions of 11q13 are not associated with sporadic PRl-cell adenoma formation, a single patient was detected with a partial loss of chromosome 11, including the putative MEN-1 site. 31 refs., 5 figs., 2 tabs.

  2. IN VITRO CELL CULTURE AND HORMONE RADIOIMMUNOASSAY OF HUAMAN PITUITARY ADENOMAS

    Institute of Scientific and Technical Information of China (English)

    陆汉魁; 林祥通; 等

    1994-01-01

    Tissues from 30 human pituitary adenomas are monolayer-cell-cultured in vitro.Hormone secretion of GH,PRL,TSH,LH and FSH by cells into medium is detected by radioimmunoassay .The pattern and amount of hormone(s0 in the medium are used to determine the nature of the cells and thus to establish functional classification of pituitary adenomas.The results show that cell culture technique provides and easy and suitable mode for investigating the nature of pituitary adenomas.Hormone radioimmunoassay of culture medium is precise and reliable and represents the whole adenoma tissue.Further studies can lead to clearer understandngs of the pathology of pituitary adenomas.

  3. Endoscopic transsphenoidal approach to pituitary adenomas invading the cavernous sinus

    Institute of Scientific and Technical Information of China (English)

    TAO Yu-xin; QU Qiu-yi; WANG Zhen-lin; ZHANG Qiu-hang

    2010-01-01

    Background Surgery of pituitary adenomas invading cavernous sinus has always been thought as a challenge due to the complex anatomical structures and high risk of complications. The purpose of this study was to evaluate endoscopic trarssphenoidal approach to pituitary adenomas invading cavernous sinus.Methods The clinical data of 22 patients who admitted to Xuanwu Hospital with pituitary adenomas invading cavernous sinus were analyzed retrospectively. All patients underwent endoscopic transsphenoidal surgery. To expose the surgical field sufficiently, the opening of sellar floor was exceeded the bone overlying the invaded cavernous sinus, and synthetic dura was used to repair and strengthen the sella floor for preventing the leak of cerebrospinal fluid.Results Among 22 patients, total resection was achieved in 14, subtotal resection in 5, and partial resection in 3; no patient underwent insufficient resection. Visual symptoms improved in 7 of 9 patients. In one patient diplopia disappeared.Headache was relieved to various extents in all patients. No serious complications were found. Patient's hospital stay ranged from 7 to 20 days.Conclusion These data suggest that the endoscopic transsphenoid approach is a safe, minimally invasive, and efficient surgical technique, which might be an important therapeutic strategy for the pituitary adenoms invading cavernous sinus.

  4. Three cases of ectopic sphenoid sinus pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Ernest Jan Bobeff

    2017-03-01

    Full Text Available Introduction : Ectopic sphenoid sinus pituitary adenoma is a rare tumour originating from embryologic remnants of Rathke’s pouch. Although it is considered a clinically benign neoplasm, necrosis is encountered in 25% of cases and it can invade adjacent bone structures. Aims : To establish clinical, radiological and histopathological features of ectopic sphenoid sinus pituitary adenoma. Material and methods: Analysis of three cases: two females and one man, aged 61-70. Results : One patient presented with a unilateral hearing loss, the other two with headache and vertigo. They all suffered from type 2 diabetes mellitus. Neurological examination revealed no abnormality. Radiological imaging showed a sphenoid sinus space-occupying soft-tissue lesion with bone erosion in 2 cases and empty sella in 2 patients whereas one had a normal pituitary gland. All were operated on via the transnasal approach. Total resection was achieved in one patient and subtotal in two; in two cases we observed intact sellar dura and in one intact sellar floor. Histopathology showed immunoreactivity for synaptophysin in all cases and cytokeratin in two. The Ki-67 index was less than 2%. Immunohistochemical staining demonstrated growth hormone cells in all cases whereas prolactin and adrenocorticotropin in two. The patients were discharged home in good condition with no neurological deficits. Conclusions : Ectopic sphenoid sinus pituitary adenoma should always be considered in differential diagnosis of sphenoid sinus lesion in the elderly, especially in coexistence with empty sella or type 2 diabetes mellitus. Since ectopic sphenoid sinus pituitary adenoma is a benign lesion, surgical removal is an effective treatment.

  5. Lymphocytic hypophysitis masquerading as pituitary adenoma

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    Rajneesh Mittal

    2012-01-01

    Full Text Available Introduction: Pituitary hypophysitis (PH is characterized by pituitary infiltration of lymphocytes, macrophages, and plasma cells that could lead to loss of pituitary function. Hypophysitis may be autoimmune or secondary to systemic diseases or infections. Based on the histopathological findings PH is classified into lymphocytic, granulomatous, xanthomatous, mixed forms (lymphogranulomatous, xanthogranulomatous, necrotizing and Immunoglobulin- G4 (IgG4 plasmacytic types. Objective: To report a case of lymphocytic hypophysitis (LH. Case Report: A 15-year-old girl presented with history of headache, amenorrhea, and history of polyuria for past 4 months. Initial evaluation had suppressed follicular stimulating hormone (<0.01 mIU/ml, high prolactin levels (110.85 ng/ml and diabetes insipidus (DI. Magnetic resonance imaging of sella was suggestive of pituitary macroadenoma with partial compression over optic chiasma. Patient underwent surgical decompression. Yellowish firm tissue was evacuated and xanthochromic fluid was aspirated. Histopathology was suggestive of LH. She resumed her cycles postoperatively after 4 months, prolactin levels normalized, however, she continues to have DI and is on desmopressin spray. This case has been presented here for its rare presentation in an adolescent girl because it is mostly seen in young females and postpartum period and its unique presentation as an expanding pituitary mass with optic chiasma compression. Conclusion: Definitive diagnosis of LH is based on histopathological evaluation. Therapeutic approach should be based on the grade of suspicion and clinical manifestations of LH.

  6. Identification of Differentially Expressed Genes in Pituitary Adenomas by Integrating Analysis of Microarray Data

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    Peng Zhao

    2015-01-01

    Full Text Available Pituitary adenomas, monoclonal in origin, are the most common intracranial neoplasms. Altered gene expression as well as somatic mutations is detected frequently in pituitary adenomas. The purpose of this study was to detect differentially expressed genes (DEGs and biological processes during tumor formation of pituitary adenomas. We performed an integrated analysis of publicly available GEO datasets of pituitary adenomas to identify DEGs between pituitary adenomas and normal control (NC tissues. Gene function analysis including Gene Ontology (GO, Kyoto Encyclopedia of Genes and Genomes (KEGG pathway enrichment analysis, and protein-protein interaction (PPI networks analysis was conducted to interpret the biological role of those DEGs. In this study we detected 3994 DEGs (2043 upregulated and 1951 downregulated in pituitary adenoma through an integrated analysis of 5 different microarray datasets. Gene function analysis revealed that the functions of those DEGs were highly correlated with the development of pituitary adenoma. This integrated analysis of microarray data identified some genes and pathways associated with pituitary adenoma, which may help to understand the pathology underlying pituitary adenoma and contribute to the successful identification of therapeutic targets for pituitary adenoma.

  7. Expression of Neuropeptide Y and Its Relationship with Molecular and Morphological Changes in Human Pituitary Adenomas.

    Science.gov (United States)

    Jia, Ruichao; Li, Mu; Chang, Binge; Chen, Laichao; Ma, Jingjian

    2015-12-01

    The purpose of this study was to explore the role of neuropeptide Y (NPY) on molecular and histological changes in human pituitary adenomas. The localization of NPY and its expression at the protein, messenger RNA (mRNA), and receptor levels were investigated here in different subcategories of pituitary adenomas. Immunohistochemical staining was performed in all cases to assess expression of NPY. Reverse transcription-polymerase chain reaction (RT-PCR) was used to study the mRNA expression of NPY. NPY subcellular localization was observed using immunoelectron microscopy in cytoplasm, rough endoplasmic reticulum, and cell matrix in four of the six cases of pituitary adenoma. NPY protein expression was observed in 59.6% of 57 cases of pituitary adenoma and in 2 cases of pituitary hyperplasia. mRNA expression of NPY was observed in all 57 cases of pituitary adenoma and in 2 cases of pituitary hyperplasia. Significantly different levels of expression were observed across different subcategories of pituitary adenoma. mRNA expression of Y1R and Y2R was observed across all subcategories of pituitary adenomas, and a positive correlation was observed between NPY and Y2R. In conclusion, evidence is provided here for the expression of NPY and its receptors, Y1R and Y2R, in human pituitary adenoma, and the levels of expression were found to differ across different subcategories. Differences in expression of Y2R in human pituitary adenomas were found to have remarkable statistical significance.

  8. Hypopituitarism after gamma knife radiosurgery for pituitary adenoma.

    Science.gov (United States)

    Zibar Tomšić, Karin; Dušek, Tina; Kraljević, Ivana; Heinrich, Zdravko; Solak, Mirsala; Vučinović, Ana; Ozretić, David; Mihailović Marasanov, Sergej; Hršak, Hrvoje; Kaštelan, Darko

    2017-05-24

    The aim of the study was to investigate the incidence of and risk factors for hypopituitarism after gamma knife radiosurgery (GKRS) for pituitary adenoma. We conducted a retrospective analysis of the pituitary function of 90 patients who underwent GKRS for pituitary adenoma at the University Hospital Centre Zagreb between 2003 and 2014. Twenty seven of them met the inclusion criteria and the others were excluded from the study due to pituitary insufficiency which was present before GKRS. Eighteen patients had non-functioning and 9 patients had secretory adenomas. Median patients' age was 56 years (24-82). GKRS was performed using the Leksell gamma knife Model C. The median prescription radiation dose was 20 Gy (15-25) and the median tumor volume size was 3.4 cm(3) (0.06-16.81). New onset hypopituitarism was defined as a new deficit of one of the three hormonal axes (corticotroph, thyreotroph, or gonadotroph) ≥3 months following GKRS. SPSS was used for statistical analysis, with the significance level at P<0.05. During the median follow-up period of 72 months (range 6-144), 30% of patients developed new hypopituitarism after GKRS. This corresponds to incidence of one new case of hypopituitarism per 15 patient-years. Age, gender, tumor function, tumor volume, suprasellar extension, prescription dose of radiation, as well as dose-volume to the pituitary gland, stalk and hypothalamus were not predictive factors for the development of hypopituitarism. In our cohort of patients with pituitary tumors who underwent GKRS, 30% developed new hypopituitarism during the follow-up period.

  9. MR imaging of growth hormone-secreting pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Masayuki; Ueda, Fumiaki; Fujinaga, Yasunari [Kanazawa Univ. (Japan). School of Medicine] (and others)

    2000-11-01

    We evaluated MR imaging of 51 growth hormonesecreting pituitary adenomas. On T1WI, 22 tumors were isointense with gray matter (GM), nine isointense with GM and white matter (WM), 14 isointense with WM, and six more hyperintense than WM. On T2WI of 45 patients, only fifteen tumors showed hypointensity than WM, 10 were isointense with WM, eight isointense with GM and WM, 12 showed in part isointensity with GM, and one was more hyperintense than GM. The dynamic study demonstrated the tumor more clearly than the delayed study in 10, while the opposite was true for two patients. The dynamic study is inevitable for MR imaging of GH-secreting pituitary adenomas. (author)

  10. Prothymosin-alpha and Ki-67 expression in pituitary adenomas

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    Iga Wierzbicka-Tutka

    2016-11-01

    Full Text Available Introduction: Prothymosin alpha (PTMA, a nuclear oncoprotein involved in cell cycle regulation, is used as a prognostic marker in many cancers. The histopathology of pituitary carcinomas and locally invasive adenomas is indistinguishable from that of benign tumors. A new marker is needed to differentiate these lesions. We evaluated PTMA in pituitary adenomas to determine its usefulness as a prognostic factor of tumor proliferation.Material/Methods: We conducted a retrospective analysis of a group of 27 patients, including 15 females (56% and 12 males (44% with a mean age of 58.6±12 years, who underwent pituitary tumor surgery between 2003 and 2012. The Ki-67 and PTMA-nuclear (PTMA-n and PTMA-cytoplasmic (PTMA-c indices were determined by immunohistochemical staining. We studied histopathological features, clinical symptoms, and magnetic resonance imaging or computed tomography performed before surgery and one year following surgery to evaluate tumor size and progression.Results: The expression of Ki-67 was revealed in 77.8% of adenomas, PTMA-n in 81.5% and PTMA-c in 92.6%. The mean value of the Ki-67 index was 1.8%, PTMA-n was 1.84%, and PTMA-c was 35.6%. There was a significant positive correlation between Ki-67 and PTMA-n (p=0.009. We did not find any correlation between Ki-67, PTMA-c, and tumor progression. PTMA-n was found to be correlated with tumor size (p=0.045 and was higher in the case of gonadotropinomas (p=0.026.Conclusions: The positive nuclear expression of Ki-67 and PTMA was observed in the majority of pituitary adenomas. Neither the expression of Ki-67 nor that of PTMA-c was related to tumor recurrence or local invasion.

  11. Fatal complication after transsphenoidal surgery of pituitary adenoma: case report

    OpenAIRE

    Conceição Aparecida Dornelas; Tereza N. A. G. Nogueira; Evandro T. Alves; River A. B. Coêlho

    2015-01-01

    ABSTRACT The objective of this study was to report a rare fatal complication in the postoperative period of transsphenoidal surgery of the pituitary gland (adenoma), with a brief review of the subject. The patient was a 54-year-old white man with acromegaly and severe heart failure, who after microsurgery developed blood pressure instability within 32 hours after the procedure and died. The autopsy revealed: hypertrophy and ventricular dilation with myocarditis, pericarditis and myocardial fi...

  12. Management of clinically non-functioning pituitary adenoma.

    Science.gov (United States)

    Chanson, Philippe; Raverot, Gerald; Castinetti, Frédéric; Cortet-Rudelli, Christine; Galland, Françoise; Salenave, Sylvie

    2015-07-01

    Clinically NFPA is currently the preferred term for designing all the pituitary adenomas which are not hormonally active (in other words, not associated with clinical syndromes such as amenorrhea-galactorrhea in the context of prolactinomas, acromegaly, Cushing's disease or hyperthyroidism secondary to TSH-secreting adenomas). They account for 15-30% of pituitary adenomas. Diagnosis is usually made either in the context of mass effect due to a macroadenoma or, increasingly, fortuitously during imaging performed for some unrelated purpose; the latter case is known as pituitary incidentaloma. Surgery is indisputably indicated in case of tumoral syndrome, but other aspects of NFPA (hormonal work-up, follow-up, and especially postoperative follow-up, management of remnant or recurrence, the special case of incidentaloma, or apoplexy) remain controversial. The French Endocrinology Society (SFE) therefore set up an expert working group of endocrinologists, neurosurgeons, ophthalmologists, neuroradiologists, pathologists and biologists to draw up guidelines, at the 2012 SFE Congress in Toulouse, France. The present article presents the guidelines suggested by this group of French-speaking experts. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  13. Expression of p53 protein in pituitary adenomas

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    Oliveira M.C.

    2002-01-01

    Full Text Available Inactivating mutations of TP53, a tumor suppressor gene, are associated with abnormal cell proliferation. Although p53 expression is common in many human malignancies, p53 protein has seldom been evaluated in pituitary tumors. When detected, the percentage of p53-positive cells is low, and, in general, it is exclusive for invasive lesions. The aim of the present study was to use immunohistochemistry to determine the presence of p53 protein in pituitary adenomas from tumor samples of 163 surgeries performed in 148 patients (40% male, 60% female. In 35% of the cases the adenoma was nonfunctional, while in the others it was associated with PRL, GH and/or ACTH endocrine hypersecretion syndrome. Macroadenomas were observed in 83.2% of the cases with available neuroimage evaluation, of which 28% invaded the cavernous, sphenoid and/or ethmoidal sinus, bone, third ventricle or subfrontal lobe. p53 protein was detected in 2/148 patients (1.3%. Immunohistochemistry was positive for PRL and GH in these cases. Due to the high percentage of invasive pituitary adenomas found in our study, the low frequency of p53 detection suggests that it is inadequate as a routine marker for aggressiveness and as a predictive factor of tumor behavior.

  14. Anaplastic astrocytoma 14 years after radiotherapy for pituitary adenoma

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    Tamura, Masaru; Misumi, Syuuzou; Kurosaki, Syuuhei; Shibasaki, Takashi; Ohye, Chihiro (Gunma Univ., Maebashi (Japan). School of Medicine)

    1992-04-01

    A case of anaplastic astrocytoma following radiotherapy for growth hormone secreting pituitary adenoma is presented with a review of the literature. A 43 year old female was admitted with signs of acromegaly and hypertension. An eosinophilic pituitary adenoma was subtotally removed by transsphenoidal approach, followed by 60 Gy irradiation using a 2x2 cm lateral field. Fourteen years later at the age of 57, she suffered from headache, recent-memory disturbance and uncinate fits. CT scan and MRI disclosed ring-like enhanced mass lesion in the left temporal lobe, corresponding to the previous irradiated field. {sup 18}F-FDG PET showed hypermetabolism at the lesion. Left frontotemporal craniotomy was performed, and a reddish gray gelatinous tumor containing necrotic center and cyst was partially removed. Histologically, the tumor consisted of hypercellular astrocytic cells with perivascular pseudorosette. Coagulation necrosis at the center of the tumor, and hyalinosis and fibrosis of the blood vessels in and around the tumor, which might have been caused by the antecedent radiotherapy, were recognized. Postoperative radiotherapy and chemotherapy, were given, however, she expired 13 months after the operation. Seven cases, including ours, of malignant glioma following radiotherapy for pituitary adenoma were reported in the literature. A total dose of irradiation varies from 45 to 95 Gy with a mean of 50 Gy. The period of latency before tumor occurrence ranges from 5 to 22 years with a mean of 10 years. The differentiation of radiation-induced gliomas from radionecrosis of the brain is also discussed. (author).

  15. Visual pathway impairment by pituitary adenomas: quantitative diagnostics by diffusion tensor imaging.

    Science.gov (United States)

    Lilja, Ylva; Gustafsson, Oscar; Ljungberg, Maria; Starck, Göran; Lindblom, Bertil; Skoglund, Thomas; Bergquist, Henrik; Jakobsson, Karl-Erik; Nilsson, Daniel

    2017-09-01

    OBJECTIVE Despite ample experience in surgical treatment of pituitary adenomas, little is known about objective indices that may reveal risk of visual impairment caused by tumor growth that leads to compression of the anterior visual pathways. This study aimed to explore diffusion tensor imaging (DTI) as a means for objective assessment of injury to the anterior visual pathways caused by pituitary adenomas. METHODS Twenty-three patients with pituitary adenomas, scheduled for transsphenoidal tumor resection, and 20 healthy control subjects were included in the study. A minimum suprasellar tumor extension of Grade 2-4, according to the SIPAP (suprasellar, infrasellar, parasellar, anterior, and posterior) scale, was required for inclusion. Neuroophthalmological examinations, conventional MRI, and DTI were completed in all subjects and were repeated 6 months after surgery. Quantitative assessment of chiasmal lift, visual field defect (VFD), and DTI parameters from the optic tracts was performed. Linear correlations, group comparisons, and prediction models were done in controls and patients. RESULTS Both the degree of VFD and chiasmal lift were significantly correlated with the radial diffusivity (r = 0.55, p visual pathways that were compressed by pituitary adenomas. The correlation between radial diffusivity and visual impairment may reflect a gradual demyelination in the visual pathways caused by an increased tumor effect. The low level of axial diffusivity found in the patient group may represent early atrophy in the visual pathways, detectable on DTI but not by conventional methods. DTI may provide objective data, detect early signs of injury, and be an additional diagnostic tool for determining indication for surgery in cases of pituitary adenomas.

  16. Análisis de un registro de adenomas pituitarios Analysis of a pituitary adenoma registry

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    Carolina Albiero

    2010-10-01

    Full Text Available Dada la complejidad que reviste el enfoque diagnóstico y terapéutico de los tumores pituitarios, el registro y análisis de la experiencia clínica acumulada es de gran ayuda en la toma de decisiones. En este trabajo se informan datos clínico-terapéuticos, extraídos de un registro computarizado, sobre 519 de un total de 670 pacientes con adenomas pituitarios. Trescientos cuarenta y cinco fueron mujeres (66% y 174 varones (34%, de 14 a 80 años de edad. El diagnóstico final fue: acromegalia en 176, enfermedad de Cushing en 153, prolactinoma en 101 y adenoma clínicamente no-funcionante (ANF en 89. La edad media al momento del diagnóstico de acromegalia fue 43.9 ± 13.5 (16-80, para enfermedad de Cushing 35.7 ± 12.9 (14-72, para prolactinomas 30.0 ± 13.4 (15-79 y para ANF 52.1 ± 15.2 (17-79 años. La creación de un registro institucional de tumores de hipófisis es un instrumento de gran utilidad para el análisis de la experiencia adquirida y constituye una herramienta valiosa para mejorar la estrategia terapéutica, optimizar la relación costo/beneficio y mejorar el cuidado del paciente. Contribuye a la docencia médica, tanto en el pre como en el posgrado y da base a la realización de trabajos de investigación clínica, aportando a la difusión y transferencia de conocimientos.Collection and analysis of data obtained during the clinical treatment of pituitary tumours are of great utility in the decision making process, when facing clinical situations. We report here data on 519 from 670 patients with pituitary adenomas obtained from a computerized registry. Three hundred and forty five were females (66% and 174 males (34%, aged 14-80. Final diagnosis was acromegaly in 176, Cushing's disease in 153, prolactinoma in 101 and clinically non-functioning adenoma in 89. Mean age at diagnosis was 43.9 ± 13.5 (16-80 for acromegalics, 35.7 ± 12.9 (14-72 for Cushing's, 30.0 ± 13.4 (15-79 for prolactinoma and 52.1 ± 15.2 (17-79, for non

  17. [Preservation of the pituitary stalk and the gland in transsphenoidal microsurgery for pituitary adenomas].

    Science.gov (United States)

    Li, Haoyu; Yuan, Xianrui; Liao, Yiwei; Xie, Yuanyang; Zhang, Chi; Li, Juan; Su, Jun; Wang, Xiangyu; Chen, Xiaoyu; Liu, Qing

    2014-02-01

    To improve the surgical outcome of pituitary adenomas by identifying and preserving the pituitary stalk and the gland during surgery. From October 2010 to September 2012, the author from the Department of Neurosurgery of Xiangya Hospital, Central South University operated on 51 patients with pituitary adenoma. During the operations, we carefully identified the normal adenohypophysis, pituitary stalk, neurohypophysis and the abnormal tissues either by direct observation or by medical images, aiming to excise the tumor thoroughly, protect the pituitary function and reduce the postoperative complications. Totally 37 patients (72.5%, 37/51) had total resection of the tumor, 12 (23.5%, 12/51) had subtotal tumor resection and the other 2 had major removal. The gland and the pituitary stalk were well identified and reserved. Detection of hormone content proved that the operation had little effect on the free triiodothyronine (FT3) and adrenocorticotropic hormone (ACTH), while for free tetraiodothyronine (FT4) and thyroid stimulating hormone (TSH) and postoperative followup significant alleviation was found. There was no significant fluctuation for the testosterone in the men preoperatively and postoperatively (all the above results were obtained without hormone replacement therapy). The main postoperative complications were as follows: temporary diabetes insipidus in 5 patients (9.8%, 5/51); electrolyte disorder (the appearance of hyponatremia) in 17 (33.3%, 17/51); and cerebrospinal fluid rhinorrhea and postoperative intracranial infection in 1 (2%, 1/51). No one died during the perioperation period. Microscopic transsphenoidal surgery is effective for pituitary adenomas including tumors violating the cavernous sinus. Accurate identification of the pituitary stalk, the gland and the abnormal tissue during the microscopic transsphenoidal operation plays a critical role in preserving the pituitary function and promoting postoperative rehabilitation.

  18. Severe hyponatremia after transsphenoidal surgery for pituitary adenomas.

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    Boehnert, M; Hensen, J; Henig, A; Fahlbusch, R; Gross, P; Buchfelder, M

    1998-02-01

    Severe hyponatremia has been described after elective surgery with subsequent permanent brain damage. Other authors, however, have noted that morbidity and mortality rates of severe hyponatremia have been greatly overestimated. We retrospectively examined 19 patients (8 male, 11 female) who developed severe hyponatremia (100 to 124 mmol/liter) after transsphenoidal surgery for pituitary adenomas. Eight patients had hormonally inactive adenomas, 5 ACTH-secreting adenomas, 2 GH-secreting adenomas and 4 prolactin-secreting adenomas. The mean age of the patients was 47.5 years, with a range from 16 to 71 years. The mean preoperative serum sodium level was 137.8 mmol/liter. The timing of hyponatremia showed two different patterns. Five patients developed early postoperative hyponatremia (mean 114.0 mmol/liter +/- 4.85) and 14 patients showed the lowest mean serum level one week after surgery (118.1 mmol/liter +/- 6.86). Patients with early hyponatremia had fewer and less severe symptoms than patients with delayed hyponatremia. None of the patients developed seizures or a demyelination syndrome. Despite severe degree of hyponatremia for most of our patients treatment with water restriction and oral sodium supplementation was sufficient.

  19. Signal intensity of magnetic resonance imaging of pituitary adenoma reflects its collagen content

    Institute of Scientific and Technical Information of China (English)

    Hui Wang; Xianrui Yuan; Weixi Jiang

    2006-01-01

    BACKGROUND:At present,results of a few studies demonstrate that preoperative magnetic resonance imagling (MRI)examination reveals the texture of pituitary adenoma,I.e.on the T2-weighted image,solid pituitary adenoma shows weak signal and soft one shows strong signal.Also,solid pituitary adenoma is caused by fibrosis,which is confirmlea.However,some key problems are still in question and disputation,such as how to exactly quantize MRI signal intensity,which signal is used as prediction index,and the relationship of MRI signal and collagen content which reflects the texture of pituitary adenoma,and so on.OBJECTIVE:To observe the relationship of MRI signal intensity of different textures of pituitary adenoma and its collagen content,and investigate the best prediction index of the texture of pituitary adenoma.DESIGN:Case-control observation.SETTING:Department of Neurosurgery,Third Hospital Affiliated to Sun Yat-sen University;Department of Neurosurgery,Xiangya Hospital,Central South University.PARTICIPANTS:Fifty-seven patients with pituitary adenoma,including 32 males and 25 females,aged 20 to 65 years,who received treatment in the Department of Neurosurgery,Xiangya Hospital,Central South University during June 2003 to January 2004.The involved patients were all diagnosed by MRI and confirmed by pathological resection.Informed consents were obtained from all the patients.The samples of above-mentioned patients resected by operation were fixed with 40 g/L formaldehyde for sirius red staining.METHODS:①Accordling to the texture of pituitary adenoma observed in the operation:The 57 samples of pituitary adenoma were divided into 2 groups:non-flbrosis group(n=49)and fibrosis group(n=8).In the non-fibrosis group,the texture of pituitary adenoma was soft,I.e.pituitary adenoma tissue automatically flew out,and could be aspirated by aspirater or erased by curette,and the superior part of saddle could fall in the saddle,In the fibrosis group,pituitary adenoma tissue could be

  20. Application and advance of temozolomide in the treatment of pituitary adenomas

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    Yi-guang LIN

    2015-12-01

    Full Text Available Pituitary adenoma is a common primary tumor in central nervons system. The aggressive pituitary adenomas show invasive characteristics with higher recurrence rate and worse prognosis, which normally need the comprehensive therapy of surgery, radiotherapy and chemical medications. The therapy of aggressive pituitary adenomas by temozolomide and whether O6-methylguanine-DNA methyltransferase (MGMT could predict the curative effect of temozolomide have become hot spots in recent years. This review intends to illustrate the advance of the therapy of aggressive pituitary adenomas by temozolomide. DOI: 10.3969/j.issn.1672-6731.2015.12.017

  1. Outcome of visual acuity after surgical removal of pituitary adenomas

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    Grković Desanka

    2013-01-01

    Full Text Available Introduction. Pituitary adenomas with suprasellar extension may produce anterior visual pathway compression, resulting in characteristic visual deficit. Surgical decompression of these structures prevents further visual deterioration and its postop­ erative recovery. Objective. The aim of this study was to investigate pre­ and postoperative visual acuity (VA in patients with pituitary ad­ enomas, and to detect the influence of prognostic factors, such as symptoms duration, degree of visual acuity reduction and tumor size in the assessment of the prognosis of postoperative visual function. Methods. We analyzed 40 consecutive patients who fulfilled three criteria: evidence of preoperative visual dysfunction, transsphenoidal or transfrontal tumor resection and hystologically verified pituitary adenoma. A visual examination was performed under standard conditions, pre and postoperatively (10 days, one month and six months after surgery. A paired t­test was used to assess the differences of pre­ and postoperative characteristics values, and the Chisquare test of independence in the assessment of the influence of prognostic factors. Results. Postoperative improvement of VA was seen in 84.61% patients (68% eyes. Eyes with preoperative mild and moderate degree of VA reduction showed improvement in 89.65% eyes in contrast to 22.60% eyes with preoperative severe reduction of VA, which was all statistically significant. Eyes in patients with tumor smaller than 20 mm had improvement of VA in 91.66% eyes, while eyes with tumor larger than 40 mm had improvement of VA in 61.11% eyes, which was statistically significant. When symptoms duration was below two years the improvement of VA was detected in 65.38% eyes as related to 50% eyes with symptoms duration exceeding two years, which was not statistically significant. Conclusion. Pituitary adenomas commonly cause visual impairment. Postoperatively the majority of patients show a distinct improvement of

  2. Radiosurgery for pituitary adenomas: evaluation of its efficacy and safety

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    Canteras Miguel M

    2010-11-01

    Full Text Available Abstract Object To assess the effects of radiosurgery (RS on the radiological and hormonal control and its toxicity in the treatment of pituitary adenomas. Methods Retrospective analysis of 42 patients out of the first 48 consecutive patients with pituitary adenomas treated with RS between 1999 and 2008 with a 6 months minimum follow-up. RS was delivered with Gamma Knife as a primary or adjuvant treatment. There were 14 patients with non-secretory adenomas and, among functioning adenomas, 9 were prolactinomas, 9 were adrenocorticotropic hormone-secreting and 10 were growth hormone-secreting tumors. Hormonal control was defined as hormonal response (decline of more than 50% from the pre-RS levels and hormonal normalization. Radiological control was defined as stasis or shrinkage of the tumor. Hypopituitarism and visual deficit were the morbidity outcomes. Hypopituitarism was defined as the initiation of any hormone replacement therapy and visual deficit as loss of visual acuity or visual field after RS. Results The median follow-up was 42 months (6-109 months. The median dose was 12,5 Gy (9 - 15 Gy and 20 Gy (12 - 28 Gy for non-secretory and secretory adenomas, respectively. Tumor growth was controlled in 98% (41 in 42 of the cases and tumor shrinkage ocurred in 10% (4 in 42 of the cases. The 3-year actuarial rate of hormonal control and normalization were 62,4% and 37,6%, respectively, and the 5-year actuarial rate were 81,2% and 55,4%, respectively. The median latency period for hormonal control and normalization was, respectively, 15 and 18 months. On univariate analysis, there were no relationships between median dose or tumoral volume and hormonal control or normalization. There were no patients with visual deficit and 1 patient had hypopituitarism after RS. Conclusions RS is an effective and safe therapeutic option in the management of selected patients with pituitary adenomas. The short latency of the radiation response, the highly

  3. Double, synchronous pituitary adenomas causing acromegaly and Cushing's disease. A case report and review of literature.

    Science.gov (United States)

    Zieliński, Grzegorz; Maksymowicz, Maria; Podgórski, Jan; Olszewski, Włodzimierz T

    2013-06-01

    Double pituitary adenomas are very rare and present up to 1 % of pituitary adenomas in unselected autopsy series and up to 2 % in large surgical series. We report a case of a 47-year-old man presented slight clinical features of acromegaly with 2 years duration. Endocrine evaluation confirmed active acromegaly and revealed adrenocorticotropin hormone-dependent hypercortisolemia. Preoperative magnetic resonance imaging of the pituitary demonstrated clearly separated double microadenomas with different intensity. The patient underwent transsphenoidal surgery and both tumors were completely removed and were fixed separately. The histological and ultrastructural examination confirmed coincidence of the double, clearly separated pituitary adenomas in one gland. Postoperative function of the hypothalamo-hypophyseal axis was normalized. We conclude from this case and a literature review that double endocrinologically active pituitary adenomas leading to acromegaly and Cushing's disease may occur. Additionally, a review of the literature regarding multiple pituitary adenomas has also been performed.

  4. Acromegaly with no pituitary adenoma and no evidence of ectopic source

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    Deepak Khandelwal

    2011-01-01

    Full Text Available More than 99% of patients with acromegaly harbor a growth hormone (GH secreting pituitary adenoma. As the time from onset of signs/symptoms to diagnosis of acromegaly is long (symptom onset to diagnosis is often 4-10 years, pituitary adenomas that cause GH excess are often large and are nearly always visible on conventional magnetic resonance imaging (MRI. However, in rare circumstances, acromegalic patients without an ectopic source will not have imaging evidence of a pituitary adenoma. Management of these patients poses special challenge, and once ectopic source of GH/growth-hormone-releasing hormone (GHRH is ruled out, an exploration of pituitary might be useful. We herein report a case of acromegaly with imaging evidence of sellar floor osteoma, but no pituitary adenoma, and negative work up for an ectopic source of GH/GHRH tumor, and on surgical exploration pituitary adenoma could be identified and removed and confirmed on histopathologic examination.

  5. Temozolomide therapy in patients with aggressive pituitary adenomas or carcinomas.

    Science.gov (United States)

    Losa, Marco; Bogazzi, Fausto; Cannavo, Salvo; Ceccato, Filippo; Curtò, Lorenzo; De Marinis, Laura; Iacovazzo, Donato; Lombardi, Giuseppe; Mantovani, Giovanna; Mazza, Elena; Minniti, Giuseppe; Nizzoli, Maurizio; Reni, Michele; Scaroni, Carla

    2016-02-01

    Temozolomide is effective in some patients with progressive pituitary adenoma or carcinoma. We report a survey study of Italian patients treated with Temozolomide because of aggressive pituitary adenoma or carcinoma resistant to standard therapies. Italian endocrinologists were surveyed and asked to participate into the study. A questionnaire was sent to all those who agreed and had used Temozolomide in at least one patient with pituitary tumor. Database was closed in December 2013. A literature review was also performed. Thirty-one patients were included into the analysis. Mean age at start of Temozolomide treatment was 58.3 ± 1.9 years (± standard error). Six of the 31 (19.4%) Italian patients had a pituitary carcinoma. Twenty-five patients (80.6%) had disease control during Temozolomide treatment, while 6 patients (19.4%) had disease progression. Median follow-up after beginning Temozolomide was 43 months. Thirteen patients had tumor growth after stopping Temozolomide. The 2-year progression-free survival was 47.7% (95% CI 29.5-65.9%), while the 2-year disease control duration was 59.1% (95% CI 39.1-79.1%). Eleven patients died of progressive disease and other two patients of unrelated causes. The 2-year and 4-year overall survival rates were 83.9% (95% CI 70.7-97.1%) and 59.6% (95% CI 40.0-79.2%), respectively. Temozolomide is an additional effective therapeutic option for the treatment of aggressive pituitary tumors. The drug is well tolerated and causes few severe adverse effects. Recurrence of the tumor can occur after an initial positive response and usually portends a grim outcome.

  6. Peroxisome proliferator-activated receptor gamma in the human pituitary gland: expression and splicing pattern in adenomas versus normal pituitary.

    Science.gov (United States)

    Occhi, G; Albiger, N; Berlucchi, S; Gardiman, M; Scanarini, M; Scienza, R; Fassina, A; Mantero, F; Scaroni, C

    2007-07-01

    Pituitary adenomas are slow-growing tumours arising within the pituitary gland. If secreting, they give rise to well-known syndromes such as Cushing's disease or acromegaly; when hormonally inactive, they come to clinical attention often with local mass effects or pituitary deficiency. Peroxisome proliferator-activated receptor gamma (PPARgamma), a nuclear hormone receptor with a key role in fat and glucose metabolism, but also involved in several neoplasia, has recently been detected in pituitary adenomas. In the present study, we evaluated the occurrence and splicing profile of PPARgamma in 43 cases of pituitary adenoma of different subtypes and compared it to 12 normal pituitary glands. By real-time polymerase chain reaction, PPARgamma was expressed as much in adrenocorticotrophic hormone (ACTH)-secreting and ACTH-silent adenomas as in controls, with a moderate underexpression in somatotrophinomas and prolactinomas and overexpression in 54% of nonfunctioning pituitary adenomas (NFPA). There was no apparent qualitative change in the splicing profile of pathological pituitary glands, nor was the presence of specific isoforms with dominant negative effects against PPARgamma detected. Western blotting revealed similar expression levels in the different subgroups of pituitary adenomas and normal glands. Immunohistochemistry confirmed PPARgamma expression in approximately one-half of analysed samples. The intra- and intergroup differences observed in pituitary adenomas may represent new elements in the process of understanding the different clinical responses of Cushing's and Nelson patients to PPARgamma-ligand treatment. Moreover, the higher level of PPARgamma expression detected in the NFPA subgroup may suggest its possible role as a molecular target in these pituitary adenomas, paving the way for investigations on the effectiveness of treatment with thiazolidinediones in such patients.

  7. Human pituitary adenoma proteomics: new progresses and perspectives

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    Xianquan eZhan

    2016-05-01

    Full Text Available Pituitary adenoma (PA is a commonly intracranial neoplasm that impacts on human health through interfering hypothalamus-pituitary-target organ axis systems. The development of proteomics gives great promises in clarification of molecular mechanisms of a pituitary adenoma and discovery of effective biomarkers for prediction, prevention, early-stage diagnosis and treatment of a PA. A great progress in the field of PA proteomics has been made in the past ten years, including (i the use of laser capture microdissection, (ii proteomics analyses of functional PAs (FPAs, such as prolactinoma, invasive and noninvasive nonfunctional PAs (NFPAs, protein post-translational modifications (PTMs including phosphorylation and tyrosine nitration, NFPA heterogeneity, and hormone isoforms, (iii the use of protein antibody array, (iv serum proteomics and peptidomics, (v integration of proteomics and other omics data, and (vi proposal of multi-parameter systematic strategy for a PA. This review will summarize those progresses of proteomics in PAs, point out the existing drawbacks, propose the future research directions, and address the clinical relevance of PA proteomics data, in order to achieve our long-term goal that is use of proteomics to clarify molecular mechanisms, construct molecular networks, and discover effective biomarkers.

  8. [Rol of pituitary tumour-transforming gene (PTTG) in the pituitary adenomas].

    Science.gov (United States)

    Sánchez-Ortiga, Ruth; Sánchez Tejada, Laura; Peiró Cabrera, Gloria; Moreno-Pérez, Oscar; Arias Mendoza, Nieves; Aranda López, F Ignacio; Picó Alfonso, Antonio

    2010-01-01

    The pathogenesis of pituitary tumours is far to be understood. Pituitary transforming tumour gene (PTTG), a gen that induces aneuploidy, genetic instability, cellular proliferation and to stimulate angiogenesis, has been involved in neoplasic transformation and shown overexpressed in many neoplasm as lung, breast, endometrium, thyroid and colon malignant tumours. On the other hand, PTTG has been inconsistently studied in pituitary tumours. The majority of studies have been performed in animals and there is a great variability in the methods used in its determination. The goal of this review is to resume the role of PTTG in tumourogenesis and critically to revise the studies published in humans in order to advance in the knowledge of the pathogenesis of pituitary adenomas and to find clinical useful predictors of the behavior of these tumours.

  9. Fatal complication after transsphenoidal surgery of pituitary adenoma: case report

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    Conceição Aparecida Dornelas

    2015-06-01

    Full Text Available ABSTRACT The objective of this study was to report a rare fatal complication in the postoperative period of transsphenoidal surgery of the pituitary gland (adenoma, with a brief review of the subject. The patient was a 54-year-old white man with acromegaly and severe heart failure, who after microsurgery developed blood pressure instability within 32 hours after the procedure and died. The autopsy revealed: hypertrophy and ventricular dilation with myocarditis, pericarditis and myocardial fibrosis; mesenteric ischemia with transmural coagulation necrosis of the intestinal loops; acute tubular necrosis; and hepatic steatosis. The findings are consistent with cardiogenic shock and abdominal sepsis due to necrosis of the intestinal loops.

  10. Analysis of regulatory networks constructed based on gene coexpression in pituitary adenoma.

    Science.gov (United States)

    Gong, Jie; Diao, Bo; Yao, Guo Jie; Liu, Ying; Xu, Guo Zheng

    2013-12-01

    Gene coexpression patterns can reveal gene collections with functional consistency. This study systematically constructs regulatory networks for pituitary tumours by integrating gene coexpression, transcriptional and posttranscriptional regulation. Through network analysis, we elaborate the incidence mechanism of pituitary adenoma. The Pearson's correlation coefficient was utilized to calculate the level of gene coexpression. By comparing pituitary adenoma samples with normal samples, pituitary adenoma-specific gene coexpression patterns were identified. For pituitary adenoma-specific coexpressed genes, we integrated transcription factor (TF) and microRNA (miRNA) regulation to construct a complex regulatory network from the transcriptional and posttranscriptional perspectives. Network module analysis identified the synergistic regulation of genes by miRNAs and TFs in pituitary adenoma. We identified 142 pituitary adenoma-specific active genes, including 43 TFs and 99 target genes of TFs. Functional enrichment of these 142 genes revealed that the occurrence of pituitary adenoma induced abnormalities in intracellular metabolism and angiogenesis process. These 142 genes were also significantly enriched in adenoma pathway. Module analysis of the systematic regulatory network found that three modules contained elements that were closely related to pituitary adenoma, such as FGF2 and SP1, as well as transcription factors and miRNAs involved in the tumourigenesis. These results show that in the occurrence of pituitary adenoma, miRNA, TF and genes interact with each other. Based on gene expression, the proposed method integrates interaction information from different levels and systematically explains the occurrence of pituitary tumours. It facilitates the tracing of the origin of the disease and can provide basis for early diagnosis of complex diseases or cancer without obvious symptoms.

  11. Analysis of regulatory networks constructed based on gene coexpression in pituitary adenoma

    Indian Academy of Sciences (India)

    Jie Gong; Bo Diao; Guo Jie Yao; Ying Liu; Guo Zheng Xu

    2013-12-01

    Gene coexpression patterns can reveal gene collections with functional consistency. This study systematically constructs regulatory networks for pituitary tumours by integrating gene coexpression, transcriptional and posttranscriptional regulation. Through network analysis, we elaborate the incidence mechanism of pituitary adenoma. The Pearson’s correlation coefficient was utilized to calculate the level of gene coexpression. By comparing pituitary adenoma samples with normal samples, pituitary adenoma-specific gene coexpression patterns were identified. For pituitary adenoma-specific coexpressed genes, we integrated transcription factor (TF) and microRNA (miRNA) regulation to construct a complex regulatory network from the transcriptional and posttranscriptional perspectives. Network module analysis identified the synergistic regulation of genes by miRNAs and TFs in pituitary adenoma. We identified 142 pituitary adenoma-specific active genes, including 43 TFs and 99 target genes of TFs. Functional enrichment of these 142 genes revealed that the occurrence of pituitary adenoma induced abnormalities in intracellular metabolism and angiogenesis process. These 142 genes were also significantly enriched in adenoma pathway. Module analysis of the systematic regulatory network found that three modules contained elements that were closely related to pituitary adenoma, such as FGF2 and SP1, as well as transcription factors and miRNAs involved in the tumourigenesis. These results show that in the occurrence of pituitary adenoma, miRNA, TF and genes interact with each other. Based on gene expression, the proposed method integrates interaction information from different levels and systematically explains the occurrence of pituitary tumours. It facilitates the tracing of the origin of the disease and can provide basis for early diagnosis of complex diseases or cancer without obvious symptoms.

  12. Disulfiram sensitizes pituitary adenoma cells to temozolomide by regulating O6-methylguanine-DNA methyltransferase expression.

    Science.gov (United States)

    Zhao, Yachao; Xiao, Zheng; Chen, Wenna; Yang, Jinsheng; Li, Tao; Fan, Bo

    2015-08-01

    O6-methylguanine-DNA methyltransferase (MGMT) activity is responsible for temozolomide (TMZ) resistance in patients harboring aggressive pituitary adenomas. Recently, disulfiram (DSF) has been shown to induce the loss of MGMT protein and increase TMZ efficacy in glioblastoma cells, while CD133+ nestin+ cells isolated from the cell population have been implicated as pituitary adenoma stem-like cells. However, whether DSF is able to potentiate the cytotoxic effects of TMZ on human pituitary adenoma cells has not been investigated to date. In the present study, CD133+ nestin+ phenotype cells were isolated from primary cultured human pituitary adenoma cells using microbeads. It was found that DSF reduced MGMT protein expression and sensitized human pituitary adenoma cells and stem-like cells to TMZ in vitro, while the proteasome inhibitor PS-341 abrogated the inhibitory effect of DSF on MGMT in vitro. The sensitizing effect of DSF was also verified in primary cultured human pituitary adenoma cells in vivo. The results of the present study suggested that DSF can increase the efficacy of the anti-tumor effect of TMZ on human pituitary adenoma cells and CD133+ nestin+ stem like cells via the ubiquitin-proteasomal MGMT protein elimination route. DSF combined with TMZ may be an effective therapeutic strategy against aggressive pituitary adenomas.

  13. Recurrence of chromophobe pituitary adenomas after operation and postoperative radiotherapy

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    Salmi, J.; Pelkonen, R. (Third Department of Medicine, University of Helsinki, Finland); Grahne, B. (Department of Otorhinolaryngology, University oF Helsinki, finland); Valtonen, S. (Department of Neurosurgery, University of Helsinki, Finland)

    1982-01-01

    The rate of recurrence is reported in a prospective study of 56 patients (28 men, 28 women) with large chromophobe pituitary adenoma (with or without hyperprolactinemia). The surgical approach was transfrontal in 44 and transseptospehnoidal in 12 patients. Cryoapplication was combined with the transsphenoidal operation. All but one patient received postopertive pituitary irradiation. Altogether, 11 (20 %) clinical relapses (10 men) occurred between 0.5 and 6 years after the transfrontal operation. Patients that relapsed had had larger tumors than those remaining in remission. Occurence of the tumors appeared with a deterioration of the visual field defect in 9 patients. There were no differences in the degrees of hypopituitarism in patients who relapsed as compared to patients remaining in remission.

  14. Progress in the diagnosis and classification of pituitary adenomas

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    Luis V Syro

    2015-06-01

    Full Text Available Pituitary adenomas are common neoplasms. Their classification is based upon size, invasion of adjacent structures, sporadic or familial cases, biochemical activity, clinical manifestations, morphological characteristics, response to treatment and recurrence. Although they are considered benign tumors, some of them are difficult to treat due to their tendency to recur, despite standardized treatment. Functional tumors present other challenges for normalizing their biochemical activity. Novel approaches for early diagnosis as well as different perspectives on classification may help to identify subgroups of patients with similar characteristics, creating opportunities to match each patient with the best personalized treatment option. In this paper we present the progress in the diagnosis and classification of different subgroups of patients with pituitary tumors that may be managed with specific considerations according to their tumor subtype.

  15. Radiation therapy in the multimodal treatment approach of pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Becker, G. [Klinik am Eichert, Goeppingen (Germany). Dept. of Radiooncology and Radiation Therapy; Radiooncologic Univ. Clinic, Tuebingen (Germany); Kocher, M.; Mueller, R.P. [Koeln Univ. (Germany). Clinic of Radiation Therapy; Kortmann, R.D.; Paulsen, F.; Jeremic, B.; Bamberg, M. [Radiooncologic Univ. Clinic, Tuebingen (Germany)

    2002-04-01

    In this paper, literature will be reviewed to assess the role of modern radiotherapy and radiosurgery in the management of pituitary adenomas. Material and Methods: Nowadays, magnetic resonance imaging for the definition of the target volume and a real three-dimensional (3-D) treatment planning with field conformation and the possibility for non-coplanar irradiation has to be recommended. Most groups irradiate these benign tumors with single doses of 1.8-2.0 Gy up to a total dose of 45 Gy or 50.4 Gy in extensive parasellar adenomas. Adenomas are mostly small, well circumscribed lesions, and have, therefore, attracted the use of stereotactically guided high-precision irradiation techniques which allow extreme focussing and provide steep dose gradients with selective treatment of the target and optimal protection of the surrounding brain tissue. Results: Radiation therapy controls tumor growth in 80-98% of patients with non-secreting adenomas and 67-89% for endocrine active tumors. Reviewing the recent literature including endocrine active and non-secreting adenomas, irradiated postoperatively or in case of recurrence the 5-, 10- and 15-year local control rates amount 92%, 89% and 79%. In cases of microprolactinoma primary therapy consists of dopamine agonists. Irradiation should be preferred in patients with macroprolactinomas, when drug therapy and/or surgery failed or for patients medically unsuitable for surgery. Reduction and control of prolactin secretion can be achieved in 44-70% of patients. After radiotherapy in acromegaly patients somatomedin-C and growth hormone concentrations decrease to normal levels in 70-90%, with a decrease rate of 10-30% per year. Hypercortisolism is controlled in 50-83% of adults and 80% of children with Cushing's disease, generally in less than 9 months. Hypopituitarism is the most common side effect of pituitary irradiation with an incidence of 13-56%. Long-term overall risk for brain necrosis in a total of 1,388 analyzed

  16. Human Pituitary Adenoma Proteomics: New Progresses and Perspectives

    Science.gov (United States)

    Zhan, Xianquan; Wang, Xiaowei; Cheng, Tingting

    2016-01-01

    Pituitary adenoma (PA) is a common intracranial neoplasm that impacts on human health through interfering hypothalamus–pituitary–target organ axis systems. The development of proteomics gives great promises in the clarification of molecular mechanisms of a PA and discovery of effective biomarkers for prediction, prevention, early-stage diagnosis, and treatment for a PA. A great progress in the field of PA proteomics has been made in the past 10 years, including (i) the use of laser-capture microdissection, (ii) proteomics analyses of functional PAs (such as prolactinoma), invasive and non-invasive non-functional pituitary adenomas (NFPAs), protein post-translational modifications such as phosphorylation and tyrosine nitration, NFPA heterogeneity, and hormone isoforms, (iii) the use of protein antibody array, (iv) serum proteomics and peptidomics, (v) the integration of proteomics and other omics data, and (vi) the proposal of multi-parameter systematic strategy for a PA. This review will summarize these progresses of proteomics in PAs, point out the existing drawbacks, propose the future research directions, and address the clinical relevance of PA proteomics data, in order to achieve our long-term goal that is use of proteomics to clarify molecular mechanisms, construct molecular networks, and discover effective biomarkers. PMID:27303365

  17. Image-guided endoscopic transnasal removal of recurrent pituitary adenomas.

    Science.gov (United States)

    Lasio, Giovanni; Ferroli, Paolo; Felisati, Giovanni; Broggi, Giovanni

    2002-07-01

    To assess the role that neuronavigation plays in assisting endoscopic transsphenoidal reoperations for recurrent pituitary adenomas. During a 45-month period, 19 endoscopic endonasal transsphenoidal reoperations were performed for recurrent pituitary adenomas. In 11 of 19 patients, the procedure was performed with the aid of an optically guided system. Clinical records were reviewed retrospectively, with attention to the following: comparison of baseline clinical data, the duration of surgery, and the postoperative course and complications of both image-guided and non-image-guided endoscopic reoperations. In addition, to test the reliability of the neuronavigation system, we made measurements of intraoperative accuracy in five additional transnasal endoscopic procedures in "virgin" noses and sphenoidal sinuses. In both groups studied, we found no difference with regard to either morbidity or mortality, which were null. The mean setup time was 13 minutes shorter in non-image-guided procedures (P = 0.021), and the operative time was 36 minutes shorter in image-guided procedures (P = 0.038). No other statistically significant differences were found between the two groups. In all cases, we found that the system performed without malfunction. Continuous information regarding instrument location and trajectory was provided to the surgeon. Measurements of the intraoperative accuracy in the axial, coronal, and sagittal planes indicated a mean intraoperatively verified system error of 1.6 +/- 0.6 mm. Neuronavigation can be applied during endonasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It makes reoperation easier, faster, and probably safer.

  18. Radiotherapy for pituitary adenomas: long-term outcome and complications

    Energy Technology Data Exchange (ETDEWEB)

    Rim, Chai Hong; Yang, Dae Sik; Park, Young Je; Yoon, Won Sup; Lee, Jung AE; Kim, Chul Yong [Korea University Medical Center, Seoul (Korea, Republic of)

    2011-09-15

    To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas. We retrospectively reviewed the medical records of 60 patients treated with EBRT for pituitary adenoma at Korea University Medical Center from 1996 and 2006. Thirty-fi ve patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had received RT alone. Median total dose was 54 Gy (range, 36 to 61.2 Gy). The definition of tumor progression were as follows: evidence of tumor progression on computed tomography or magnetic resonance imaging, worsening of clinical sign requiring additional operation or others, rising serum hormone level against a previously stable or falling value, and failure of controlling serum hormone level so that the hormone level had been far from optimal range until last follow-up. Age, sex, hormone secretion, tumor extension, tumor size, and radiation dose were analyzed for prognostic significance in tumor control. Median follow-up was 5.7 years (range, 2 to 14.4 years). The 10-year actuarial local control rates for non-secreting and secreting adenomas were 96% and 66%, respectively. In univariate analysis, hormone secretion was significant prognostic factor (p = 0.042) and cavernous sinus extension was marginally significant factor (p = 0.054) for adverse local control. All other factors were not significant. In multivariate analysis, hormone secretion and gender were significant. Fifty-three patients had mass-effect symptoms (headache, dizziness, visual disturbance, hypopituitarism, loss of consciousness, and cranial nerve palsy). A total of 17 of 23 patients with headache and 27 of 34 patients with visual impairment were improved. Twenty-seven patients experienced symptoms of endocrine hypersecretion (galactorrhea, amenorrhea, irregular menstruation, decreased libido, gynecomastia, acromegaly, and Cushing

  19. Differential gene expression by fiber-optic beadarray and pathway in adrenocorticotrophin-secreting pituitary adenomas

    Institute of Scientific and Technical Information of China (English)

    JIANG Zhi-quan; GUI Song-bo; ZHANG Ya-zhuo

    2010-01-01

    Background Adrenocorticotrophin (ACTH)-secreting pituitary adenomas account for approximately 7%-14% of all pituitary adenomas, but its pathogenesis is still enigmatic. This study aimed to explore mechanisms underlying the pathogenesis of ACTH-secreting pituitary adenomas.Methods We used fiber-optic beadarray to examine gene expression in three ACTH-secreting adenomas compared with three normal pituitaries. Four differentially expressed genes from the three ACTH-secreting adenomas and three normal pituitaries were chosen randomly for validation by reverse transcriptase-real time quantitative polymerase chain reaction (RT-qPCR). We then analyzed the differentially expressed gene profile with Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway.Results Fiber-optic beadarray analysis showed that the expression of 28 genes and 8 expressed sequence tags (ESTs)were significantly increased and the expression of 412 genes and 31 ESTs were significantly decreased. Bioinformatic and pathway analysis showed that the genes HIGD1B, EPS8, HPGD, DAPK2, and IGFBP3 and the transforming growth factor (TGF)-β signaling pathway and extracellular matrix (ECM)-receptor interaction pathway may play important roles in tumorigenesis and progression of ACTH-secreting pituitary adenomas.Conclusions Our data suggest that numerous aberrantly expressed genes and several pathways are involved in the pathogenesis of ACTH-secreting pituitary adenomas. Fiber-optic beadarray combined with pathway analysis of differential gene expression appears to be a valid method of investigating tumour pathogenesis.

  20. Endoscopic endonasal trans-sphenoid surgery of pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Y R Yadav

    2012-01-01

    Full Text Available Endoscopic endonasal trans-sphenoid surgery (EETS is increasingly used for pituitary lesions. Pre-operative CT and MRI scans and peroperative endoscopic visualization can provide useful anatomical information. EETS is indicated in sellar, suprasellar, intraventricular, retro-infundibular, and invasive tumors. Recurrent and residual lesions, pituitary apoplexy and empty sella syndrome can be managed by EETS. Modern neuronavigation techniques, ultrasonic aspirators, ultrasonic bone curette can add to the safety. The binostril approach provides a wider working area. High definition camera is much superior to three-chip camera. Most of the recent reports favor EETS in terms of safety, quality of life and tumor resection, hospital stay, better endocrinological, and visual outcome as compared to the microscopic technique. Nasal symptoms, blood loss, operating time are less in EETS. Various naso-septal flaps and other techniques of CSF leak repair could help reduce complications. Complications can be further reduced after achieving the learning curve, good understanding of limitations with proper patient selection. Use of neuronavigation, proper post-operative care of endocrine function, establishing pituitary center of excellence and more focused residency and endoscopic fellowship training could improve results. The faster and safe transition from microscopic to EETS can be done by the team concept of neurosurgeon/otolaryngologist, attending hands on cadaveric dissection, practice on models, and observation of live surgeries. Conversion to a microscopic or endoscopic-assisted approach may be required in selected patients. Multi-modality treatment could be required in giant and invasive tumors. EETS appears to be a better surgical option in most pituitary adenoma.

  1. Endoscopic endonasal trans-sphenoid surgery of pituitary adenoma.

    Science.gov (United States)

    Yadav, Yr; Sachdev, S; Parihar, V; Namdev, H; Bhatele, Pr

    2012-09-01

    Endoscopic endonasal trans-sphenoid surgery (EETS) is increasingly used for pituitary lesions. Pre-operative CT and MRI scans and peroperative endoscopic visualization can provide useful anatomical information. EETS is indicated in sellar, suprasellar, intraventricular, retro-infundibular, and invasive tumors. Recurrent and residual lesions, pituitary apoplexy and empty sella syndrome can be managed by EETS. Modern neuronavigation techniques, ultrasonic aspirators, ultrasonic bone curette can add to the safety. The binostril approach provides a wider working area. High definition camera is much superior to three-chip camera. Most of the recent reports favor EETS in terms of safety, quality of life and tumor resection, hospital stay, better endocrinological, and visual outcome as compared to the microscopic technique. Nasal symptoms, blood loss, operating time are less in EETS. Various naso-septal flaps and other techniques of CSF leak repair could help reduce complications. Complications can be further reduced after achieving the learning curve, good understanding of limitations with proper patient selection. Use of neuronavigation, proper post-operative care of endocrine function, establishing pituitary center of excellence and more focused residency and endoscopic fellowship training could improve results. The faster and safe transition from microscopic to EETS can be done by the team concept of neurosurgeon/otolaryngologist, attending hands on cadaveric dissection, practice on models, and observation of live surgeries. Conversion to a microscopic or endoscopic-assisted approach may be required in selected patients. Multi-modality treatment could be required in giant and invasive tumors. EETS appears to be a better surgical option in most pituitary adenoma.

  2. GROWTH HORMONE-, ALPHA-SUBUNIT AND THYROTROPIN-COSECRETING PITUITARY-ADENOMA IN FAMILIAL SETTING OF PITUITARY-TUMOR

    NARCIS (Netherlands)

    LINKS, TP; MONKELBAAN, JF; DULLAART, RPF; VANHAEFTEN, TW

    1993-01-01

    A patient with acromegaly and hyperthyroidism due to a growth hormone-, thyrotrophin- and alpha-subunit-secreting pituitary adenoma is described. His deceased father had suffered from a pituitary tumour, and was likely to have had acromegaly as well. Plasma growth hormone and insulin-like growth fac

  3. Endoscopic Endonasal Extended Approaches for the Management of Large Pituitary Adenomas.

    Science.gov (United States)

    Cappabianca, Paolo; Cavallo, Luigi Maria; de Divitiis, Oreste; de Angelis, Michelangelo; Chiaramonte, Carmela; Solari, Domenico

    2015-07-01

    The management of giant and large pituitary adenomas with wide intracranial extension or infrasellar involvement of nasal and paranasal cavities is a big challenge for neurosurgeons and the best surgical approach indications are still controversial. Endoscopic extended endonasal approaches have been proposed as a new surgical technique for the treatment of such selected pituitary adenomas. Surgical series coming from many centers all around the world are flourishing and results in terms of outcomes and complications seem encouraging. This technique could be considered a valid alternative to the transcranial route for the management of giant and large pituitary adenomas.

  4. Seesaw nystagmus caused by giant pituitary adenoma: case report Nistagmo em gangorra causado por adenoma pituitário gigante: relato de caso

    OpenAIRE

    Frederico Castelo Moura; Allan Christian Pieroni Gonçalves; Mário Luiz Ribeiro Monteiro

    2006-01-01

    Giant pituitary adenomas are uncommonly large tumors, greater than 4 cm in size that can produces endocrine symptoms, visual loss and cranial nerve palsies. We report the rare occurrence of seesaw nystagmus as the presenting sign of giant pituitary adenoma. A 50-year-old man presented with headache associated with visual loss and seesaw nystagmus. Perimetry revealed bitemporal hemianopia and magnetic resonance imaging showed a giant pituitary adenoma. After surgery, nystagmus disappeared. Our...

  5. Ganglion cell tumours in the sella turcica in close morphological connection with pituitary adenomas.

    Science.gov (United States)

    Matyja, Ewa; Maksymowicz, Maria; Grajkowska, Wiesława; Zieliński, Grzegorz; Kunicki, Jacek; Bonicki, Wiesław; Witek, Przemysław; Naganska, Ewa

    2015-01-01

    Ganglion cell tumours in the sellar region are uncommon. They are usually associated with pituitary adenomas, while isolated ganglion cell neoplasms are extremely rare. We report the clinicopathological studies of five cases diagnosed as ganglion cell tumours located in the intrasellar region: four mixed/collision tumours composed of gangliocytoma and pituitary adenoma, and one isolated ganglioglioma unrelated to adenoma. Clinically, two patients presented with acromegaly, while three others were initially diagnosed as non-functioning adenomas. In four cases, the histopathological examination of surgical specimens revealed intermixed lesions composed of pituitary adenoma and ganglion cell elements. The adenomas appeared to secrete growth hormone. Electron microscopy enabled identification of the sparsely granulated somatotroph cells. Neoplastic neuronal lesions were composed of mature ganglion cells, including binucleate or multinucleate cells. In all cases, boundaries between adenomatous and gangliocytic components were not clearly demarcated, and numerous gangliocytic cells were closely intermingled with adenomatous tissue. One case lacked endocrine symptoms, and no pituitary adenoma was identified in the surgically excised material; it was finally diagnosed as low-grade ganglioglioma. The etiopathogenesis of ganglion cell neoplasms in the sellar region is not clearly defined. Our study revealed that if ganglion cell neoplasms were combined with adenoma, both neoplastic components were closely related to each other, and numerous neuronal elements were strictly intermingled with adenoma cells. Such a tissue pattern indicates that these neoplastic changes, including their common respective etiopathogeneses, are closely related. The identification of both components in sellar regions may have some nosological implications.

  6. Stereotactic Irradiation of GH-Secreting Pituitary Adenomas

    Directory of Open Access Journals (Sweden)

    G. Minniti

    2012-01-01

    Full Text Available Radiotherapy (RT is often employed in patients with acromegaly refractory to medical and/or surgical interventions in order to prevent tumour regrowth and normalize elevated GH and IGF-I levels. It achieves tumour control and hormone normalization up to 90% and 70% of patients at 10–15 years. Despite the excellent tumour control, conventional RT is associated with a potential risk of developing late toxicity, especially hypopituitarism, and its role in the management of patients with GH-secreting pituitary adenomas remains a matter of debate. Stereotactic techniques have been developed with the aim to deliver more localized irradiation and minimize the long-term consequences of treatment, while improving its efficacy. Stereotactic irradiation can be given in a single dose as stereotactic radiosurgery (SRS or in multiple doses as fractionated stereotactic radiotherapy (FSRT. We have reviewed the recent published literature on stereotactic techniques for GH-secreting pituitary tumors with the aim to define the efficacy and potential adverse effects of each of these techniques.

  7. Transsphenoidal approach for pituitary adenomas in patients with McCune-Albright syndrome.

    Science.gov (United States)

    Dou, Wanchen; Di, Xiao; Wang, Renzhi; Zhu, Huijuan; Yao, Yong; Deng, Kan; Feng, Ming; Li, Guilin; Wei, Junji

    2013-06-01

    The feasibility of transsphenoidal approach under a guidance of neuronavigation was explored to remove pituitary adenomas for patients with McCune-Albright syndrome (MAS). From August, 2008 to July, 2010, there were 5 patients diagnosed with MAS associated with a pituitary adenoma in our department of Peking Union Medical College Hospital. All the patients underwent transsphenoidal surgery for the removal of pituitary adenomas with the assistant of neuronavigation and all the procedures went uneventfully. Four of the five patients have got cured radiologically by imaging and 3 of them have got cured based on endocrinological criteria. Transsphenoidal approach under the neuronavigational guidance is a safe and effective management for the MAS patients with pituitary adenomas.

  8. Accuracy of Surgeon's Estimation of Sella Margins during Endoscopic Surgery for Pituitary Adenomas: Verification Using Neuronavigation

    National Research Council Canada - National Science Library

    Wang, Yi; Thiryayi, Wasiq; Ramaswamy, Ragu; Gnanalingham, Kanna

    2011-01-01

    ... types of pathology in which neuronavigation is of most benefit. We performed a prospective cohort study of 32 consecutive patients undergoing image-guided endoscopic transsphenoidal surgery for pituitary adenomas...

  9. Advancing Treatment of Pituitary Adenomas through Targeted Molecular Therapies: The Acromegaly and Cushing Disease Paradigms

    Science.gov (United States)

    Mooney, Michael A.; Simon, Elias D.; Little, Andrew S.

    2016-01-01

    The current treatment of pituitary adenomas requires a balance of conservative management, surgical resection, and in select tumor types, molecular therapy. Acromegaly treatment is an evolving field where our understanding of molecular targets and drug therapies has improved treatment options for patients with excess growth hormone levels. We highlight the use of molecular therapies in this disease process and advances in this field, which may represent a paradigm shift for the future of pituitary adenoma treatment. PMID:27517036

  10. Pituitary mammosomatotroph adenomas develop in old mice transgenic for growth hormone-releasing hormone

    DEFF Research Database (Denmark)

    Asa, S L; Kovacs, K; Stefaneanu, L

    1990-01-01

    It has been shown that mice transgenic for human growth hormone-releasing hormone (GRH) develop hyperplasia of pituitary somatotrophs and mammosomatotrophs, cells capable of producing both growth hormone and prolactin, by 8 months of age. We now report for the first time that old GRH-transgenic m......-transgenic mice, 16 to 24 months of age, develop pituitary mammosomatotroph adenomas. These findings provide conclusive evidence that protracted stimulation of secretory activity can cause proliferation, hyperplasia and adenoma of adenohypophysial cells....

  11. Advancing Treatment of Pituitary Adenomas through Targeted Molecular Therapies: The Acromegaly & Cushing Disease Paradigms

    Directory of Open Access Journals (Sweden)

    Michael Anthony Mooney

    2016-07-01

    Full Text Available The current treatment of pituitary adenomas requires a balance of conservative management, surgical resection, and in select tumor types, molecular therapy. Acromegaly treatment is an evolving field where our understanding of molecular targets and drug therapies has improved treatment options for patients with excess growth hormone levels. We highlight the use of molecular therapies in this disease process and advances in this field, which may represent a paradigm shift for the future of pituitary adenoma treatment.

  12. [Pituitary adenomas--where is the treatment heading at the beginning of the 21st century?].

    Science.gov (United States)

    Marek, J

    2010-07-01

    To treat pituitary adenomas, three modes of treatment are usually combined: neurosurgery, radiation and pharmacological. Prolactinomas are an exception with predominantly pharmacological management. Patients with acromegaly are usually diagnosed late and thus many neurosurgeries fail to completely remove the adenoma. Any residual tumour tissue is usually irradiated with the Leksell Gamma Knife, and dopamine agonists, somatostatine analogues or growth hormone receptor antagonists are used to normalize the hormonal hypersecretion until the complete effect of the radiation. The same surgical and Gamma Knife procedures are used in patients with the Cushing's disease and TSH-secreting adenomas. Ketoconazole, metyrapone and cabergoline are used until the radiation effect in the Cushing's disease is complete, similarly, somatostatine analogues are used in TSH-secreting adenomas. Nonfunctional adenomas are less responsive to pharmacological treatment. Proautophagic cytostatic temozolamide has been used in aggressive pituitary adenomas and carcinomas.

  13. BIM-23A760 influences key functional endpoints in pituitary adenomas and normal pituitaries: molecular mechanisms underlying the differential response in adenomas.

    Science.gov (United States)

    Ibáñez-Costa, Alejandro; López-Sánchez, Laura M; Gahete, Manuel D; Rivero-Cortés, Esther; Vázquez-Borrego, Mari C; Gálvez, María A; de la Riva, Andrés; Venegas-Moreno, Eva; Jiménez-Reina, Luis; Moreno-Carazo, Alberto; Tinahones, Francisco J; Maraver-Selfa, Silvia; Japón, Miguel A; García-Arnés, Juan A; Soto-Moreno, Alfonso; Webb, Susan M; Kineman, Rhonda D; Culler, Michael D; Castaño, Justo P; Luque, Raúl M

    2017-02-09

    Chimeric somatostatin/dopamine compounds such as BIM-23A760, an sst2/sst5/D2 receptors-agonist, have emerged as promising new approaches to treat pituitary adenomas. However, information on direct in vitro effects of BIM-23A760 in normal and tumoral pituitaries remains incomplete. The objective of this study was to analyze BIM-23A760 effects on functional parameters (Ca(2+) signaling, hormone expression/secretion, cell viability and apoptosis) in pituitary adenomas (n = 74), and to compare with the responses of normal primate and human pituitaries (n = 3-5). Primate and human normal pituitaries exhibited similar sst2/sst5/D2 expression patterns, wherein BIM-23A760 inhibited the expression/secretion of several pituitary hormones (specially GH/PRL), which was accompanied by increased sst2/sst5/D2 expression in primates and decreased Ca(2+) concentration in human cells. In tumoral pituitaries, BIM-23A760 also inhibited Ca(2+) concentration, hormone secretion/expression and proliferation. However, BIM-23A760 elicited stimulatory effects in a subset of GHomas, ACTHomas and NFPAs in terms of Ca(2+) signaling and/or hormone secretion, which was associated with the relative somatostatin/dopamine-receptors levels, especially sst5 and sst5TMD4. The chimeric sst2/sst5/D2 compound BIM-23A760 affects multiple, clinically relevant parameters on pituitary adenomas and may represent a valuable therapeutic tool. The relative ssts/D2 expression profile, particularly sst5 and/or sst5TMD4 levels, might represent useful molecular markers to predict the ultimate response of pituitary adenomas to BIM-23A760.

  14. BIM-23A760 influences key functional endpoints in pituitary adenomas and normal pituitaries: molecular mechanisms underlying the differential response in adenomas

    Science.gov (United States)

    Ibáñez-Costa, Alejandro; López-Sánchez, Laura M.; Gahete, Manuel D.; Rivero-Cortés, Esther; Vázquez-Borrego, Mari C.; Gálvez, María A.; de la Riva, Andrés; Venegas-Moreno, Eva; Jiménez-Reina, Luis; Moreno-Carazo, Alberto; Tinahones, Francisco J.; Maraver-Selfa, Silvia; Japón, Miguel A.; García-Arnés, Juan A.; Soto-Moreno, Alfonso; Webb, Susan M.; Kineman, Rhonda D.; Culler, Michael D.; Castaño, Justo P.; Luque, Raúl M.

    2017-01-01

    Chimeric somatostatin/dopamine compounds such as BIM-23A760, an sst2/sst5/D2 receptors-agonist, have emerged as promising new approaches to treat pituitary adenomas. However, information on direct in vitro effects of BIM-23A760 in normal and tumoral pituitaries remains incomplete. The objective of this study was to analyze BIM-23A760 effects on functional parameters (Ca2+ signaling, hormone expression/secretion, cell viability and apoptosis) in pituitary adenomas (n = 74), and to compare with the responses of normal primate and human pituitaries (n = 3–5). Primate and human normal pituitaries exhibited similar sst2/sst5/D2 expression patterns, wherein BIM-23A760 inhibited the expression/secretion of several pituitary hormones (specially GH/PRL), which was accompanied by increased sst2/sst5/D2 expression in primates and decreased Ca2+ concentration in human cells. In tumoral pituitaries, BIM-23A760 also inhibited Ca2+ concentration, hormone secretion/expression and proliferation. However, BIM-23A760 elicited stimulatory effects in a subset of GHomas, ACTHomas and NFPAs in terms of Ca2+ signaling and/or hormone secretion, which was associated with the relative somatostatin/dopamine-receptors levels, especially sst5 and sst5TMD4. The chimeric sst2/sst5/D2 compound BIM-23A760 affects multiple, clinically relevant parameters on pituitary adenomas and may represent a valuable therapeutic tool. The relative ssts/D2 expression profile, particularly sst5 and/or sst5TMD4 levels, might represent useful molecular markers to predict the ultimate response of pituitary adenomas to BIM-23A760. PMID:28181484

  15. Xanthomatous Hypophysitis Mimicking a Pituitary Adenoma: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Laura Aste

    2010-01-01

    Full Text Available Background. Hypophysitis is an inflammatory disease of the pituitary gland that may mimic pituitary tumors clinically and radiologically. Case Description. We report a case of a xanthomatous hypophysitis initially diagnosed as pituitary adenoma. A 31-year-old woman presented with headache, diabetes insipidus, and amenorrhea. A head CT scan showed no intrasellar changes, while an MRI scan showed a sellar cystic mass. An endocrinological work up revealed mild hypocortisolism and diabetes insipidus (DI. Transsphenoidal surgery was performed. The intraoperative histological examination suggested a pituitary adenoma. The removed tissue showed central necrosis surrounded by accumulation of foamy cells and xanthomatous epithelioid cells. The patient made an uneventful postoperative recovery, Nevertheless, DI persisted and the adenohypophysis hypofunction did not recover. Conclusion. We describe an unusual inflammatory lesion of the pituitary gland mimicking an adenoma. A high level of clinical suspicion of inflammatory disorders is necessary for correct diagnosis and optimal management.

  16. Matrix metalloproteinase-9 and -2 and tissue inhibitor of matrix metalloproteinase-2 in invasive pituitary adenomas

    Science.gov (United States)

    Liu, Hong-Yan; Gu, Wei-Jun; Wang, Cheng-Zhi; Ji, Xiao-Jian; Mu, Yi-Ming

    2016-01-01

    Abstract The extracellular matrix is important for tumor invasion and metastasis. Normal function of the extracellular matrix depends on the balance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). The objective of this meta-analysis was to assess the relationship between expression of MMP-9, MMP-2, and TIMP-2 and invasion of pituitary adenomas. We searched Pubmed, Embase, and the Chinese Biomedical Database up to October 2015. RevMan 5.1 software (Cochrane Collaboration, Copenhagen, Denmark) was used for statistical analysis. We calculated the standardized mean difference (SMD) for data expressed as mean ± standard deviation because of the difference in the detection method. Twenty-four studies (1320 patients) were included. MMP-9 expression was higher in the patients with invasive pituitary adenomas (IPAs) than patients with noninvasive pituitary adenomas (NIPAs) with detection methods of IHC [odds ratio (OR) = 5.48, 95% confidence interval (CI) = 2.61–11.50, P prolactinomas and nonfunctioning pituitary adenomas was also no difference (OR = 1.03, 95% CI = 0.48–2.20, P = 0.95). The results indicated that MMP-9 and -2 may be correlated with invasiveness of pituitary adenomas, although their relationship with functional status of pituitary adenomas is still not clear. TIMP-2 expression in IPAs needs to be investigated further. PMID:27310993

  17. Ectopic Suprasellar Thyrotropin-Secreting Pituitary Adenoma: Case Report and Literature Review.

    Science.gov (United States)

    Wang, Qing; Lu, Xiao-Jie; Sun, Jun; Wang, Jing; Huang, Ci You; Wu, Zhi Feng

    2016-11-01

    Ectopic thyroid-stimulating hormone (TSH)-secreting pituitary adenomas are rare and can often be misdiagnosed as primary hyperthyroidism. We present a case of an ectopic suprasellar TSH-secreting pituitary adenoma. A literature review of previously reported ectopic TSH-secreting and suprasellar pituitary adenomas is included to illustrate the clinical characteristics of this disease entity and the diversity of operative approaches to treating ectopic suprasellar pituitary adenomas. A 46-year-old man presented with typical clinical signs of hyperthyroidism and a history of progressive visual field impairment and vision loss. Laboratory investigations revealed that the patient had elevated levels of free thyroxine and free triiodothyronine and a normal level of TSH. Neuro-ophthalmologic examination showed right eye/left eye = 1.0/0.6 and left temporal hemianopia. Magnetic resonance imaging revealed a mass located in the suprasellar space. The patient underwent preoperative short-term octreotide treatment followed by gross total resection of the tumor via the extended endoscopic endonasal transtuberculum sellar approach. At 6-month follow-up evaluation, the patient's endocrinologic function tests met the criteria for cure, and magnetic resonance imaging revealed a normal pituitary gland and stalk with no tumor recurrence. Histologic diagnosis confirmed the presence of a TSH-secreting pituitary adenoma. To the best of our knowledge, this is the first reported case of an ectopic suprasellar TSH-secreting pituitary adenoma. Preoperative preparation and complete resection are the keys to a cure. The extended endoscopic endonasal transtuberculum sellar approach is an alternative minimally invasive method for the removal of an ectopic suprasellar pituitary adenoma. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. A thyrotropin-secreting pituitary adenoma as a cause of thyrotoxic periodic paralysis

    NARCIS (Netherlands)

    Alings, AMW; Fliers, E; de Herder, WW; Hofland, LJ; Sluiter, HE; Links, TP; van der Hoeven, JH; Wiersinga, WM

    1998-01-01

    We describe a patient with thyrotoxic periodic paralysis (TPP) caused by a thyrotropin-secreting pituitary adenoma. The diagnosis TPP was based on the combination of episodes of reversible hypokalaemic paralysis, hyperthyroidism and electrophysiological findings. A thyrotropin-secreting pituitary ad

  19. In1-ghrelin splicing variant is overexpressed in pituitary adenomas and increases their aggressive features.

    Science.gov (United States)

    Ibáñez-Costa, Alejandro; Gahete, Manuel D; Rivero-Cortés, Esther; Rincón-Fernández, David; Nelson, Richard; Beltrán, Manuel; de la Riva, Andrés; Japón, Miguel A; Venegas-Moreno, Eva; Gálvez, Ma Ángeles; García-Arnés, Juan A; Soto-Moreno, Alfonso; Morgan, Jennifer; Tsomaia, Natia; Culler, Michael D; Dieguez, Carlos; Castaño, Justo P; Luque, Raúl M

    2015-03-04

    Pituitary adenomas comprise a heterogeneous subset of pathologies causing serious comorbidities, which would benefit from identification of novel, common molecular/cellular biomarkers and therapeutic targets. The ghrelin system has been linked to development of certain endocrine-related cancers. Systematic analysis of the presence and functional implications of some components of the ghrelin system, including native ghrelin, receptors and the recently discovered splicing variant In1-ghrelin, in human normal pituitaries (n = 11) and pituitary adenomas (n = 169) revealed that expression pattern of ghrelin system suffers a clear alteration in pituitary adenomasas compared with normal pituitary, where In1-ghrelin is markedly overexpressed. Interestingly, in cultured pituitary adenoma cells In1-ghrelin treatment (acylated peptides at 100 nM; 24-72 h) increased GH and ACTH secretion, Ca(2+) and ERK1/2 signaling and cell viability, whereas In1-ghrelin silencing (using a specific siRNA; 100 nM) reduced cell viability. These results indicate that an alteration of the ghrelin system, specially its In1-ghrelin variant, could contribute to pathogenesis of different pituitary adenomas types, and suggest that this variant and its related ghrelin system could provide new tools to identify novel, more general diagnostic, prognostic and potential therapeutic targets in pituitary tumors.

  20. Magnetic resonance imaging of the pituitary adenoma: Analysis of the enhancement patterns

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Ik; Choi, Woo Suk; Shin, In Soo; Ryu, Kyung Nam; Yoon, Yup [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1993-11-15

    The magnetic resonance images (MRI) of 30 patients with surgically or biochemically confirmed pituitary adenomas (20 macroadenomas, 10 microadenomas) were retrospectively evaluated. Ten patients had hyperprolactinaemia, another eight had acromegaly, another eight had nonfunctioning adenoma and four had cushing disease. The examinations were performed at a1.5 T superconducting MR system using a multisection spin-echo technique with 3 mm thick sections and a 256 X 224 matrix. TI weighted sagittal and coronal images were obtained before and within 30 minutes after the administration of Gd-DTPA (0.1 mmol/kg). Analysis of the MRI was focused on the signal intensity and enhancement patterns of the pituitary adenoma before and after Gd-DTPA administration. Compared with endocrinological diagnosis, macroadenoma showed heterogeneous enhancement in 55%, rim enhancement in 35% and homogeneous enhancement in 10%. Conclusively, the enhancement patterns of the pituitary adenoma did not correlate with the subtypes made according to hormone production.

  1. Acromegaly due to a Macroinvasive Plurihormonal Pituitary Adenoma and a Rectal Carcinoid Tumor

    Directory of Open Access Journals (Sweden)

    Sang Ouk Chin

    2015-09-01

    Full Text Available A macroinvasive pituitary adenoma with plurihormonality usually causes acromegaly and hyperprolactinemia, and also accompanies with neurologic symptoms such as visual disturbances. However, its concurrent presentation with a rectal carcinoid tumor is rarely observed. This study reports the history, biochemical, colonoscopic and immunohistochemical results of a 48-year-old female with acromegaly and hyperprolactinemia. Despite the large size and invasive nature of the pituitary adenoma to adjacent anatomical structures, she did not complain of any neurologic symptoms such as visual disturbance or headache. Immunohistochemical staining of the surgical specimen from the pituitary adenoma revealed that the tumor cells were positive for growth hormone (GH, prolactin (PRL, and thyroid stimulating hormone (TSH. Staining for pituitary-specific transcription factor-1 (Pit-1 was shown to be strongly positive, which could have been possibly contributing to the plurihormonality of this adenoma. Colonoscopy found a rectal polyp that was identified to be a carcinoid tumor using immunohistochemical staining. A macroinvasive pituitary adenoma with concomitant rectal carcinoid tumor was secreting GH, PRL, and TSH, which were believed to be in association with over-expression of Pit-1. This is the first case report of double primary tumors comprising a plurihormonal pituitary macroadenoma and rectal carcinoid tumor.

  2. Somatostatin and dopamine receptor regulation of pituitary somatotroph adenomas.

    Science.gov (United States)

    Ben-Shlomo, Anat; Liu, Ning-Ai; Melmed, Shlomo

    2017-02-01

    Somatostatin and dopamine receptors are expressed in normal and tumoral somatotroph cells. Upon receptor stimulation, somatostatin and the somatostatin receptor ligands octreotide, lanreotide, and pasireotide, and to a lesser extent, dopamine and the dopamine analogs bromocriptine and cabergoline, suppress growth hormone (GH) secretion from a GH-secreting pituitary somatotroph adenoma. Somatostatin and dopamine receptors are Gαi-protein coupled that inhibit adenylate cyclase activity and cAMP production and reduce intracellular calcium concentration and calcium flux oscillations. Although their main action on somatotroph cells is acute inhibition of GH secretion, they also may inhibit GH production and possibly somatotroph proliferation. These receptors have been reported to create complexes that exhibit functions distinct from that of receptor monomers. Somatostatin suppression of GH is mediated mainly by somatostatin receptor subtype 2 and to a lesser extent by SST5. Human somatostatin receptor subtype 5 has also been shown to harbor mutations associated with GH levels, somatotroph tumor behavior, and somatostatin receptor ligand (SRL) responsiveness. Reviewing current knowledge of somatostatin and dopamine receptor expression and signaling in normal and tumoral somatotroph cells offers insights into mechanisms underlying SRL and dopamine agonist effectiveness in patients with acromegaly.

  3. Prolactinomas, Cushing's disease and acromegaly: debating the role of medical therapy for secretory pituitary adenomas

    Directory of Open Access Journals (Sweden)

    Bonert Vivien S

    2010-05-01

    Full Text Available Abstract Pituitary adenomas are associated with a variety of clinical manifestations resulting from excessive hormone secretion and tumor mass effects, and require a multidisciplinary management approach. This article discusses the treatment modalities for the management of patients with a prolactinoma, Cushing's disease and acromegaly, and summarizes the options for medical therapy in these patients. First-line treatment of prolactinomas is pharmacotherapy with dopamine agonists; recent reports of cardiac valve abnormalities associated with this class of medication in Parkinson's disease has prompted study in hyperprolactinemic populations. Patients with resistance to dopamine agonists may require other treatment. First-line treatment of Cushing's disease is pituitary surgery by a surgeon with experience in this condition. Current medical options for Cushing's disease block adrenal cortisol production, but do not treat the underlying disease. Pituitary-directed medical therapies are now being explored. In several small studies, the dopamine agonist cabergoline normalized urinary free cortisol in some patients. The multi-receptor targeted somatostatin analogue pasireotide (SOM230 shows promise as a pituitary-directed medical therapy in Cushing's disease; further studies will determine its efficacy and safety. Radiation therapy, with medical adrenal blockade while awaiting the effects of radiation, and bilateral adrenalectomy remain standard treatment options for patients not cured with pituitary surgery. In patients with acromegaly, surgery remains the first-line treatment option when the tumor is likely to be completely resected, or for debulking, especially when the tumor is compressing neurovisual structures. Primary therapy with somatostatin analogues has been used in some patients with large extrasellar tumors not amenable to surgical cure, patients at high surgical risk and patients who decline surgery. Pegvisomant is indicated in patients

  4. Pituitary adenoma and vestibular schwannoma: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Niu Y

    2010-01-01

    Full Text Available The concurrence of the intracranial multiple primary tumors (MPTs consisting of acoustic neuroma (AN and pituitary adenoma is very rare. Here, we report a 42-year-old female who presented with left AN associated with pituitary adenoma. A total of three such cases have been reported before and which also presented with left AN with pituitary adenoma. Recently, a new "field cancerization" model has been proposed, which could explain MPTs and is consistent with the pathogenesis of such cases. The model also indicates that when a pituitary tumor or AN is detected separately, we might consider the development of "expanding field" after oncological treatment especially after radiotherapy in order to prevent the second field tumor occurring.

  5. Angiogenesis in Pituitary Adenomas: Human Studies and New Mutant Mouse Models

    Directory of Open Access Journals (Sweden)

    Carolina Cristina

    2014-01-01

    Full Text Available The role of angiogenesis in pituitary tumor development has been questioned, as pituitary tumors have been usually found to be less vascularized than the normal pituitary tissue. Nevertheless, a significantly higher degree of vasculature has been shown in invasive or macropituitary prolactinomas when compared to noninvasive and microprolactinomas. Many growth factors and their receptors are involved in pituitary tumor development. For example, VEGF, FGF-2, FGFR1, and PTTG, which give a particular vascular phenotype, are modified in human and experimental pituitary adenomas of different histotypes. In particular, vascular endothelial growth factor, VEGF, the central mediator of angiogenesis in endocrine glands, was encountered in experimental and human pituitary tumors at different levels of expression and, in particular, was higher in dopamine agonist resistant prolactinomas. Furthermore, several anti-VEGF techniques lowered tumor burden in human and experimental pituitary adenomas. Therefore, even though the role of angiogenesis in pituitary adenomas is contentious, VEGF, making permeable pituitary endothelia, might contribute to adequate temporal vascular supply and mechanisms other than endothelial cell proliferation. The study of angiogenic factor expression in aggressive prolactinomas with resistance to dopamine agonists will yield important data in the search of therapeutical alternatives.

  6. 99mTc(V)-DMSA. A useful radio isotopic material for the diagnosis of pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Shinichi; Yamamura, Koji; Chang, Chia-Cheng; Kojima, Yasuhiro; Yamamoto, Isao; Ikegami, Tadashi [Yokohama City Univ., Kanagawa (Japan). School of Medicine

    2000-06-01

    We compared images of pituitary adenoma, parasellar tumors, and non-pituitary adenoma using the tumor-seeking agent technetium-99m-labeled pentavalent dimercaptosuccinic acid (99mTc(V)-DMSA) and evaluated the relationship between 99mTc(V)-DMSA uptake and pituitary hormone level. Fifteen patients with pituitary adenoma were studied: 3 non-functioning adenoma, 6 prolactinoma, 4 GH secreting adenoma, and 2 ACTH secreting adenoma. As a control group, we studied 6 patients without adenoma who had undergone a pathological examination. Planar and SPECT images were obtained 2-hours after intravenous injection of approximately 740 MBq 99mTc(V)-DMSA. Uptake ratios between normal background and tumor lesion were calculated. Three non-functioning adenoma (100%), five prolactinoma (83%), three GH secreting adenoma (75%) and no ACTH secreting adenoma (0%) significantly concentrated 99mTc(V)-DMSA. One of the non-adenomatous tumors, a Rathke's cleft cyst concentrated 99mTc(V)-DMSA in the pituitary while the others did not. The 99mTc(V)-DMSA scintigraphy showed an overall sensitivity of 73% (11/15) in detecting pituitary adenomas. Uptake ratios were higher in hormone-secreting adenoma than non-secreting adenoma. We were able to detect residual tumors and distinguish pituitary adenoma from surgical non-tumoral lesion with 99mTc(V)-DMSA. These results suggest that 99mTc(V)-DMSA imaging is useful in detecting pituitary adenoma and noninvasively differentiating tumor types in parasellar lesion. (author)

  7. CT scan in diagnosis of pituitary adenomas, 5. CT findings of GH secreting adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Sakoda, K.; Yonezawa, M.; Gen, M. (Hiroshima Univ. (Japan). School of Medicine)

    1981-10-01

    Clinical findings and radiological findings in 19 cases of GH secreting adenoma were reported. In diagnosis of GH secreting adenoma, conventional radiography and computed tomography of the sella turcica are useful. The CT of this kind of adenomas shows a characteristically higher x-ray absorption coefficient than other adenomas.

  8. Temozolomide and pasireotide treatment for aggressive pituitary adenoma: expertise at a tertiary care center.

    Science.gov (United States)

    Ceccato, Filippo; Lombardi, Giuseppe; Manara, Renzo; Emanuelli, Enzo; Denaro, Luca; Milanese, Laura; Gardiman, Marina Paola; Bertorelle, Roberta; Scanarini, Massimo; D'Avella, Domenico; Occhi, Gianluca; Boscaro, Marco; Zagonel, Vittorina; Scaroni, Carla

    2015-03-01

    Aggressive pituitary adenomas (PAs) are clinically challenging for endocrinologists and neurosurgeons due to their locally invasive nature and resistance to standard treatment (surgery, medical or radiotherapy). Two pituitary-directed drugs have recently been proposed: temozolomide (TMZ) for aggressive PA, and pasireotide for ACTH-secreting PA. We describe the experience of our multidisciplinary team of endocrinologists, neurosurgeons, neuroradiologists, oncologists, otolaryngologists and pathologists with TMZ and pasireotide treatment for aggressive PAs in terms of their radiological shrinkage and genetic features. We considered five patients with aggressive PA, three of them non-secreting (two ACTH-silent and one becoming ACTH secreting), and two secreting (one GH and one ACTH). TMZ was administrated orally at 150-200 mg/m(2) daily for 5 days every 28 days to all 5 patients, and 2 of them also received pasireotide 600-900 µg bid sc. We assessed the MRI at the baseline and during TMZ or pasireotide treatment. We also checked for MGMT promoter methylation and IDH, BRAF and kRAS mutations. Considering TMZ, two patients showed PA progression, one stable disease and two achieved radiological and clinical response. Pasireotide was effective in reducing hypercortisolism and mass volume, combined with TMZ in one case. Both treatments were generally well tolerated; one patient developed a grade 2 TMZ-induced thrombocytopenia. None of patients developed hypopituitarism while taking TMZ or pasireotide treatment. No genetic anomalies were identified in the adenoma tissue. TMZ and pasireotide may be important therapies for aggressive PA, alone or in combination.

  9. Segmentation of pituitary adenoma: a graph-based method vs. a balloon inflation method.

    Science.gov (United States)

    Egger, Jan; Zukić, Dženan; Freisleben, Bernd; Kolb, Andreas; Nimsky, Christopher

    2013-06-01

    Among all abnormal growths inside the skull, the percentage of tumors in sellar region is approximately 10-15%, and the pituitary adenoma is the most common sellar lesion. A time-consuming process that can be shortened by using adequate algorithms is the manual segmentation of pituitary adenomas. In this contribution, two methods for pituitary adenoma segmentation in the human brain are presented and compared using magnetic resonance imaging (MRI) patient data from the clinical routine: Method A is a graph-based method that sets up a directed and weighted graph and performs a min-cut for optimal segmentation results: Method B is a balloon inflation method that uses balloon inflation forces to detect the pituitary adenoma boundaries. The ground truth of the pituitary adenoma boundaries - for the evaluation of the methods - are manually extracted by neurosurgeons. Comparison is done using the Dice Similarity Coefficient (DSC), a measure for spatial overlap of different segmentation results. The average DSC for all data sets is 77.5±4.5% for the graph-based method and 75.9±7.2% for the balloon inflation method showing no significant difference. The overall segmentation time of the implemented approaches was less than 4s - compared with a manual segmentation that took, on the average, 3.9±0.5min.

  10. Measurement of Ki-67 antigen in 159 pituitary adenomas using the MIB-1 monoclonal antibody

    Directory of Open Access Journals (Sweden)

    C.B. Pizarro

    2004-02-01

    Full Text Available Pituitary adenomas sometimes show rapid growth and recurrence, and about one third invade the structures surrounding the sella turcica. In an attempt to determine aggressive behavior at an early stage, we used the MIB-1 antibody to identify the Ki-67 antigen. The present study was designed to evaluate pituitary adenomatous tissue in terms of secretion and proliferation and to correlate the Ki-67 index with hormone phenotype and invasive behavior. Material from 159 patients submitted to one or more resections of pituitary adenomas was evaluated. Forty-two non-secretory adenomas and 43 adenomas immunoreactive for growth hormone, 19 for prolactin, 18 for growth hormone and prolactin, 16 for adrenocorticotropic hormone (ACTH, and 21 cases of plurihormonal/gonadotropin adenomas were detected by immunohistochemistry. The MIB-1 antibody was positive in 139 samples and the Ki-67 index ranged from 0.16 to 15.48% (mean = 1.22 ± 2.09%, with no significant difference between genders, age groups, or secretory and non-secretory status. The Ki-67 index was higher in ACTH-secreting adenomas. Invasive pituitary adenomas had a significantly higher Ki-67 index (2.01 ± 3.15% than macroadenomas with or without supra-sellar extension (1.12 ± 1.87%; P = 0.02. The index was not significantly different in the subgroup of adenomas with invasion of the cavernous sinus compared to groups with other types of invasion. We conclude that tumoral proliferative activity evaluated by the detection of the Ki-67 antigen is significantly higher in invasive than noninvasive adenomas, information which can be useful in therapeutic postoperative management since index cut-off values associated with aggressive behavior can be established.

  11. Expression and mutation analysis of Tpit in the canine pituitary gland and corticotroph adenomas.

    Science.gov (United States)

    Hanson, J M; Mol, J A; Leegwater, P A J; Bilodeau, S; Drouin, J; Meij, B P

    2008-04-01

    Pituitary-dependent hyperadrenocorticism (PDH) in dogs is caused by a pituitary corticotroph adenoma. Although PDH is a common disorder in dogs, little is known about the underlying pathogenesis. In the pituitary glands of humans and mice, the pro-opiomelanocortin (POMC)-expressing cell lineages, the corticotrophs and melanotrophs, have a specific marker in common, the T-box transcription factor Tpit (Tbx19), which is obligate for POMC expression. Tpit also regulates the late differentiation of the corticotrophs and melanotrophs, and therefore may contribute to the pathogenesis of the corticotroph adenomas. The aim of this study was to perform an expression and mutation analysis of Tpit in the normal canine pituitary and in corticotroph adenomas. The distribution of the Tpit protein in the pituitary gland was studied with immunohistochemistry and the expression of the gene with RT-PCR. The coding region of Tpit cDNA from 14 dogs with PDH was screened for mutations. Tpit was expressed in corticotroph and melanotroph cells of the normal and adenomatous canine pituitary, and remained present in non-adenomatous corticotrophs of pituitaries from PDH dogs. No tumor-specific mutation in the Tpit cDNA from the corticotroph adenomas was found. However, a missense polymorphism in the highly conserved DNA-binding domain, the T-box, was discovered in one dog. It is concluded that Tpit can be used as a reliable marker for the corticotroph and melanotroph cells in the canine pituitary tissue and that mutations in the Tpit gene are unlikely to play a major role in the pathogenesis of canine corticotroph adenomas.

  12. Gamma Knife radiosurgery in pituitary adenomas: Why, who, and how to treat?

    Science.gov (United States)

    Castinetti, Frederic; Brue, Thierry

    2010-08-01

    Pituitary adenomas are benign tumors that can be either secreting (acromegaly, Cushing's disease, prolactinomas) or non-secreting. Transsphenoidal neurosurgery is the gold standard treatment; however, it is not always effective. Gamma Knife radiosurgery is a specific modality of stereotactic radiosurgery, a precise radiation technique. Several studies reported the efficacy and low risk of adverse effects induced by this technique: in secreting pituitary adenomas, hypersecretion is controlled in about 50% of cases and tumor volume is stabilized or decreased in 80-90% of cases, making Gamma Knife a valuable adjunctive or first-line treatment. As hormone levels decrease progressively, the main drawback is the longer time to remission (12-60 months), requiring an additional treatment during this period. Hypopituitarism is the main side effect, observed in 20-40% cases. Gamma Knife is thus useful in the therapeutic algorithms of pituitary adenomas in well-defined indications, mainly low secreting small lesions well identified on magnetic resonance imaging (MRI).

  13. TFF3 knockout in human pituitary adenoma cell HP75 facilitates cell apoptosis via mitochondrial pathway.

    Science.gov (United States)

    Gao, Feng; Pan, Suxia; Liu, Bing; Zhang, Huanzhi

    2015-01-01

    Trefoil factor 3 (TFF3), a regulatory protein composed of 59 amino acids, has been suggested to be involved in pathogenesis, proliferation, differentiation, invasion, migration and apoptosis in multiple malignant tumors. This study thus investigated the effect of TFF3 knockout in human pituitary adenoma cell line HP75 on cell apoptosis and related pathways. RNA interference approach was used to knock down the expression of TFF3 protein. The gene silencing was validated by RNA denaturing gel electrophoresis and Western blotting. The effect of TFF3 knockout on cell apoptosis was analyzed by Western blotting and flow cytometry. TFF3 protein level in pituitary adenoma was about 3.61 ± 0.48 folds of that in normal tissues (P TFF3, the apoptotic ration was significantly elevated (P TFF3 protein knockout can facilitate apoptosis of human pituitary adenoma HP75 cells via mitochondrial pathway.

  14. TFF3 knockout in human pituitary adenoma cell HP75 facilitates cell apoptosis via mitochondrial pathway

    Science.gov (United States)

    Gao, Feng; Pan, Suxia; Liu, Bing; Zhang, Huanzhi

    2015-01-01

    Trefoil factor 3 (TFF3), a regulatory protein composed of 59 amino acids, has been suggested to be involved in pathogenesis, proliferation, differentiation, invasion, migration and apoptosis in multiple malignant tumors. This study thus investigated the effect of TFF3 knockout in human pituitary adenoma cell line HP75 on cell apoptosis and related pathways. RNA interference approach was used to knock down the expression of TFF3 protein. The gene silencing was validated by RNA denaturing gel electrophoresis and Western blotting. The effect of TFF3 knockout on cell apoptosis was analyzed by Western blotting and flow cytometry. TFF3 protein level in pituitary adenoma was about 3.61 ± 0.48 folds of that in normal tissues (P TFF3, the apoptotic ration was significantly elevated (P TFF3 protein knockout can facilitate apoptosis of human pituitary adenoma HP75 cells via mitochondrial pathway. PMID:26823779

  15. Incidence, causative mechanisms, and anatomic localization of stroke in pituitary adenoma patients treated with postoperative radiation therapy versus surgery alone

    NARCIS (Netherlands)

    Sattler, Margriet; Vroomen, Patrick; Sluiter, Wim J.; Schers, Henk J.; van den Berg, Gerrit; Langendijk, Johannes A.; Wolffenbuttel, Bruce H. R.; van den Bergh, Alphons C. M.; van Beek, Andre P.

    2013-01-01

    PURPOSE: To assess and compare the incidence of stroke and stroke subtype in pituitary adenoma patients treated with postoperative radiation therapy (RT) and surgery alone. METHODS AND MATERIALS: A cohort of 462 pituitary adenoma patients treated between 1959 and 2008 at the University Medical Cente

  16. The incidence of second tumours and mortality in pituitary adenoma patients treated with postoperative radiotherapy versus surgery alone

    NARCIS (Netherlands)

    Sattler, M.G.A.; van Beek, A.P.; Wolffenbuttel, B.H.R.; van den Berg, G.; Sluiter, W.J.; Langendijk, J.A.; van den Bergh, A.C.M.

    2012-01-01

    Background and purpose: To assess and compare the incidence of intra- and extracranial tumours and mortality in pituitary adenoma patients treated with postoperative radiotherapy and surgery alone. Patients and methods: A total of 462 pituitary adenoma patients were treated between 1959 and 2008 at

  17. Effect of treatment modality on the hypothalamic-pituitary function of patients treated with radiation therapy for pituitary adenomas: Hypothalamic dose and endocrine outcomes.

    OpenAIRE

    Andrew eElson; Joseph eBovi; Kawaljeet eKaur; Diana eMaas; Grant eSinson; Chris eSchultz

    2014-01-01

    Background: Both fractionated external beam radiotherapy and single fraction radiosurgery for pituitary adenomas are associated with the risk of hypothalamic-pituitary (HP) axis dysfunction.Objective: To analyze the effect of treatment modality (Linac, TomoTherapy, or Gamma Knife) on hypothalamic dose and correlate these with HP-Axis deficits after radiotherapy.Methods:Radiation plans of patients treated postoperatively for pituitary adenomas using Linac-based 3D Conformal Radiotherapy (CRT) ...

  18. Effect of Treatment Modality on the Hypothalamic–Pituitary Function of Patients Treated with Radiation Therapy for Pituitary Adenomas: Hypothalamic Dose and Endocrine Outcomes

    OpenAIRE

    Elson, Andrew; Bovi, Joseph; Kaur, Kawaljeet; Maas, Diana; Sinson, Grant; Schultz, Chris

    2014-01-01

    Background: Both fractionated external beam radiotherapy and single fraction radiosurgery for pituitary adenomas are associated with the risk of hypothalamic–pituitary (HP) axis dysfunction. Objective: To analyze the effect of treatment modality (Linac, TomoTherapy, or gamma knife) on hypothalamic dose and correlate these with HP-axis deficits after radiotherapy. Methods: Radiation plans of patients treated post-operatively for pituitary adenomas using Linac-based 3D-conformal radiother...

  19. Enhanced nestin expression and small blood vessels in human pituitary adenomas.

    Science.gov (United States)

    Perez-Millan, María Inés; Berner, Silvia Inés; Luque, Guillermina María; De Bonis, Cristian; Sevlever, Gustavo; Becu-Villalobos, Damasia; Cristina, Carolina

    2013-09-01

    The role of angiogenesis in human pituitary tumor progression is questioned. Our aim was to characterize the morphologic changes that occur in the vasculature of pituitary adenomas, in correlation with the expression of nestin, a protein found in endothelial cells of newly formed vessels of developing organs. We also evaluated the relation of angiogenic markers and nestin with Ki-67 index. Immunohistochemical studies were performed on paraffin embedded samples of 47 pituitary adenomas and six normal pituitaries. We determined microvessel density (number of CD31+ or CD34+ vessels per square millimetre), vascular area (cumulative area occupied by vessels), average vessel size, and further classified vessels as small ( 100 μm2). We correlated the above parameters with nestin expression and Ki-67 index. Lower vascular area compared to normal tissue was found in adenomas (p vessels than control pituitaries (p controls, so that nestin positive area was significantly higher in tumors. Furthermore, nestin area correlated positively with the % of small vessels. Ki-67 correlated neither with vascular area nor with nestin expression. In human pituitary tumors there was a predominance of small capillaries in correlation with increased expression of the progenitor marker nestin. We suggest that angiogenesis is an active process in these tumors, in spite of their low total vascular area when compared to normal pituitaries.

  20. Clinical results of LINAC-based stereotactic radiosurgery for pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Muramatsu, Julia; Yoshida, Masanori; Shioura, Hiroki; Kawamura, Yasutaka; Ito, Harumi; Takeuchi, Hiroaki; Kubota, Toshihiko [Fukui Medical Univ., Matsuoka (Japan); Maruyama, Ichiro [The Wakasa Wan Energy Research Center, Tsuruga, Fukui (Japan)

    2003-05-01

    We retrospectively evaluated our clinical results of stereotactic radiosurgery (SRS) for pituitary adenoma. Between 1995 and 2000, 13 patients were treated with SRS for pituitary adenoma. In all cases, the tumors had already been surgically resected. The adenomas were functional in 5 and non-functional in 8 patients. The median follow-up period was 30 months. SRS was performed with the use of a dedicated stereotactic 10-MV linear accelerator (LINAC). The median dose to the tumor margin was 15 Gy. The dose to the optic apparatus was limited to less than 8 Gy. MR images of 12 patients revealed tumor complete response (CR) in one case and partial response (PR) in 9 cases; in the remaining two patients, tumor size decreased by less than 50%. There was no recognizable regrowth of any of the tumors. In two of four GH-secreting adenomas, hormonal overproduction normalized, while the other two showed reduced hormonal production. One PRL-secreting adenoma did not respond. Reduction of visual acuity and field was seen in one patient. This patient also had a brain infarction. None of the patients developed brain radionecrosis or radiation-induced hypopituitarism. Although further studies based on greater numbers of cases and longer follow-up periods are needed, our results suggest that SRS seems to be a safe, effective treatment for pituitary adenoma. (author)

  1. THE ROLE OF CALCIUM ION IN THE PATHOGENESIS OF HUMAN PITUITARY GH-SECRETING ADENOMAS

    Institute of Scientific and Technical Information of China (English)

    邓洁英; 史轶蘩; 尹娟娟

    1996-01-01

    To study the role of Ca2+ in the pathogenesis of pituitary growth hormone secreting adenornas,the function of Ca2+ in 23 cases of human pituitary GH-secreting adenoma was investigated in monolayer cell culture.It was found that Ca2- channel blockers nicardipin and nifedipin inhibited hasal and growth hormone releasing hormone (GRH)-stimulated GH secretion in 87.5% and 100.0% of the GH adenomas.respectively,demonstrating that in most human pituitary GH agonist octreotide regulated the processes of GH secretion via Ca2+ had defects in different steps including receptor.postreceptor Ca2+ channel and Ca2+-GH secreting coupling in 6(66.6%)and 5(55.5%) cases of 9 GH adenomas respectively.Among them,the defects in GRH receptor and SRIF regulated Ca2+ channel are the main causes of the dysfunction of GH adenomas.These defects may be related to GH hypersecretion in GH adenomas.Our data provides advance evidences for intrinsic defects of GH adenomas.

  2. Interrater and intrarater reliability of the Knosp scale for pituitary adenoma grading.

    Science.gov (United States)

    Mooney, Michael A; Hardesty, Douglas A; Sheehy, John P; Bird, Robert; Chapple, Kristina; White, William L; Little, Andrew S

    2016-07-01

    OBJECTIVE The goal of this study was to determine the interrater and intrarater reliability of the Knosp grading scale for predicting pituitary adenoma cavernous sinus (CS) involvement. METHODS Six independent raters (3 neurosurgery residents, 2 pituitary surgeons, and 1 neuroradiologist) participated in the study. Each rater scored 50 unique pituitary MRI scans (with contrast) of biopsy-proven pituitary adenoma. Reliabilities for the full scale were determined 3 ways: 1) using all 50 scans, 2) using scans with midrange scores versus end scores, and 3) using a dichotomized scale that reflects common clinical practice. The performance of resident raters was compared with that of faculty raters to assess the influence of training level on reliability. RESULTS Overall, the interrater reliability of the Knosp scale was "strong" (0.73, 95% CI 0.56-0.84). However, the percent agreement for all 6 reviewers was only 10% (26% for faculty members, 30% for residents). The reliability of the middle scores (i.e., average rated Knosp Grades 1 and 2) was "very weak" (0.18, 95% CI -0.27 to 0.56) and the percent agreement for all reviewers was only 5%. When the scale was dichotomized into tumors unlikely to have intraoperative CS involvement (Grades 0, 1, and 2) and those likely to have CS involvement (Grades 3 and 4), the reliability was "strong" (0.60, 95% CI 0.39-0.75) and the percent agreement for all raters improved to 60%. There was no significant difference in reliability between residents and faculty (residents 0.72, 95% CI 0.55-0.83 vs faculty 0.73, 95% CI 0.56-0.84). Intrarater reliability was moderate to strong and increased with the level of experience. CONCLUSIONS Although these findings suggest that the Knosp grading scale has acceptable interrater reliability overall, it raises important questions about the "very weak" reliability of the scale's middle grades. By dichotomizing the scale into clinically useful groups, the authors were able to address the poor

  3. MANAGEMENT OF ENDOCRINE DISEASE: Present and future perspectives for medical therapy of nonfunctioning pituitary adenomas.

    Science.gov (United States)

    Greenman, Yona

    2017-09-01

    In contrast to the clear indication for surgical treatment in symptomatic patients with clinically nonfunctioning pituitary adenomas (NFPA), there are no randomized controlled studies comparing therapeutic strategies such as watchful waiting, irradiation or medical therapy for the management of NFPA after surgery. Further, no medical therapy is currently approved for the treatment of NFPA. In this review, we summarize accumulating data on medications currently approved for secreting pituitary adenomas, used off-label in patients with NFPA. Perspectives on overall treatment optimization and potential future therapies are also detailed. © 2017 European Society of Endocrinology.

  4. Differentiation of pituitary adenomas from other sellar and parasellar tumors by {sup 99m}Tc(V)-DMSA scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yamamura, Koji [Yokohama City Univ. (Japan). Medical Center; Suzuki, Shinichi; Yamamoto, Isao [Yokohama City Univ. (Japan). School of Medicine

    2003-04-01

    Pentavalent technetium-99m dimercaptosuccinic acid [{sup 99m}Tc(V)-DMSA] scintigraphy was evaluated for the differentiation of pituitary adenomas, especially non-functioning adenomas, from other sellar and parasellar lesions. Diffuse {sup 99m}Tc(V)-DMSA accumulation within the tumor was found in seven of seven non-functioning, three of four growth hormone-secreting, and seven of eight prolactin-secreting adenomas, but only partial accumulation in only two of 16 non-pituitary adenomas and normal pituitary glands. There were no significant relationship between tumor-to-background ratios and tumor size or serum hormone level. {sup 99m}Tc(V)-DMSA scintigraphy showed overall sensitivity of 81% (17/21 cases) for detecting pituitary adenomas, in particular 100% for non-functioning adenomas. {sup 99m}Tc(V)-DMSA may be useful for detecting pituitary adenomas, especially non-functioning adenomas, and for the differentiation of non-functioning pituitary adenomas from other sellar and parasellar lesions. (author)

  5. Outcomes of Proton Therapy for Patients With Functional Pituitary Adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Wattson, Daniel A.; Tanguturi, Shyam K. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Spiegel, Daphna Y. [Tufts University School of Medicine, Boston, Massachusetts (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Biller, Beverly M.K.; Nachtigall, Lisa B. [Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts (United States); Bussière, Marc R. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Swearingen, Brooke; Chapman, Paul H. [Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (United States); Loeffler, Jay S. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Shih, Helen A., E-mail: hshih@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2014-11-01

    Purpose/Objective(s): This study evaluated the efficacy and toxicity of proton therapy for functional pituitary adenomas (FPAs). Methods and Materials: We analyzed 165 patients with FPAs who were treated at a single institution with proton therapy between 1992 and 2012 and had at least 6 months of follow-up. All but 3 patients underwent prior resection, and 14 received prior photon irradiation. Proton stereotactic radiosurgery was used for 92% of patients, with a median dose of 20 Gy(RBE). The remainder received fractionated stereotactic proton therapy. Time to biochemical complete response (CR, defined as ≥3 months of normal laboratory values with no medical treatment), local control, and adverse effects are reported. Results: With a median follow-up time of 4.3 years (range, 0.5-20.6 years) for 144 evaluable patients, the actuarial 3-year CR rate and the median time to CR were 54% and 32 months among 74 patients with Cushing disease (CD), 63% and 27 months among 8 patients with Nelson syndrome (NS), 26% and 62 months among 50 patients with acromegaly, and 22% and 60 months among 9 patients with prolactinomas, respectively. One of 3 patients with thyroid stimulating hormone—secreting tumors achieved CR. Actuarial time to CR was significantly shorter for corticotroph FPAs (CD/NS) compared with other subtypes (P=.001). At a median imaging follow-up time of 43 months, tumor control was 98% among 140 patients. The actuarial 3-year and 5-year rates of development of new hypopituitarism were 45% and 62%, and the median time to deficiency was 40 months. Larger radiosurgery target volume as a continuous variable was a significant predictor of hypopituitarism (adjusted hazard ratio 1.3, P=.004). Four patients had new-onset postradiosurgery seizures suspected to be related to generously defined target volumes. There were no radiation-induced tumors. Conclusions: Proton irradiation is an effective treatment for FPAs, and hypopituitarism remains the primary

  6. Double, Synchronous Pituitary Adenomas Causing Acromegaly and Cushing’s Disease. A Case Report and Review of Literature

    OpenAIRE

    Zieliński, Grzegorz; Maksymowicz, Maria; Podgórski, Jan; Olszewski, Włodzimierz T

    2013-01-01

    Double pituitary adenomas are very rare and present up to 1 % of pituitary adenomas in unselected autopsy series and up to 2 % in large surgical series. We report a case of a 47-year-old man presented slight clinical features of acromegaly with 2 years duration. Endocrine evaluation confirmed active acromegaly and revealed adrenocorticotropin hormone-dependent hypercortisolemia. Preoperative magnetic resonance imaging of the pituitary demonstrated clearly separated double microadenomas with d...

  7. The Neuro Imaging Description of Giant Pituitary Adenomas Depending on Mechanical Factor

    Directory of Open Access Journals (Sweden)

    Yu.M. Urmanova

    2016-08-01

    Full Text Available The research aim is to analyze of magnetically-resonance tomography data depending on the mechanical factor of giant pituitary adenomas. Materials and methods. Twenty-two adult patients with giant pituitary adenomas were observed during the period from 2015 to 2016 (men 50 %, aged 48.5 years old. The duration of disease varied from 2 months to 25 years. Results. Patients with endo-suprasellar growth of pituitary tumour had signs of chiasmal syndrome with bitemporal hemianopsia, initial or complete homonym hemianopsia, scotomas and others. Such variant of pituitary tumour growth was observed in 7 cases (31.8 %. 4.5 % patients with retro-sellar growth of pituitary tumour typically had violations caused by the growth of tumour into brainstem, that stipulated both the lesion of craniocerebral nerves and vegetative disorders, and also pyramid symptomatology (pathological reflexes, symptoms of oral automatism. Patients with the endo-laterosellar growth of tumour suffered from decline of sharpness of sight on one eye, one-sided headaches, lesion of oculomotorius. For 4.5 % patients with the endo-infrasellar growth of tumour violations of the nasal breathing and swallowing (odynophagia were typical. Conclusions. The most expressed neuroendocrine, ophthalmology and pillar disorders were observed in patients with the total growth of tumor. The giant pituitary adenomas are often accompanied by an invasion growth into surrounding anatomic structures (69.2 % that is a basic factor limiting radical operative intervention and increasing the number of relapses.

  8. Diagnosis of pituitary adenomas by bone window CT. A comparative study with hypocycloidal tomography

    Energy Technology Data Exchange (ETDEWEB)

    Tanabe, S.; Sato, O.; Tsuchita, H.; Nakagaki, Y.; Tsuruta, J. (Sapporo Medical Coll. (Japan))

    1981-02-01

    The CT scan is useful for the diagnosis of pituitary adenomas when they are well enhanced and show remarkable suprasellar extension. However, the deformity or the destruction of the sella turcica by pituitary adenomas is not well demonstrated by the conventional CT scan because of the artifacts or the partial volume effect elicited by the surrounding bony structures. To overcome these difficulties, the authors have developed the bone window CT scan, which demonstrates not only the soft tissue of the tumor, but also the bony changes of the sella turcica. The bone-window CT scan means a CT scan by the reverse-mode-display method, with a window width of 400 and a window level of 100. We analysed 36 cases of the sella turcica in pituitary adenomas by the bone-window CT scan in both axial and coronal sections and compared the results with those by hypocycloidal tomography. From the deformities of the sella turcica, we classified five types of sellar changes in pituitary adenomas. The bone window CT scan proved to be useful for the detection of not only the tumor mass but also the deformities of the sella. From the findings of the sellar deformities, the intrasellar location and the mode of extrasellar extension of the pituitary adenomas were defined. But the disadvantage of the bone window CT scan lies in the inaccurate delineation of the tumor extension into the sphenoid sinus or upward to suprasellar area and in the poor diagnostic value for pituitary microadenomas. These disadvantages will be supplemented by hypocycloidal tomography or conventional enhanced CT scan.

  9. mTOR inhibition reduces cellular proliferation and sensitizes pituitary adenoma cells to ionizing radiation.

    Science.gov (United States)

    Sukumari-Ramesh, Sangeetha; Singh, Nagendra; Dhandapani, Krishnan M; Vender, John R

    2011-02-23

    Pituitary adenomas are the most frequent brain tumor in adults. Although histologically benign, pituitary tumors cause significant morbidity and mortality. Neurosurgery and medical therapeutics may lessen the morbidity and mortality associated with pituitary tumors; however, these treatments are associated with significant adverse side effects. Thus, an improved understanding of pituitary adenomas at the molecular and cellular level is needed to design novel therapeutic compounds. To assess the effect of mammalian target of rapamycin (mTOR) inhibition on pituitary adenoma cells, rat GH3 or MMQ cells were treated with the clinically useful mTOR inhibitors, rapamycin or RAD001. Cellular proliferation and growth following exposure to mTOR inhibitors or radiation were assessed using biochemical methods. In the present study, we observed basal activation of mTOR, downstream of constitutive Akt signaling, in rat GH3 adenoma cells. Functionally, the mTOR inhibitors, rapamycin and RAD001 (500 pM-5 nM), induced G1 growth arrest within 24 hours, an effect associated with reduced cellular proliferation. Both rapamycin and RAD001 decreased the phosphorylation of mTOR at the serine 2448, a key determinant of mTOR activity. Inhibition of mTOR also radiosensitized GH3 cells such that 2.5 Gy in combination with 500 pM rapamycin or RAD001 reduced cellular viability more effectively than 2.5 or 10 Gy alone. These data may support a possible therapeutic role for mTOR inhibitors in limiting the cellular proliferation and radioresistance of pituitary adenoma cells.

  10. Endoscopic versus microscopic transsphenoidal pituitary adenoma surgery: a meta-analysis

    Science.gov (United States)

    2014-01-01

    Background Endoscopic transsphenoidal surgery has gradually come to be regarded as a preferred option in the treatment of pituitary adenomas because of its advantages of improved visualization and its minimal invasiveness. The aim of this study was to compare and evaluate the outcomes and complications of endoscopic and microscopic transsphenoidal surgery in the treatment of pituitary adenomas. Methods We performed a systematic literature search of MEDLINE, EMBASE, the Cochrane Library and the Web of Science between January 1992 and May 2013. Studies with consecutive patients that explicitly and fully compared endoscopic and microscopic approaches in the treatment of pituitary adenomas were included. Results A total of 15 studies (n = 1,014 patients) met the inclusion criteria among 487 studies that involved endoscopic surgery and 527 studies that dealt with microscopic surgery. The rate of gross tumor removal was higher in the endoscopic group than in the microscopic group. The post-operative rates of septal perforation were less frequent in patients who underwent endoscopic surgery. There was no significant difference between the two techniques in the incidence rates of meningitis, diabetes insipidus, cerebrospinal fluid leak, epistaxis or hypopituitarism. The post-operative hospital stay was significantly shorter for the endoscopic surgery group compared with the microscopic surgery group (P  0.05). Conclusions The present study indicates that the endoscopic transsphenoidal approach is safer and more effective than microscopic surgery in the treatment of pituitary adenomas. PMID:24721812

  11. Spontaneous remission of acromegaly or gigantism due to subclinical apoplexy of pituitary growth hormone adenoma

    Institute of Scientific and Technical Information of China (English)

    WANG Xian-ling; DOU Jing-tao; L(U) Zhao-hui; ZHONG Wen-wen; BA Jian-ming; JIN Du; LU Ju-ming; PAN Chang-yu; MU Yi-ming

    2011-01-01

    Background Subclinical apoplexy of pituitary functional adenoma can cause spontaneous remission of hormone hypersecretion.The typical presence of pituitary growth hormone (GH) adenoma is gigantism and/or acromegaly.We investigated the clinical characteristics of patients with spontaneous partial remission of acromegaly or gigantism due to subclinical apoplexy of GH adenoma.Methods Six patients with spontaneous remission of acromegaly or gigantism were enrolled.The clinical characteristics,endocrinological evaluation and imageological characteristics were retrospectively analyzed.Results In these cases,the initial clinical presences were diabetes mellitus or hypogonadism.No abrupt headache,vomiting,visual function impairment,or conscious disturbance had ever been complained of.The base levels of GH and insulin growth factor-1 (IGF-1) were normal or higher,but nadir GH levels were all still >1 μg/L in 75 g oral glucose tolerance test.Magnetic resonance imaging detected enlarged sella,partial empty sella and compressed pituitary.The transsphenoidal surgery was performed in 2 cases,and the other patients were conservatively managed.All the patients were in clinical remission.Conclusions When the clinical presences,endocrine evaluation,biochemical examination and imageology indicate spontaneous remission of GH hypersecretion in patients with gigantism or acromegaly,the diagnosis of subclinical apoplexy of pituitary GH adenoma should be presumed.To these patients,conservative therapy may be appropriate.

  12. Long-term outcomes of surgery and radiotherapy for secreting and non-secreting pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Young; Kim, Jin Hee; Oh, Young Kee; Kim, El [Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2016-06-15

    To investigate treatment outcome and long term complication after surgery and radiotherapy (RT) for pituitary adenoma. From 1990 to 2009, 73 patients with surgery and RT for pituitary adenoma were analyzed in this study. Median age was 51 years (range, 25 to 71 years). Median tumor size was 3 cm (range, 1 to 5 cm) with suprasellar (n = 21), cavernous sinus extension (n = 14) or both (n = 5). Hormone secreting tumor was diagnosed in 29 patients; 16 patients with prolactin, 12 patients with growth hormone, and 1 patient with adrenocorticotrophic hormone. Impairment of visual acuity or visual field was presented in 33 patients at first diagnosis. Most patients (n = 64) received RT as postoperative adjuvant setting. Median RT dose was 45 Gy (range, 45 to 59.4 Gy). Median follow-up duration was 8 years (range, 3 to 22 years). In secreting tumors, hormone normalization rate was 55% (16 of 29 patients). For 25 patients with evaluable visual field and visual acuity test, 21 patients (84%) showed improvement of visual disturbance after treatment. The 10-year tumor control rate for non-secreting and secreting adenoma was 100% and 58%, respectively (p < 0.001). Progression free survival rate at 10 years was 98%. Only 1 patient experienced endocrinological recurrence. Following surgery, 60% (n = 44) suffered from pituitary function deficit. Late complication associated with RT was only 1 patient, who developed cataract. Surgery and RT are very effective and safe in hormonal and tumor growth control for secreting and non-secreting pituitary adenoma.

  13. Spontaneous remission of acromegaly or gigantism due to subclinical apoplexy of pituitary growth hormone adenoma.

    Science.gov (United States)

    Wang, Xian-Ling; Dou, Jing-Tao; Lü, Zhao-Hui; Zhong, Wen-Wen; Ba, Jian-Ming; Jin, Du; Lu, Ju-Ming; Pan, Chang-Yu; Mu, Yi-Ming

    2011-11-01

    Subclinical apoplexy of pituitary functional adenoma can cause spontaneous remission of hormone hypersecretion. The typical presence of pituitary growth hormone (GH) adenoma is gigantism and/or acromegaly. We investigated the clinical characteristics of patients with spontaneous partial remission of acromegaly or gigantism due to subclinical apoplexy of GH adenoma. Six patients with spontaneous remission of acromegaly or gigantism were enrolled. The clinical characteristics, endocrinological evaluation and imageological characteristics were retrospectively analyzed. In these cases, the initial clinical presences were diabetes mellitus or hypogonadism. No abrupt headache, vomiting, visual function impairment, or conscious disturbance had ever been complained of. The base levels of GH and insulin growth factor-1 (IGF-1) were normal or higher, but nadir GH levels were all still > 1 µg/L in 75 g oral glucose tolerance test. Magnetic resonance imaging detected enlarged sella, partial empty sella and compressed pituitary. The transsphenoidal surgery was performed in 2 cases, and the other patients were conservatively managed. All the patients were in clinical remission. When the clinical presences, endocrine evaluation, biochemical examination and imageology indicate spontaneous remission of GH hypersecretion in patients with gigantism or acromegaly, the diagnosis of subclinical apoplexy of pituitary GH adenoma should be presumed. To these patients, conservative therapy may be appropriate.

  14. Cerebral salt wasting syndrome in a patient with a pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Singh S

    2003-01-01

    Full Text Available Cerebral salt wasting syndrome (CSWS is often an unrecognized cause of hyponatremia that occurs in the setting of intracranial lesions. It is important to differentiate CSWS from the syndrome of inappropriate ADH secretion, as this would alter the management of hyponatremia. We describe a case of CSWS that occurred in association with a non­functioning pituitary adenoma.

  15. Lack of radiation optic neuropathy in 72 patients treated for pituitary adenoma

    NARCIS (Netherlands)

    van den Bergh, ACM; Dullaart, RPF; van der Vliet, AM; Szabo, BG; ter Weeme, CA; Pott, JWR

    The incidence of radiation optic neuropathy (RON) after external photon beam radiation therapy for nonfunctioning pituitary adenoma (NFA) is not well-studied. Retrospective review of ophthalmological and imaging data in 72 patients with NFA treated between 1985 and 1998 with external beam radiation

  16. Cerebral salt wasting syndrome in a patient with a pituitary adenoma.

    Science.gov (United States)

    Singh, S K; Unnikrishnan, A G; Reddy, V S; Sahay, R K; Bhadada, S K; Agrawal, J K

    2003-03-01

    Cerebral salt wasting syndrome (CSWS) is often an unrecognized cause of hyponatremia that occurs in the setting of intracranial lesions. It is important to differentiate CSWS from the syndrome of inappropriate ADH secretion, as this would alter the management of hyponatremia. We describe a case of CSWS that occurred in association with a non-functioning pituitary adenoma.

  17. Somatomammotrophic cells in GH-secreting and PRL-secreting human pituitary adenomas.

    Science.gov (United States)

    Bassetti, M; Brina, M; Spada, A; Giannattasio, G

    1989-11-01

    A morphological study has been carried out on 20 GH-secreting adenomas removed from acromegalic normoprolactinemic patients, on 29 PRL-secreting adenomas removed from hyperprolactinemic patients without signs of acromegaly and on one normal human anterior pituitary gland collected at autopsy. The protein A-gold immunoelectron microscopic technique has been utilized in order to verify the presence of mixed cells producing both GH and PRL (somatomammotrophs) in these pituitary tissues. In the normal pituitary a considerable number of somatomammotrophs (15-20%) was found, thus supporting the idea that these cells are normal components of the human anterior pituitary gland. In 10 GH-secreting adenomas and in 10 PRL-secreting adenomas somatomammotrophs were present in a variable number (from 4 to 20% of the whole cell population in GH adenomas and from 1 to 47% in PRL tumors). It can be concluded therefore that these cells, largely present in all GH/PRL-secreting adenomas, can also be found in GH-secreting and PRL-secreting tumors without clinical evidence of a mixed secretion. Adenomatous somatomammotrophs displayed ultrastructural features of adenomatous somatotrophs and mammotrophs (prominent Golgi complexes, abundant rough endoplasmic reticulum, irregular nuclei). The size and the number of granules were variable. In some cells GH and PRL were stored in distinct secretory granules, in others in mixed granules or both in mixed and distinct granules, thus suggesting that in adenomatous somatomammotrophs the efficiency of the mechanisms of sorting of the two hormones varies from one cell to another.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Pituitary Adenoma as a Rare Form of Secondary Adrenal Insufficiency. A Case Report

    Directory of Open Access Journals (Sweden)

    Ana María León Blasco

    2014-02-01

    Full Text Available Pituitary adenomas are benign tumors arising from one of the five cell types in the anterior pituitary. Secondary adrenal insufficiency occurs when the adrenal glands do not produce hormones due to the lack of pituary adrenocorticotropic hormone or hypothalamic corticotropin-releasing factor. The case of a 37-year-old female patient who started developing muscle twitching in legs and arms, muscular weakness, fatigue, muscle aches, severe and throbbing hemicrania on the right side, among other symptoms, a year ago is presented. Several tests were performed (cortisol level, adrenocorticotropic hormone, calcium and phosphorus in blood and urine, magnetic resonance imaging of the skull, leading to the diagnosis of pituitary adenoma with isolated adrenocorticotropic hormone deficiency and secondary adrenal insufficiency. Treatment with steroids and calcium supplements ensured a satisfactory recovery.

  19. Transformation of a microprolactinoma into a mixed growth hormone and prolactin-secreting pituitary adenoma

    Directory of Open Access Journals (Sweden)

    CEDRIC eDESSIMOZ

    2012-01-01

    Full Text Available Combined prolactin (PRL and growth hormone (GH secretion by a single pituitary tumor can occur in approximately 5% of cases. However, in all previously reported patients, combined secretion of both hormones was present at the time of diagnosis. Here we describe a patient initially diagnosed with a pure prolactin-secreting microadenoma, who experienced the progressive apparition of symptomatic autonomous GH secretion while on intermittent long term dopamine agonist therapy. She was operated on, and immunohistochemical analysis of tumour tissue confirmed the diagnosis of pituitary adenoma with uniform co-staining of all cells for both GH and PRL. This patient represents the first documented occurrence of asynchronous development of combined GH and PRL secretion in a pituitary adenoma. Although pathogenic mechanisms implicated remain largely speculative, it emphasizes the need for long term hormonal follow up of patients harboring prolactinomas.

  20. Immunohistochemical detection of estrogen receptor alpha in pituitary adenomas and its correlation with cellular replication.

    Science.gov (United States)

    Pereira-Lima, Julia F S; Marroni, Caroline P; Pizarro, Cristina B; Barbosa-Coutinho, Ligia M; Ferreira, Nelson P; Oliveira, Miriam C

    2004-03-01

    With the aim of evaluating the relationship between pituitary tumorigenesis and the presence of estrogen receptor-alpha (ERalpha) by immunohistochemistry (IH) and their relevance to patients' clinical presentation, hormonal phenotypes of adenomas, preoperative neuroimaging findings, and the index of cellular replication MIB-1, a study was conducted with material from 91 women and 67 men with pituitary adenomas. The patients had acromegaly (29.7%), Cushing's disease (14.6%), hyperprolactinemic syndrome (20.9%), and clinically nonfunctioning tumors (34.8%). Of the patients, 14.6% had microadenomas, 52.5% had macroadenomas with or without suprasellar growth, 28.5% had invasive macroadenomas and in 4.4% the adenoma was not visualized. IH showed that 43 were positive for growth hormone (GH), 16 for corticotropin (ACTH), 18 for prolactin (PRL), 18 for PRL+GH, 6 for luteinizing hormone (LH) and follicle-stimulating hormone (FSH), 15 had a plurihormonal reaction, and 42 had nonfunctioning adenomas. The presence of ERalpha was positive in 9/158 adenomas with a median value for the percentage of labeled cells of 42.89%, and in 6/16 controls (autopsy samples) with a median value for the percentage of labeled cells of 0.024%. ERalpha was significantly more prevalent in controls than in patients with adenomas (37.5 versus 5.7%; p = 0.001); however, the mean ERalpha concentration in adenomas was significantly greater than in controls (42.89 versus 0.024%; p < 0.001). No significant difference in the concentration of ERalpha was found across the clinical presentations, hormonal phenotypes or findings of preoperative CT. Among the ERalpha-positive adenomas, ERalpha values were significantly greater in invasive macroadenomas (80%) than in microadenomas (3.33%). MIB-1 values did not differ significantly between ERalpha-positive and -negative adenomas, nor did the correlation between ERalpha values and the MIB-1 index attain significance in the total sample, even when only ERalpha

  1. Immediate postoperative radiotherapy in residual nonfunctioning pituitary adenoma : Beneficial effect on local control without additional negative impact on pituitary function and life expectancy

    NARCIS (Netherlands)

    Van den Bergh, Alfons C. M.; Berg, van den Gerrit; Schoorl, Michiel A.; Sluiter, Wim J.; Vliet , van der Anton M.; Hoving, Eelco W.; Szabo, Ben G.; Langendijk, Johannes A.; Wolffenbuttel, Bruce H. R.; Dullaart, Robin P. F.

    2007-01-01

    Purpose: To demonstrate the benefit of immediate postoperative radiotherapy in residual nonfunctioning pituitary adenoma (NFA) in perspective to the need for hormonal substitution and life expectancy. Methods and Materials: Retrospective cohort analysis of 122 patients, operated for NFA between 1979

  2. Treatment of Aggressive Prolactin-Secreting Pituitary Adenomas with Adjuvant Temozolomide Chemotherapy: A Review.

    Science.gov (United States)

    Moisi, Marc; Cruz, Aurora S; Benkers, Tara; Rostad, Steven; Broyles, Frances Broyles; Yuen, Kevin; Mayberg, Marc

    2016-01-01

    Most prolactin-secreting pituitary adenomas demonstrate slow growth and are effectively managed with medical/surgical therapy. Rarely, these tumors can behave aggressively with rapid growth and invasion of local tissues, and are refractory to medical, surgical, or radio-surgical therapies. We report a case of a prolactin-secreting adenoma in a young woman, which became progressively aggressive and refractory to usual treatment modalities, but responded to treatment with the chemotherapeutic agent temozolomide. In addition, we review the literature for treatment of refractory adenomas with temozolomide. The clinical and pathologic characteristics of aggressive prolactin-secreting adenomas are reviewed, as well as their response to dopamine agonists, surgery, radiotherapy, and chemotherapy.

  3. Clinical and morphological features of undifferentiated monomorphous GH/TSH-secreting pituitary adenoma.

    Science.gov (United States)

    Skorić, T; Korsić, M; Zarković, K; Plavsić, V; Besenski, N; Breskovac, L; Giljević, Z; Paladino, J

    1999-06-01

    A 41-year-old male presented with progressive visual defects, acromegaly and hyperthyroidism. After clinical evaluation a giant GH/TSH-secreting pituitary adenoma was diagnosed. Administration of the somatostatin analog octreotide at doses of 150 microg s.c. per day inhibited the secretion of both GH and TSH. A three-week treatment with octreotide prior to surgery led to slight visual improvement and CT scan showed some new necrotic areas within the tumor mass. Transcranial surgery was performed. By immunohistochemical analyses of the adenoma tissue GH, prolactin and beta-chorionic gonadotropin were detected; TSH was negative. Electron microscopy revealed an undifferentiated, monomorphous adenoma with morphological features of an acidophil stem cell adenoma such as the presence of misplaced exocytoses, fibrous bodies and mitochondrial gigantism. However, the tumor cells contained small secretory granules (up to 250 nm) accumulated along the cell membrane characteristic of thyrotrope cells. Furthermore, some adenoma cells were fusiform with long cytoplasmic processes resembling thyrotropes. Two months after the operation CT scan revealed a large residual tumor. Serum GH and TSH levels had increased again and the TSH level was even higher than before the treatment. The patient died suddenly, most probably of lethal arrhythmia. Specimens of the adenoma tissue obtained at autopsy confirmed the previous findings with the exception of positive immunostaining for TSH which was found in less than 1% of the adenoma cells. This undifferentiated, monomorphous GH/TSH-secreting pituitary adenoma represents an entity that is unusual both in its ultrastructural features and clinical manifestations suggesting a cytogenesis from an early, undifferentiated stem cell.

  4. Endoscopic endonasal trans-sphenoid surgery of pituitary adenoma

    OpenAIRE

    Yadav, Y. R.; Sachdev, S.; Parihar, V.; H Namdev; P R Bhatele

    2012-01-01

    Endoscopic endonasal trans-sphenoid surgery (EETS) is increasingly used for pituitary lesions. Pre-operative CT and MRI scans and peroperative endoscopic visualization can provide useful anatomical information. EETS is indicated in sellar, suprasellar, intraventricular, retro-infundibular, and invasive tumors. Recurrent and residual lesions, pituitary apoplexy and empty sella syndrome can be managed by EETS. Modern neuronavigation techniques, ultrasonic aspirators, ultrasonic bone curette can...

  5. Endoscopic Endonasal Versus Microscopic Transsphenoidal Surgery for Recurrent and/or Residual Pituitary Adenomas.

    Science.gov (United States)

    Esquenazi, Yoshua; Essayed, Walid I; Singh, Harminder; Mauer, Elizabeth; Ahmed, Mudassir; Christos, Paul J; Schwartz, Theodore H

    2017-05-01

    Surgery for recurrent/residual pituitary adenomas is increasingly being performed through endoscopic surgery. Whether this new technology has altered the indications and outcomes of surgery is unknown. We conducted a systematic review and meta-analysis of published studies to compare the indications and outcomes between microscopic and endoscopic approaches. A PubMed search was conducted (1985-2015) to identify surgical series of endoscopic endonasal and microscopic transsphenoidal resection of residual or recurrent pituitary adenomas. Data were extracted regarding tumor characteristics, surgical treatment, extent of resection, endocrine remission, visual outcome, and complications. Twenty-one studies met inclusion criteria. A total of 292 patients were in the endoscopic group, and 648 patients were in the microscopic group. Endoscopic cases were more likely nonfunctional (P microscopic group. Endocrine remission was achieved in 53.0% and 46.7% of patients, and visual improvement occurred in 73.2% and 49.6% for the endoscopic and microscopic groups. Cerebrospinal fluid leak and pituitary insufficiency were higher in the endoscopic group. This meta-analysis indicates that the use of the endoscope to reoperate on residual or recurrent adenomas has only led to modest increases in resection rates. However, larger more complex cases are being tackled, so direct comparisons are misleading. The most dramatic change has been in visual improvement along with modest increases in risk. Reoperation for recurrent or residual adenomas is a safe and effective treatment option. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Identification of a subtype-specific ENC1 gene related to invasiveness in human pituitary null cell adenoma and oncocytomas.

    Science.gov (United States)

    Feng, Jie; Hong, Lichuan; Wu, Yonggang; Li, Chuzhong; Wan, Hong; Li, Guilin; Sun, Yilin; Yu, Shenyuan; Chittiboina, Prashant; Montgomery, Blake; Zhuang, Zhengping; Zhang, Yazhuo

    2014-09-01

    Non-functioning pituitary adenomas (NFPAs) may be locally invasive. Surgery is a treatment option, but unlike the case for functional pituitary adenomas, there are almost no drug treatments available for NFPAs. Markers of invasiveness are needed to guide therapeutic decision-making and identify potential adjuvant drugs. Owing to the highly heterogeneous nature of NFPAs, little is known regarding the subtype-specific gene expression profiles associated with invasiveness. To identify important biomarkers of invasiveness, we selected 23 null cell adenomas and 20 oncocytomas. These tumors were classified as invasive or non-invasive adenomas based on magnetic resonance imaging, pathology slides and surgical findings. Firstly, we observed that there were significant differences in expression between invasive (n = 3) and non-invasive (n = 4) adenomas by gene expression microarray. A total of 1,188 genes were differentially expressed in the invasive and non-invasive adenomas. Among these 1,188 genes, 578 were upregulated and 610 were downregulated in invasive adenomas. Secondly, the expression of ENC1, which displayed the significant alterations, was further confirmed by qRT-PCR and Western blot analysis in all 43 tumor samples and three normal pituitary glands. Low levels of ENC1 were found in tumor samples, while high levels were detected in normal pituitary glands. Interestingly, the ENC1 expression level was low in invasive null cell adenomas compared with non-invasive adenomas, but this relationship was not observed in invasive oncocytomas. Immunohistochemistry also demonstrated that the staining of ENC1 was different between invasive and non-invasive null cell adenomas. In addition, bioinformatics studies, including gene ontology and protein interaction analyses, were also performed to better understand the critical role of ENC1 in the development and progression of null cell adenomas and oncocytomas. Consequently, ENC1 may be an important biomarker for null cell

  7. Fat-suppressed dynamic MR imaging for the postoperative evaluation of pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Akada, Kiyohiro [Tokyo Medical Coll. (Japan)

    2000-07-01

    The usefulness of the early post operative evaluation of pituitary adenomas with fat-suppressed MR imaging was studied. Thirty patients with pituitary adenoma, who underwent trans-sphenoidal surgery were analyzed. These include 22 with macroadenoma (3 recurrent cases) and 8 with microadenoma (2 recurrent cases). In all cases after adenoma resection, fat tissue was placed into the sella turcica to prevent postoperative cerebro-spinal fluid leakage and infections. T1-weighted and Gd DTPA-enhanced MR images were obtained using a 1.5-T superconductive MRI system (Shimadzu Co., Ltd.) by a standard technique and also by a fat suppression technique (chemical shift selective presaturation: CHESS) after surgery. It was difficult to discriminate between hematoma, fat tissue and pituitary posterior lobe on T1-weighted images within 1 month after surgery because of high-signal intensity. However, these regions could be distinguished one another by the CHESS technique. Normal pituitary anterior lobe could be identified in 86% of macroadenoma cases using Gd CHESS dynamic study, whereas it was identified only in 23% by standard technique. Normal anterior lobe was identified in 100% of microadenoma cases using Gd CHESS dynamic study. The residual tumors were found to invade into the supra sella or cavernous sinus, and these lesions could be distinguished from the surrounding tissue by the CHESS dynamic study in 83%, whereas only 33% could be distinguished by the standard technique. Although the fat tissue showed a time-sequence decrease in volume, high-signal intensity sometimes lasted long in association with degenerative granulation. In conclusion, CHESS dynamic MR Imaging study is useful for detection of the normal pituitary lobe and residual adenomas after trans-sphenoidal surgery. (author)

  8. The Expression of Integrinβ1 and FAK in Pituitary Adenomas and Their Correlation with Invasiveness

    Institute of Scientific and Technical Information of China (English)

    Feng WAN; Kai SHU; Ting LEI; Delin XUE

    2008-01-01

    Summary: The expression and possible role of integrin-focal adhesion kinase signal pathway in invasive pituitary adenomas were explored. Forty-nine human pituitary adenomas were detected for the expression of integrinβ1 (INTβ1) and focal adhesion kinase (FAK) by immunohistochemistry, and their correlation with the invasiveness of pituitary adenomas as well as between themselves was analyzed. The results showed that INTβ1 was expressed in 46 cases (93.9%) and FAK in 36 cases (73.5%), respectively, and their expression levels were highly correlated with tumor invasiveness, but not with the tumor types. It was suggested that the integrin-focal adhesion kinase signal pathway plays a role in the invasiveness of pituitary adenomas.

  9. AIP mutation in pituitary adenomas in the 18th century and today.

    Science.gov (United States)

    Chahal, Harvinder S; Stals, Karen; Unterländer, Martina; Balding, David J; Thomas, Mark G; Kumar, Ajith V; Besser, G Michael; Atkinson, A Brew; Morrison, Patrick J; Howlett, Trevor A; Levy, Miles J; Orme, Steve M; Akker, Scott A; Abel, Richard L; Grossman, Ashley B; Burger, Joachim; Ellard, Sian; Korbonits, Márta

    2011-01-06

    Gigantism results when a growth hormone-secreting pituitary adenoma is present before epiphyseal fusion. In 1909, when Harvey Cushing examined the skeleton of an Irish patient who lived from 1761 to 1783, he noted an enlarged pituitary fossa. We extracted DNA from the patient's teeth and identified a germline mutation in the aryl hydrocarbon-interacting protein gene (AIP). Four contemporary Northern Irish families who presented with gigantism, acromegaly, or prolactinoma have the same mutation and haplotype associated with the mutated gene. Using coalescent theory, we infer that these persons share a common ancestor who lived about 57 to 66 generations earlier.

  10. Clinical application of anatomy landmarks for microscopic endonasal transsphenoidal surgery for pituitary adenomas.

    Science.gov (United States)

    Wang, Shou-Sen; Li, Jun-Feng; Chen, Hong-Jie; Wang, Ru-Mi

    2013-01-01

    It is important to identify relevant anatomical landmarks on the route of endonasal transsphenoidal surgery (TSS) for pituitary adenomas to improve the gross total resection and the remission of disease. We therefore retrospectively studied the clinical outcomes of 148 patients who underwent single nostril endonasal TSS for pituitary adenomas. The anatomic basis of these procedures was evaluated. The important landmarks included the mucosal sphenoid ostia, the sphenoid keel, the osseous ostia and the nutrient arteries nearby, the sellar bulge, and the carotid protuberance, which outlined a clear route to the sella turcica with the best view and less tissue damage. Based on these landmarks, 148 cases of endonasal TSS were successfully performed to achieve 70.3% of gross total resection and remission, respectively. The complications were controlled to the least. Therefore, the application of these landmarks will help to prevent complications and improve the long-term outcomes.

  11. Mutation and genomic amplification of the PIK3CA proto-oncogene in pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Murat, C.B.; Braga, P.B.S.; Fortes, M.A.H.Z. [Laboratório de Endocrinologia Celular e Molecular (LIM-25), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Bronstein, M.D. [Unidade de Neuroendocrinologia, Serviço de Endocrinologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Corrêa-Giannella, M.L.C.; Giorgi, R.R. [Laboratório de Endocrinologia Celular e Molecular (LIM-25), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil)

    2012-07-13

    The tumorigenesis of pituitary adenomas is poorly understood. Mutations of the PIK3CA proto-oncogene, which encodes the p110-α catalytic subunit of PI3K, have been reported in various types of human cancers regarding the role of the gene in cell proliferation and survival through activation of the PI3K/Akt signaling pathway. Only one Chinese study described somatic mutations and amplification of the PIK3CA gene in a large series of pituitary adenomas. The aim of the present study was to determine genetic alterations of PIK3CA in a second series that consisted of 33 pituitary adenomas of different subtypes diagnosed by immunohistochemistry: 6 adrenocorticotropic hormone-secreting microadenomas, 5 growth hormone-secreting macroadenomas, 7 prolactin-secreting macroadenomas, and 15 nonfunctioning macroadenomas. Direct sequencing of exons 9 and 20 assessed by qPCR was employed to investigate the presence of mutations and genomic amplification defined as a copy number ≥4. Previously identified PIK3CA mutations (exon 20) were detected in four cases (12.1%). Interestingly, the Chinese study reported mutations only in invasive tumors, while we found a PIK3CA mutation in one noninvasive corticotroph microadenoma. PIK3CA amplification was observed in 21.2% (7/33) of the cases. This study demonstrates the presence of somatic mutations and amplifications of the PIK3CA gene in a second series of pituitary adenomas, corroborating the previously described involvement of the PI3K/Akt signaling pathway in the tumorigenic process of this gland.

  12. Neuronavigation used for the transsphenoidal resection of a pituitary adenoma accompanied by a concha sphenoid sinus.

    Science.gov (United States)

    Sun, Libo; Gao, Yufei; Fu, Chao; Li, Fang; Zhao, Conghai

    2012-01-01

    A concha non-pneumatized sphenoid is considered to be a contraindication for the transsphenoidal resection of a pituitary adenoma. Specifically, this anatomical variation makes it difficult to approach the sella turcica. However, in this report, an intra-operative navigational system was used as a guide to access the sella through the sphenoid sinus. This procedure was found to be both reasonable and safe.

  13. Reduced sleep quality and depression associate with decreased quality of life in patients with pituitary adenomas.

    Science.gov (United States)

    Leistner, Sarah M; Klotsche, Jens; Dimopoulou, Christina; Athanasoulia, Anastasia P; Roemmler-Zehrer, Josefine; Pieper, Lars; Schopohl, Jochen; Wittchen, Hans-Ulrich; Stalla, Günter K; Fulda, Stephany; Sievers, Caroline

    2015-06-01

    Several studies reported decreased quality of life (QoL) and sleep as well as increased rates of depression for patients with pituitary adenomas. Our aim was to explore to what extent differences in depression and sleep quality contribute to differences in QoL between patients with pituitary adenomas and controls. A cross-sectional case-control study. Endocrine Outpatient Unit of the Max Planck Institute of Psychiatry, Munich, Department of Internal Medicine, Ludwig-Maximilians-University, Munich, and the Institute of Clinical Psychology and Psychotherapy, Technical University, Dresden. Patients with pituitary adenomas (n=247) and controls (from the DETECT cohort, a large epidemiological study in primary care patients) matched individually by age and gender (n=757). Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and QoL was measured by the generic EQ-5D and calculated by the time trade-off- and VAS-method. Depression was categorized as 'no depression', 'subclinical depression', and 'clinical depression' according to the Beck Depressions Inventory for patients and the Depression Screening Questionnaire for control subjects. General linear and generalized, logistic mixed models as well as proportional odds mixed models were calculated for analyzing differences in baseline characteristics and in different subgroups. Patients with pituitary adenomas showed decreased QoL (VAS index: 0.73±0.19) and sleep (PSQI score: 6.75±4.17) as well as increased rates of depression (subclinical or clinical depression: 41.4%) compared with their matched control subjects (VAS index: 0.79±0.18, PSQI score: 5.66±4.31, subclinical or clinical depression: 25.9%). We have shown that a substantial proportion of the reduced QoL (48% respectively 65%) was due to the incidence of depression and reduced sleep quality. These findings emphasize the importance of diagnosing depressive symptoms and sleep disturbances in patients with pituitary disease, with the ultimate

  14. Pituitary Adenoma and Hyperprolactinemia Accompanied by Idiopathic Granulomatous Mastitis.

    Science.gov (United States)

    Destek, Sebahattin; Gul, Vahit Onur; Ahioglu, Serkan; Serin, Kursat Rahmi

    2017-01-01

    Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of the breast, and its etiology remains not fully elucidated. IGM is observed more often in patients with autoimmune disease. Hyperprolactinemia is observed during pregnancy, lactation, and a history of oral contraceptive use. A 39-year-old patient with no history of oral contraceptive use presented with complaints such as redness, pain, and swelling in her left breast. Ultrasound and magnetic resonance imaging (MRI) revealed a suspicious inflamed mass lesion. Core biopsy was performed to exclude breast cancer and to further diagnose. The breast abscess was drained and steroids were given for treatment. In order to monitor any progression during the three months of treatment, hormone levels were routinely examined. Prolactin level was above the reference range, and pituitary MRI revealed a pituitary prolactinoma. After treatment with prolactin inhibitors, IGM also improved with hyperprolactinemia. This report emphasizes attention to hyperprolactinemia in cases of IGM diagnosis and treatment.

  15. Pituitary Adenoma and Hyperprolactinemia Accompanied by Idiopathic Granulomatous Mastitis

    Directory of Open Access Journals (Sweden)

    Sebahattin Destek

    2017-01-01

    Full Text Available Idiopathic granulomatous mastitis (IGM is a rare chronic inflammatory disease of the breast, and its etiology remains not fully elucidated. IGM is observed more often in patients with autoimmune disease. Hyperprolactinemia is observed during pregnancy, lactation, and a history of oral contraceptive use. A 39-year-old patient with no history of oral contraceptive use presented with complaints such as redness, pain, and swelling in her left breast. Ultrasound and magnetic resonance imaging (MRI revealed a suspicious inflamed mass lesion. Core biopsy was performed to exclude breast cancer and to further diagnose. The breast abscess was drained and steroids were given for treatment. In order to monitor any progression during the three months of treatment, hormone levels were routinely examined. Prolactin level was above the reference range, and pituitary MRI revealed a pituitary prolactinoma. After treatment with prolactin inhibitors, IGM also improved with hyperprolactinemia. This report emphasizes attention to hyperprolactinemia in cases of IGM diagnosis and treatment.

  16. Pituitary Adenoma and Hyperprolactinemia Accompanied by Idiopathic Granulomatous Mastitis

    Science.gov (United States)

    Destek, Sebahattin; Ahioglu, Serkan; Serin, Kursat Rahmi

    2017-01-01

    Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of the breast, and its etiology remains not fully elucidated. IGM is observed more often in patients with autoimmune disease. Hyperprolactinemia is observed during pregnancy, lactation, and a history of oral contraceptive use. A 39-year-old patient with no history of oral contraceptive use presented with complaints such as redness, pain, and swelling in her left breast. Ultrasound and magnetic resonance imaging (MRI) revealed a suspicious inflamed mass lesion. Core biopsy was performed to exclude breast cancer and to further diagnose. The breast abscess was drained and steroids were given for treatment. In order to monitor any progression during the three months of treatment, hormone levels were routinely examined. Prolactin level was above the reference range, and pituitary MRI revealed a pituitary prolactinoma. After treatment with prolactin inhibitors, IGM also improved with hyperprolactinemia. This report emphasizes attention to hyperprolactinemia in cases of IGM diagnosis and treatment. PMID:28321344

  17. Cushing Disease After Treatment of Nonfunctional Pituitary Adenoma: A Case Report and Literature Review.

    Science.gov (United States)

    Fang, Hongjuan; Tian, Rui; Wu, Huanwen; Xu, Jian; Fan, Hong; Zhou, Jian; Zhong, Liyong

    2015-12-01

    We describe a very rare case of nonfunctional pituitary adenoma (NFPA) that exhibited corticotrophic activity after resection and radiotherapy. The possible mechanisms of the transformation from NFPA to Cushing disease (CD) are discussed.A 43-year-old man presented with impaired vision, bilateral frontal headaches, and hyposexuality. He had no symptoms suggestive of hypercortisolism, and 8 am plasma cortisol concentration was 67.88 ng/mL. Brain imaging revealed a 15 × 15 × 21-mm sellar mass suggestive of a macroadenoma. The tumor was resected by transsphenoidal surgery and identified by immunohistochemical analysis as a chromophobic adenoma that did not stain for pituitary hormones. The patient was treated with prednisone and levothyroxine replacement therapy. After a third recurrence, the patient presented with clinical features and physical signs of Cushing syndrome. Plasma adrenocorticotropic hormone (ACTH) and cortisol concentrations were elevated, and there was a loss of circadian rhythms. Inferior petrosal sinus sampling after desmopressin showed the central-peripheral ACTH ratio was greater than 3:1. A repeat transsphenoidal resection was undertaken. Immunohistochemistry revealed ACTH positivity. Three months following surgery, imaging showed little residual tumor, but plasma ACTH remained elevated. He was referred for postoperative Gamma Knife radiotherapy.The immunological activity and biological features of the hormones secreted from a pituitary adenoma vary with time. Because long-term outcomes are unpredictable, postoperative follow-up is essential to detect postoperative transformation from NFPA to CD.

  18. Visual acuity and pattern of visual field loss at presentation in pituitary adenoma.

    Science.gov (United States)

    Ogra, Siddharth; Nichols, Andrew D; Stylli, Stanley; Kaye, Andrew H; Savino, Peter J; Danesh-Meyer, Helen V

    2014-05-01

    Our purpose was to analyse the demographics, prevalence and pattern of visual field defects in patients with pituitary adenoma. We prospectively recruited 103 consecutive patients (206 eyes) presenting to a neurosurgical unit with pituitary adenoma. Ophthalmological examination and standard automated perimetry (Humphrey, 24-2 threshold) was performed. Severity of visual field defects was also assessed. The mean population age was 53.9 years (standard deviation=15). Visual loss was the most common reason for presentation (39%) followed by endocrine abnormality (21%) and headache (15%). Patients with endocrine abnormality on presentation were 10.9 years younger than those presenting with visual loss (p=0.001). Bitemporal defects were the most prevalent pattern (n=22, 41%) followed by homonymous defects (n=7, 13%). Of the patients with visual field loss, 33% had unilateral visual field defects. The mean visual acuity in those with bitemporal defects was 6/7.5 with half of these patients having 6/6 vision in both eyes. In conclusion, the majority of patients with pituitary adenoma have visual acuity better than 6/7.5 despite having visual field defects. While a bitemporal pattern of visual field loss is the most common, a significant proportion of patients had unilateral and altitudinal defects. Assessment of the visual field is essential to rule out chiasmal compression.

  19. Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Constantine L. Karras

    2016-01-01

    Full Text Available Background. Purely ectopic pituitary adenomas are exceedingly rare. Here we report on a patient that presented with an incidental clival mass thought to be a chordoma. Endonasal resection, tumor pathology, and endocrinology workup revealed a prolactinoma. Case Presentation. A 41-year-old male presented with an incidental clival lesion presumed to be a chordoma. On MRI it involved the entire clivus, extended laterally to the petroclival junction, and invaded the cavernous sinuses bilaterally, encasing both internal carotid arteries, without direct extension into the sella. Intraoperatively, it was clear that the tumor originated from the clivus and that the sellar dura was completely intact. Frozen-section pathology was consistent with a pituitary adenoma. Immunostaining was positive for synaptophysin and prolactin with a low Ki-67 index, suggestive of a prolactinoma. Additional immunohistochemical stains seen in chordomas (EMA, S100, and Brachyury and other metastatic tumors were negative. A postoperative endocrine workup revealed an elevated serum prolactin of 881.3 ng/mL (normal < 20. Conclusions. In conclusion, it is crucial to maintain an extensive differential diagnosis when evaluating a patient with a clival lesion. Ectopic clival pituitary adenomas, although rare, may warrant an endocrinological workup preoperatively as the majority may respond to medical treatment.

  20. [Neuronavigation-guided pure endoscopic endonasai transsphenoidal approach for pituitary adenomas].

    Science.gov (United States)

    Hu, Changchen; Ji, Hongming; Zhang, Shiyuan; Hao, Xudong; Shen, Bo; Su, Luhai

    2015-02-03

    To explore the efficacies of neuronavigation-guided pure endoscopic endonasal transsphenoidal approach for removing pituitary adenomas. Retrospective analyses were conducted for the clinical data of 139 patients undergoing pure endoscopic endonasal transsphenoidal surgery for pituitary adenomas between July 2011 and July 2014. There were 55 males and 84 females with a mean age of 48. 9 (21 - 73) years. The classifications of Hardy-Wilson were I (n =16), II (n = 39), III (n = 48) and IV (n = 36). Neuronavigation was used in all patients. And neuro-ophthalmological, neuroimaging and endocrinological follow-ups were conducted postoperatively. Total (n = 95, 68. 3%), subtotal (n = 33, 23. 7%) and partial (n = 11, 7. 9%) removals were achieved. For Hardy-Wilson I, gross total removal was achieved (n = 16, 100%); Hardy-Wilson II (n = 35, 89. 7%), Hardy-Wilson III (n = 34, 70. 8%) and Hardy-Wilson IV (n = 10, 27. 8%). Postoperative visual acuity improved (92. 1%, 70/76) and endocrine remission was observed (59. 6%, 53/89). The postoperative complications included cerebrospinal fluid (CSF) leakage (n = 8, 5. 8%), meningitis (n = 3), sellar hematoma (n = 5) and delayed carotid artery rupture (n = 1). And the patient of hemorrhagic shock underwent emergency interventional procedures and was discharged successfully. Pure endoscopic endonasal transsphenoidal approach for removing pituitary adenoma is both safe and effective. And its efficacies may further increased through combined neuronavigation.

  1. [Efficacy analysis of endoscopic endonasal transsphenoidal surgery for recurrent or regrowing pituitary adenomas].

    Science.gov (United States)

    Xue, Yajun; Zhao, Yaodong; Cui, Daming; Wang, Ke; Shen, Zhaoli; Shen, Rui; Lou, Meiqing

    2015-02-03

    To analyze the safety and efficacy of surgical removal of recurrent or regrowing pituitary adenomas by endoscopic endonasal transsphenoidal approach. The clinical data were retrospectively reviewed for 28 patients undergoing endoscopic endonasal transsphenoidal surgery for recurrent or regrowing pituitary adenomas between April 2010 and December 2013. There were 9 males and 19 females with a mean age of 44. 2 (11 - 73) years. The maximal tumor diameter ranged from 2. 1 to 6.9 cm. The Knosp grades were 1 -2 (n = 11), 3 (n =8) and 4 (n =9). Fifteen tumors were endocrinically functional and the remainder endocrinically nonfunctional. All operations were performed with an assistance of intraoperative neuronavigation. Neuro-ophthalmological, neuroimaging and endocrinological results were followed up postoperatively. And surgical outcomes and risk factors were analyzed for incomplete tumor resection in previous operations. The mean follow-up period was 19. 1 (3 - 45) months. Gross total resection(n = 18, 64. 3%), subtotal resection(n = 6, 21. 4%) and partial resection(n = 4, 14. 3%) were achieved. Postoperatively, visual acuity improved in 11 patients (73. 3%) and 6 patients (40. 0%) showed endocrine remission. Qne patient had short-term postoperative leakage of cerebrospinal fluid (CSF). Endoscopic endonasal transsphenoidal surgery is both safe and effective for recurrent or regrowing pituitary adenomas.

  2. Biopsy proven pituitary sarcoidosis presenting as a possible adenoma.

    Science.gov (United States)

    Prayson, Richard A

    2016-12-01

    Sarcoidosis is a well-recognized systemic granulomatous process which involves the central nervous system in 5-15% of patients. One of the more frequent sites of central nervous system involvement is the pituitary and hypothalamic region. Involvement of the sellar region by sarcoidosis is overall an infrequent occurrence, comprising less than 1% of all intrasellar lesions. Patients typically present with an infiltrative lesion on imaging studies and clinically with symptoms related to diabetes insipidus or hyperprolactinemia. This report describes a 38-year-old woman who initially presented with a variety of symptoms including headaches, light sensitivity, nausea and vomiting, acute visual changes, cold intolerance, amenorrhea, decreased libido, fatigue and galactorrhea. She had an elevated serum prolactin level and evidence of oligoclonal bands in the cerebrospinal fluid. Imaging studies discovered a 1.8cm mass involving the pituitary gland and compressing the optic chiasm. The lesion was excised and microscopically was marked by a chronic inflammatory cell infiltrate and scattered nonnecrotizing granulomas. Stains and microbiologic cultures failed to demonstrate microorganisms. There was no evidence of other organ involvement on postoperative imaging. She was treated with prednisone with improvement of symptoms and subsequently required methotrexate to treat left eye pain and blurred vision, 29months after her surgery. Achieving treatment control in patients with pituitary and hypothalamic improvement in sarcoidosis still remains a challenge. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Evaluation of angiogenesis in 77 pituitary adenomas using endoglin as a marker.

    Science.gov (United States)

    Pizarro, Cristina B; Oliveira, Miriam C; Pereira-Lima, Julia F S; Leães, Carolina G S; Kramer, Carolina K; Schuch, Tiago; Barbosa-Coutinho, Lígia M; Ferreira, Nelson P

    2009-02-01

    Angiogenesis, a fundamental process for the development and growth of a tumor, is less expressive in adenomas than in the normal pituitary tissue. There is controversy about the behavior of angiogenesis as a function of hormonal secretion or other characteristics of pituitary tumors. Endoglin (CD105) is a proliferation-associated antigen on endothelial cells, as well as an endothelial progenitor cell marker. We used the anti-endoglin antibody, a glycoprotein expressed in endothelial cells and conjunctive tissue, as a new marker particularly associated with neovascularization, in order to determine microvascular density (MVD) in pituitary adenomas. There were 77 samples, 31 males and 46 females, carriers of micro- (n = 24) or macroadenomas (n = 53). No significant difference was found in MVD concerning the variables of age, clinical presentation, and immunohistochemical phenotype or tumor size. MVD in males (median 5.4) was significantly higher (P = 0.001) than in females (median 3.0). Cell proliferation, as evaluated by the MIB-1 antibody (a cellular proliferation index [Ki-67 antigen], which is present in all stages of the cellular cycle except for the resting cells), ranged from 0% to 19.58%. No correlation was found between MIB-1 and MVD. It is possible to infer that the lower MVD found in pituitary adenomas in females reflects an inhibitory estrogen action on TGF-beta1, a protein involved in vascular remodeling. Because of its role as a TGF receptor ligand, endoglin proved to be sensitive in detecting this gender difference in pituitary tumor angiogenesis.

  4. Seesaw nystagmus caused by giant pituitary adenoma: case report Nistagmo em gangorra causado por adenoma pituitário gigante: relato de caso

    Directory of Open Access Journals (Sweden)

    Frederico Castelo Moura

    2006-03-01

    Full Text Available Giant pituitary adenomas are uncommonly large tumors, greater than 4 cm in size that can produces endocrine symptoms, visual loss and cranial nerve palsies. We report the rare occurrence of seesaw nystagmus as the presenting sign of giant pituitary adenoma. A 50-year-old man presented with headache associated with visual loss and seesaw nystagmus. Perimetry revealed bitemporal hemianopia and magnetic resonance imaging showed a giant pituitary adenoma. After surgery, nystagmus disappeared. Our case is relevant in understanding its pathogenesis since it documents seesaw nystagmus in a patient bitemporal hemianopia due to a large tumor but without mesencephalic compression.Adenoma pituitário gigante é um tumor incomum, maior que 4 cm que produz sintomas endócrinos, perda visual e paralisia de nervos cranianos. Relatamos um caso de nistagmo em gangorra como sinal de apresentação de adenoma pituitário gigante. Um paciente de 50 anos, masculino, apresentava cefaléia, perda visual e nistagmo em gangorra. A perimetria revelou hemianopsia bitemporal e a imagem por ressonância magnética demonstrou um adenoma pituitário gigante. Após a cirurgia, o nistagmo desapareceu. Nosso caso é importante na compreensão da fisiopatogenia do nistagmo em gangorra, pois documenta sua ocorrência em paciente com hemianopsia bitemporal decorrente de tumor hipofisário sem compressão mesencefálica.

  5. A primary sellar neuroblastoma mimicking a pituitary adenoma: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Gun; Heo, Young Jin; Kim, Eun Kyoung; Baek, Jin Wook; Jeong, Hae Woong; Jung, Hyun Seok [Busan Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2016-12-15

    Intracranial neuroblastomas are uncommon malignant tumors that usually arise in the supratentorial parenchymal or paraventricular location. A primary neuroblastoma arising in the sella turcica is extremely rare. We report a case of a 76-year-old man who presented with progressive bitemporal hemianopsia. His pituitary hormone levels were within the normal range, except for slightly increased prolactin. Pituitary magnetic resonance imaging revealed a solitary sellar mass with supra- and parasellar extension that mimicked a non-functioning pituitary adenoma or meningioma. The tumor was excised by transsphenoidal resection. Histopathologic analysis revealed small cells surrounded by a dense fibrillary stroma as well as strong expression of neural markers. Hence, the patient was diagnosed with sellar neuroblastoma. Prolactin levels normalized in the immediate postoperative period, although visual disturbances persisted. Herein, we describe the clinical manifestations, MRI characteristics, and histopathologic findings of this case.

  6. Growth hormone-secreting pituitary adenoma:clinical and MR imaging findings

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    Park, Hong Suk; Chang, Kee Hyun; Han, Moon Hee; Sim, Jung Suk; Lee, Sang Hyun; Song, Jae Uoo; Yoo, In Kyu; Jung, Hee Won; Yeon, Kyung Mo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-10-01

    To describe clinical and MRI findings of growth hormone-secreting pituitary adenoma, to determine if there are any characteristic MRI findings different from those of other pituitary adenomas, to evaluate the relationship between tumor size and serum growth hormone level, and to assess the results of immunohi-stochemical study. We retrospectively analysed clinical and MRI findings of 29 patients with growth hormone-secreting pituitary adenoma confirmed by serum growth hormone level and surgery. We also evaluated the relationship between the tumor volume and serum growth hormone level, and the results of immunohistochemical study. Coronal and sagittal T1-weighted MR images in all patients and gadolinium-enhanced T1-weighted MR images in 28 patients were obtained with 2.0 T(24 cases) and 0.5 T(5 cases) MR imagers. The images were analyzed in terms of tumor size, signal intensity, degree of contrast enhancement, extent of tumor growth and the presence or absence of cystic change, hemorrhage and calcification. Clinical manifestations included facial feature change and soft tissue swelling of hands and feet(n=29), headache(n=12), impaired visual acuity(n=9), symptoms of hyperprolactinemia(n=8), visual field defect(n=5), and others(n=6). On MR images, all of the 29 cases were seen to be macroadenomas and the size of the tumors averaged 2.2cm(1-5.2cm). Supra- and infrasellar extensions were seen in 21 and 22 patients, respectively. Cavernous sinus invasion was noted in seven, and in one this was bilateral. Signal intensity was isointense with cortical grey matter in 26 cases(90%). Cystic change or necrosis was seen in eight cases(28%), hemorrhage in four(14%), and calcification in two(7%). After enhancement, most(25/28) of the tumors enhanced less than normal pituitary in degree. There was no correlation between serum growth hormone level and tumor size. Immunohistochemical study showed positive growth hormone-secreting pituitary adenomas were various and included

  7. The Coexistence of an Intrasellar Adenoma, Lymphocytic Hypophysitis, and Primary Pituitary Lymphoma in a Patient with Acromegaly

    Directory of Open Access Journals (Sweden)

    Jose Hernan Martinez

    2011-01-01

    Full Text Available The concomitant presence of three histopathologically different entities in the pituitary gland is a rare occurrence. Most publications identify at least two distinct pathologies, mainly, a pituitary adenoma coexisting with a second intrasellar lesion. We present a case of a 71-year-old female referred for evaluation and treatment of acromegaly. Questioning revealed she was experiencing facial palsy, visual disturbances, and syncopal spells for several weeks. When laboratory evaluation showed elevated somatomedin (IGF-I levels and an oral glucose tolerance test failed to demonstrate any suppression of her growth hormone (GH values, an MRI of the pituitary revealed a sellar mass. A presumptive diagnosis of pituitary adenoma was established. The patient underwent transsphenoidal resection of the sellar mass, which proved to be a large B-cell lymphoma (Stage I-E associated with areas of adenoma and lymphocytic hypophysitis.

  8. Body Image Disturbance in Acromegaly Patients Compared to Nonfunctioning Pituitary Adenoma Patients and Controls

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    Helen M. Conaglen

    2015-01-01

    Full Text Available Purpose. Excess growth hormone secretion in adults results in acromegaly, a condition in which multiple physical changes occur including bony and soft tissue overgrowth. Over time these changes can markedly alter a person’s appearance. The aim of this study was to compare body image disturbance in patients with acromegaly to those with nonfunctioning pituitary adenomas (NFAs and controls and assess the impact of obesity in these groups. Methods. A cross-sectional survey including quality of life, body image disturbance, anxiety and depression measures, growth hormone, and BMI measurement was carried out. Results. The groups did not differ with respect to body image disturbance. However separate analysis of obese participants demonstrated relationships between mood scales, body image disturbance, and pain issues, particularly for acromegaly patients. Conclusions. While the primary hypothesis that acromegaly might be associated with body image disturbance was not borne out, we have shown that obesity together with acromegaly and NFA can be associated with body image issues, suggesting that BMI rather than primary diagnosis might better indicate whether patients might experience body image disturbance problems.

  9. Positron emission tomography (PET) study of patients with pituitary adenoma using labeled amino acid

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    Mineura, Katsuyoshi; Sasajima, Toshio; Sakamoto, Tetsuya; Kowada, Masayoshi (Akita Univ. (Japan). Hospital); Shishido, Fumio; Uemura, Kazuo

    1989-12-01

    Four cases with pituitary adenomas were studied using {sup 11}C-L-methionine (C-11 Met) positron-emission tomography (PET). The C-11 Met was intravenously administered at a dose of 0.6 mCi/kg. The uptake of the tracer for tumors was calculated on the PET images 45 min after the injection; the uptake index was represented as a percentage of the total count in the arterial blood over a period of 45 min. In all cases, the C-11 Met accumulated intensely in the tumor regions; the PET images clearly delineated the extent of the tumor. The C-11 Met uptake index for pituitary adenomas varied widely from 3.94 x 10{sup -2}% to 15.36 x 10{sup -2}%, with a mean of 7.87 x 10{sup -2}%. These indices for the tumors increased markedly in comparison with that of the contralateral left temporal gray matter as a nontumor region (1.89 x 10{sup -2}% to 2.43 x 10{sup -2}% with a mean of 2.06 x 10{sup -2}%). In a case of prolactinoma, repeated PET following bromocriptine treatment showed a decrease in the C-11 Met uptake index; this decrease reflected changes in the serum prolactin value. In another case with ACTH-producing adenoma, the T/NT (tumor/nontumor) ratio fell from 3.44 to 2.40; however, the C-11 Met index remained unchanged. C-11 Met PET images facilitate determining the extent of pituitary adenomas and the monitoring of tumor response to treatment. Further application may give useful knowledge on the amino-acid metabolism of the tumor. (author).

  10. An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism.

    Science.gov (United States)

    Vargas, Guadalupe; Balcazar-Hernandez, Lourdes-Josefina; Melgar, Virgilio; Magriña-Mercado, Roser-Montserrat; Gonzalez, Baldomero; Baquera, Javier; Mercado, Moisés

    2017-01-01

    A 19-year-old woman with a history of isosexual precocious puberty and bilateral oophorectomy at age 10 years because of giant ovarian cysts, presents with headaches and mild symptoms and signs of hyperthyroidism. Hormonal evaluation revealed elevated FSH and LH levels in the postmenopausal range and free hyperthyroxinemia with an inappropriately normal TSH. Pituitary MRI showed a 2-cm macroadenoma with suprasellar extension. She underwent successful surgical resection of the pituitary tumor, which proved to be composed of two distinct populations of cells, each of them strongly immunoreactive for FSH and TSH, respectively. This mixed adenoma resulted in two different hormonal hypersecretion syndromes: the first one during childhood and consisting of central precocious puberty and ovarian hyperstimulation due to the excessive secretion of biologically active FSH and which was not investigated in detail and 10 years later, central hyperthyroidism due to inappropriate secretion of biologically active TSH. Although infrequent, two cases of isosexual central precocious puberty in girls due to biologically active FSH secreted by a pituitary adenoma have been previously reported in the literature. However, this is the first reported case of a mixed adenoma capable of secreting both, biologically active FSH and TSH. Although functioning gonadotrophinomas are infrequent, they should be included in the differential diagnosis of isosexual central precocious puberty.Some functioning gonadotrophinomas are mixed adenomas, secreting other biologically active hormones besides FSH, such as TSH.Early recognition and appropriate treatment of these tumors by transsphenoidal surgery is crucial in order to avoid unnecessary therapeutic interventions that may irreversibly compromise gonadal function.

  11. Three-dimensional Alginate-bead Culture of Human Pituitary Adenoma Cells.

    Science.gov (United States)

    Avila-Rodríguez, Dulce; Paisano-Cerón, Karina; Valdovinos-Ramírez, Irene; Solano-Agama, Carmen; Ortiz-Plata, Alma; Mendoza-Garrido, María E

    2016-02-18

    A three-dimensional culture method is described in which primary pituitary adenoma cells are grown in alginate beads. Alginate is a polymer derived from brown sea algae. Briefly, the tumor tissue is cut into small pieces and submitted to an enzymatic digestion with collagenase and trypsin. Next, a cell suspension is obtained. The tumor cell suspension is mixed with 1.2% sodium alginate and dropped into a CaCl2 solution, and the alginate/cell suspension is gelled on contact with the CaCl2 to form spherical beads. The cells embedded in the alginate beads are supplied with nutrients provided by the culture media enriched with 20% FBS. Three-dimensional culture in alginate beads maintains the viability of adenoma cells for long periods of time, up to four months. Moreover, the cells can be liberated from the alginate by washing the beads with sodium citrate and seeded on glass coverslips for further immunocytochemical analyses. The use of a cell culture model allows for the fixation and visualization of the actin cytoskeleton with minimal disorganization. In summary, alginate beads provide a reliable culture system for the maintenance of pituitary adenoma cells.

  12. Clinical applications of somatostatin analogs for growth hormone-secreting pituitary adenomas

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    Wang JW

    2014-01-01

    Full Text Available Ji-wen Wang,1,2 Ying Li,3 Zhi-gang Mao,1,2 Bin Hu,1,2 Xiao-bing Jiang,1,2 Bing-bing Song,4 Xin Wang,4 Yong-hong Zhu,4 Hai-jun Wang1,21Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, 2Key Laboratory of Pituitary Adenoma in Guangdong Province, 3State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 4Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of ChinaAbstract: Excessive growth hormone (GH is usually secreted by GH-secreting pituitary adenomas and causes gigantism in juveniles or acromegaly in adults. The clinical complications involving cardiovascular, respiratory, and metabolic systems lead to elevated morbidity in acromegaly. Control of serum GH and insulin-like growth factor (IGF 1 hypersecretion by surgery or pharmacotherapy can decrease morbidity. Current pharmacotherapy includes somatostatin analogs (SAs and GH receptor antagonist; the former consists of lanreotide Autogel (ATG and octreotide long-acting release (LAR, and the latter refers to pegvisomant. As primary medical therapy, lanreotide ATG and octreotide LAR can be supplied in a long-lasting formulation to achieve biochemical control of GH and IGF-1 by subcutaneous injection every 4–6 weeks. Lanreotide ATG and octreotide LAR provide an effective medical treatment, whether as a primary or secondary therapy, for the treatment of GH-secreting pituitary adenoma; however, to maximize benefits with the least cost, several points should be emphasized before the application of SAs. A comprehensive assessment, especially of the observation of clinical predictors and preselection of SA treatment, should be completed in advance. A treatment process lasting at least 3 months should be implemented to achieve a long-term stable blood concentration. More satisfactory surgical outcomes for noninvasive macroadenomas treated

  13. LINAC-radiosurgery for nonsecreting pituitary adenomas. Long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Runge, M.J.R.; Maarouf, M.; Hunsche, S.; Ruge, M.I.; El Majdoub, F.; Treuer, H.; Sturm, V. [Koeln Univ. (Germany). Dept. of Stereotaxy and Functional Neurosurgery; Kocher, M.; Mueller, R.P. [Koeln Univ. (Germany). Dept. of Radiation Oncology; Voges, J. [Magdeburg Univ. (Germany). Dept. of Stereotactic Neurosurgery

    2012-04-15

    Stereotactic linear accelerator-based radiosurgery (LINAC-RS) is increasingly used for microsurgically inaccessible or recurrent pituitary adenomas. This single-center study evaluates the long-term follow-up after LINAC-RS of nonsecreting pituitary adenomas (NSA). Patients and methods: Between 1992 and August 2008, 65 patients with NSA were treated. Patient treatment and follow-up were conducted according to a prospective protocol. Indications for LINAC-RS were (1) tumor recurrence or (2) residual tumor. Three patients were treated primarily. For analysis of prognostic factors, patients were grouped according to epidemiological or treatment-associated characteristics. Results: A total of 61 patients with a follow-up {>=} 12 months (median 83 months, range 15-186 months, longest follow-up of published radiosurgery series) were evaluated with regard to their clinical, radiological, and endocrinological course. The median tumor volume was 3.5 ml ({+-} 4.3 ml, range 0.3-17.3 ml) treated with a median surface and maximum dose of 13.0 Gy and 29.7 Gy, respectively. Local tumor control was achieved in 98%. One patient died of unrelated cause after 36 months and 1 patient developed a radiation-induced seizure disorder. Visual complications did not occur. In 37 of 41 patients (90.2%), pituitary function remained stable. Maximum dose to the pituitary {<=} 16 Gy and female gender were positive prognostic factors for the preservation of pituitary function. Conclusion: LINAC-RS is a minimally invasive, safe, and effective treatment for recurrent NSA or microsurgically inaccessible residual tumor. LINAC-RS yielded a high rate of local long-term tumor control with a small number of radiation-induced side effects. (orig.)

  14. Assessment of clinicopathologic features in patients with pituitary adenomas in Northeast of Iran: A 13-year retrospective study

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    Kazem Anvari

    2015-10-01

    Full Text Available Background: Intracranial lesions of the pituitary gland are common pituitary adenomas, accounting for 6-10% of all symptomatic intracranial tumors. In this retrospective study, the clinicopathologic features and survival rate of pituitary adenomas were evaluated.Methods: The present retrospective study was conducted on 83 patients with pituitary adenomas, referring to radiation oncology departments of Ghaem and Omid Hospitals, Mashhad, Iran, over a period of 13 years (1999-2012. Data obtained from clinical records including clinical features, type of surgery (if performed, treatment modality, overall survival rate, and progression-free survival rate were analyzed.Results: Eighty-three patients including 44 males (53% and 39 females (47% participated in this study. The median age was 40 years (age range: 10-69 years. Chiasm compression was reported in 62 patients (74.4%, and 45.78% of the subjects suffered from headaches. Functional and non-functional adenomas were reported in 44 (53.01% and 39 (46.99% patients, respectively. In cases with functional and non-functional adenomas, the disease was controlled in 95 and 84.5% of the subjects for 3 years, respectively. Furthermore, 1- and 3-year survival rates for functional adenoma were 84.6 and 23%, respectively; the corresponding values were 90.9 and 22.7% in non-functional adenomas, respectively.Conclusion: In this study, a significant correlation between headache severity and type of adenoma was observed. So, application of surgery and radiotherapy together could be a highly effective approach for treating functional adenomas, although it is less efficient for the non-functional type.

  15. E2F1 activation is responsible for pituitary adenomas induced by HMGA2 gene overexpression

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    Fusco Alfredo

    2006-08-01

    Full Text Available Abstract The High Mobility Group protein HMGA2 is a nuclear architectural factor that plays a critical role in a wide range of biological processes including regulation of gene expression, embryogenesis and neoplastic transformation. Several studies are trying to identify the mechanisms by which HMGA2 protein is involved in each of these activities, and only recently some new significant insights are emerging from the study of transgenic and knock-out mice. Overexpression of HMGA2 gene leads to the onset of prolactin and GH-hormone induced pituitary adenomas in mice, suggesting a critical role of this protein in pituitary tumorigenesis. This was also confirmed in the human pathology by the finding that HMGA2 amplification and/or overexpression is present in human prolactinomas. This review focuses on recent data that explain the mechanism by which HMGA2 induces the development of pituitary adenomas in mice. This mechanism entails the activation of the E2F1 protein by the HMGA2-mediated displacement of HDAC1 from pRB protein.

  16. Classification of pituitary growth hormone producing adenomas according to SIPAP: application in clinical practice

    Energy Technology Data Exchange (ETDEWEB)

    Meyer, Sofie (Dept. of Radiology, Lund Univ. and Skaane Univ. Hospital, Lund (Sweden)), email: Sofie.Meyer@skane.se; Valdemarsson, Stig (Dept. of Endocrinology, Lund Univ. and Skaane Univ. Hospital, Lund (Sweden)); Larsson, Elna-Marie (Dept. of Radiology, Uppsala Univ. Hospital, Uppsala (Sweden))

    2011-09-15

    Background: In 1997, the SIPAP classification was introduced, a guide designed for MRI, to characterize pituitary adenomas with emphasis on extrasellar extensions and impact on adjacent structures. To our knowledge no previous evaluation of the inter-observer agreement of the SIPAP classification has been performed. Purpose: To evaluate the inter-observer agreement of the SIPAP classification. Material and Methods: Sixty patients operated on for growth hormone producing pituitary adenomas at Lund Univ. Hospital 1991-2007 had an assessable preoperative MRI scan. Forty-five of them also had an assessable postoperative MRI scan. The mean time between surgery and postoperative MRI scans was 11 months. Two observers evaluated all the MRI scans independently. The outcome of the evaluation is presented as the percentage of concordance in each of the evaluated directions and the degree of discrepancy for each of the directions evaluated. Results: In 284 (79%) of 360 preoperative gradings both observers agreed completely. In 17 of the 60 preoperative MRI scans, both observers made identical assessments according to the SIPAP classification in all the six different directions of tumor extension. In 76 gradings the results differed between the observers. The difference was 1 grade (or less) in 69 cases. In 230 (85%) of 270 postoperative gradings the results were identical for both observers. In 18 of the 45 postoperative MRI scans, both observers made the same assessments according to the SIPAP classification in all the six different directions of tumor extension. In 40 gradings the results differed between the observers. The difference was 1 grade (or less) in all 40 cases. Conclusion: We found a relatively high inter-observer agreement both pre- and postoperatively, supporting the usefulness and easy applicability of the SIPAP system for grading of pituitary adenomas pre- as well as postoperatively

  17. Cushing`s disease to a giant pituitary adenoma in early infancy: CT and MRI features

    Energy Technology Data Exchange (ETDEWEB)

    Maeder, P. [Dept. of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Gudinchet, F. [Dept. of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Rillet, B. [Dept. of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Theintz, G. [Dept. of Paediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Meuli, R. [Dept. of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland)

    1996-01-01

    We report the case of a 12-month-old girl presenting with diabetes insipidus and Cushing`s disease. Brain magnetic resonance imaging (MRI) demonstrated a large tumour arising from the sella turcica, extending up to the foramen of Monro and invading the cavernous sinuses. Surgery was performed to remove the suprasellar part of the tumour, and histology revealed an adrenocorticotrophin (ACTH) secreting pituitary adenoma. This entity is very rare in this age group and the MRI features have not previously been described. (orig.)

  18. The natural history of surgically treated but radiotherapy-naïve nonfunctioning pituitary adenomas.

    LENUS (Irish Health Repository)

    O'Sullivan, Eoin P

    2009-11-01

    Transsphenoidal surgery is indicated for patients with nonfunctioning pituitary adenomas (NFPAs) causing compressive symptoms. Previous studies attempting to define the rate of recurrence\\/regrowth of surgically treated but radiation-naïve NFPAs were somewhat limited by selection bias and\\/or small numbers and\\/or lack of consistency of findings between studies. A better understanding of the natural history of this condition could allow stratification of recurrence risk and inform future management. We aimed to define the natural history of a large, mainly unselected cohort with surgically treated, radiotherapy (RT)-naïve NFPAs and to try to identify predictors of recurrence\\/regrowth.

  19. Pituitary adenomas in mice transgenic for growth hormone-releasing hormone

    DEFF Research Database (Denmark)

    Asa, S L; Kovacs, K; Stefaneanu, L

    1992-01-01

    It has been shown that mice transgenic for human GH-releasing hormone (GRH) develop hyperplasia of pituitary somatotrophs, lactotrophs, and mammosomatotrophs, cells capable of producing both GH and PRL, by 8 months of age. We now report that GRH transgenic mice 10-24 months of age develop pituita...... somatotrophs or mammosomatotrophs to cells with features of the glycoprotein hormone cell line. These findings provide conclusive evidence that protracted GRH stimulation of secretory activity can result in proliferation, hyperplasia, and adenoma of adenohypophysial cells....

  20. A case of radiation optic neuropathy after irradiation for pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Ohta, Masahiro; Sasaki, Ushio; Shinohara, Nobuya; Takeda, Tetsuji; Chaki, Takanori; Nishigakiuchi, Keiji; Kusunoki, Katsusuke (Ehime Prefectural Central Hospital, Matsuyama (Japan))

    1992-05-01

    A 60-year-old woman with radiation optic neuropathy 21 months after irradiation is reported. The patient received a total dose of 50 Gy in 25 fractions for 39 days for pituitary adenoma. She presented with bitemporal hemianopsia and loss of recent memory. Gadolinium-enhanced T1-weighted imaging was very useful for detecting lesions in the optic nerves and chiasm to the hypothalamus including mamillary bodies. Two-month steroid therapy was effective in preventing the disease progression, although visual loss and loss of recent memory were not improved. (N.K.).

  1. Treatment Complexities of a Young Woman Suffering Psychosis and Pituitary Adenoma

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    Maxine Sigman

    2011-01-01

    Full Text Available This paper is a clinical description of the presentation, therapy, and pharmacological management of a 28-year-old woman who had nine admissions to a psychiatry ward, the last four within one year. It became clear that the treatments, which the patient had received concurrently for ten years for a pituitary adenoma and for psychotic symptoms, were counteractive. The case highlights the importance of the role of prolactin in psychosis and of an interdisciplinary team approach when patients present with complex symptoms.

  2. Pituitary adenoma in monozigotic twins with Cri du Chat syndome: a rare case report

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    Canaz Gokhan

    2016-12-01

    Full Text Available Pituitary adenomas are rare tumours of pediatric population. In etiology, genetic factors are more common than they are in adults. Because of the rarity of the cases, there are only a few large case studies in the literature. Pituitary tumours in children are often related with syndromes like MEN type 1, Carney Complex and Mc Cune Albright, but there is no case in the literature associated with Cri Du Chat syndrome. Statisticlly, it has been reported that, pediatric tumours occur more often in twins, in the pediatric population. Main treatment for prolactinomas is medical intervention with dopamine agonists, as in adults. Surgery is prefered when the tumour is resistant to medical treatment or shows mass effects around sellae. In that situation, as in adults, both transcranial and transsphenoidal approach is possible.

  3. Ectopic Acromegaly Arising from a Pituitary Adenoma within the Bony Intersphenoid Septum of a Patient with Empty Sella Syndrome

    Science.gov (United States)

    Arzamendi, Audrey E.; Shahlaie, Kiarash; Latchaw, Richard E.; Lechpammer, Mirna; Arzumanyan, Hasmik

    2016-01-01

    Objective  To describe the work-up and treatment of rare ectopic acromegaly caused by a biopsy-proven somatotroph pituitary adenoma located within the bony intersphenoid septum of a patient with empty sella syndrome (ESS). Methods  We report the presentation, clinical course, diagnostic work-up, and lesion localization and treatment challenges encountered in a 55-year-old patient, with a brief review of relevant literature. Results  A 55-year-old African-American man presented with acromegaly and ESS. Attempts to definitively localize the causative tumor were unsuccessful, though petrosal sinus sampling supported central growth hormone production and imaging suggested bone-enclosed subsellar pituitary tissue. Endoscopic endonasal transphenoidal exploration was undertaken with resection of a somatotroph pituitary microadenoma, and subsequent clinical improvement and biochemical remission. Retrospective review revealed the patient's pituitary to have been located ectopically within a unique bony intersphenoid septum. Conclusion  This report describes the first known case of an ectopic pituitary adenoma located within the midline bony intersphenoid septum, which we postulate to have resulted from anomalous embryological pituitary migration. Intra-intersphenoid septal tumors should be considered in cases of apparent central acromegaly with ESS or absence of tumor tissue within the paranasal sinuses or other peripheral locations. Indexing  Acromegaly, ESS, pituitary adenoma, sphenoid sinus septum. PMID:27468406

  4. Caveolin-1 sensitizes rat pituitary adenoma GH3 cells to bromocriptine induced apoptosis

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    Huang Mu-Chiou

    2007-03-01

    Full Text Available Abstract Background Prolactinoma is the most frequent pituitary tumor in humans. The dopamine D2 receptor agonist bromocriptine has been widely used clinically to treat human breast tumor and prolactinoma through inhibition of hyperprolactinemia and induction of tumor cell apoptosis, respectively, but the molecular mechanism of bromocriptine induction of pituitary tumor apoptosis remains unclear. Caveolin-1 is a membrane-anchored protein enriched on caveolae, inverted flask-shaped invaginations on plasma membranes where signal transduction molecules are concentrated. Currently, caveolin-1 is thought to be a negative regulator of cellular proliferation and an enhancer of apoptosis by blocking signal transduction between cell surface membrane receptors and intracellular signaling protein cascades. Rat pituitary adenoma GH3 cells, which express endogenous caveolin-1, exhibit increased apoptosis and shrinkage after exposure to bromocriptine. Hence, the GH3 cell line is an ideal model for studying the molecular action of bromocriptine on prolactinoma. Results The expression of endogenous caveolin-1 in GH3 cells was elevated after bromocriptine treatment. Transiently expressed mouse recombinant caveolin-1 induced apoptosis in GH3 cells by enhancing the activity of caspase 8. Significantly, caveolin-1 induction of GH3 cell apoptosis was sensitized by the administration of bromocriptine. Phosphorylation of caveolin-1 at tyrosine 14 was enhanced after bromocriptine treatment, suggesting that bromocriptine-induced phosphorylation of caveolin-1 may contribute to sensitization of apoptosis in GH3 cells exposed to bromocriptine. Conclusion Our results reveal that caveolin-1 increases sensitivity for apoptosis induction in pituitary adenoma GH3 cells and may contribute to tumor shrinkage after clinical bromocriptine treatment.

  5. PET/MR imaging in the diagnosis of hormone-producing pituitary micro-adenoma: a prospective pilot study.

    Science.gov (United States)

    Wang, Hao; Hou, Bo; Lu, Lin; Feng, Ming; Zang, Jie; Yao, Shaobo; Feng, Feng; Wang, Renzhi; Li, Fang; Zhu, Zhaohui

    2017-08-03

    Purpose: This study was designed to evaluate positron emission tomography/magnetic resonance (PET/MR), using (18)F-FDG and (68)Ga-DOTATATE as tracers, in the detection of hormone-producing pituitary micro-adenoma, where diagnosis is difficult using magnetic resonance imaging (MRI) alone. Methods: A total of 37 patients with elevated hormone levels were recruited, including 19 patients with undiagnosable primary pituitary tumors and 18 patients with suspected recurrent pituitary adenomas (PAs). Patients underwent (18)F-FDG PET/MR and (68)Ga-DOTATATE PET/MR within one week. Finally, 27 patients underwent transsphenoidal adenomectomy within two weeks, 3 patients underwent sella region radiotherapy, 1 patient underwent somatostatin therapy, and the other 6 patients had a clinical follow-up. The image characteristics and uptake levels were correlated with the surgical findings and pathological results. Receiver-operating-characteristic (ROC) curve analysis was performed to determine an optimal cutoff pituitary to differentiate pituitary adenoma from normal pituitary tissue. The area under the ROC curve was calculated to compare the diagnostic performance. Results: The PET/MR images were in diagnostic quality without obvious image artifacts. The high contrast of PET imaging provided complementary information to the fine anatomy display of MRI. Increased (18)F-FDG uptake was clearly observed in the all patients, whereas enhanced MRI enhanced MRI using 0.05 mmol/kg Gadopentetate dimeglumine had suspicious findings only in 47% primary and 39% recurrent PAs patients, which were 37% and 50%, respectively when using 0.1 mmol/kg Gadopentetate dimeglumine. The maximum standardized uptake values (SUVmax) of (18)F-FDG activity (6.8 ± 3.7) in 16 primary pituitary adenomas who underwent transsphenoidal adenomectomy, was significantly higher than that of the rest of the normal pituitary gland (3.2 ± 1.1, P PET/MR imaging provides an ideal tool for the detection of small hormone

  6. Clusterin expression in non-neoplastic adenohypophyses and pituitary adenomas: cytoplasmic clusterin localization in adenohypophysis is related to aging.

    Science.gov (United States)

    Ekici, A Işin Doğan; Eren, Bülent; Türkmen, Nursel; Comunoğlu, Nil; Fedakar, Recep

    2008-01-01

    Clusterin is a circulating multifunctional glycoprotein produced in several kinds of epithelial and neuronal cells. Clusterin is upregulated during different physiological and pathological states, such as senescence, type-2 diabetes mellitus, Alzheimer disease, and in various neoplasms. Herein, we investigated the immunohistochemical expression of clusterin in non-neoplastic adenohypophysis of human autopsy subjects and pituitary adenomas. We also investigated the association of clusterin increase with age in adenohypophysis of autopsy subjects. Immunohistochemically, clusterin was found positive in the cytoplasm of all adenoma cases, and in the cytoplasm of parenchymal cells, stellate cells, mixed cell follicles and in colloidal material inside of the follicles of non-neoplastic adenohypophysis as well. Clusterin expression in pituitary adenomas was found significantly higher than in non-neoplastic adenohypophyses. In addition, in non-neoplastic adenohypophysis, a significant increase in clusterin expression levels between young (or=61 years) subjects (p adenohypophysis. In conclusion, the present study demonstrated that clusterin expression was found in non-neoplastic adenohypophysis and in upregulated amounts in pituitary adenomas. This study also demonstrated that in non-neoplastic adenohypophyses, increase of clusterin positive cells; histopathological findings of calcification or presence colloidal material accumulation in large follicles were associated with age. To our knowledge, immunohistochemical localization of clusterin in pituitary adenomas was not reported previously.

  7. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Ammirati, Mario; Wei, Lai; Ciric, Ivan

    2013-08-01

    Endoscopic transsphenoidal pituitary surgery has become increasingly more popular for the removal of pituitary adenomas. It is also widely recognised that transsphenoidal microscopic removal of pituitary adenomas is a well-established procedure with good outcomes. Our objective was to meta-analyse the short-term results of endoscopic and microscopic pituitary adenoma surgery. We undertook a systematic review of the English literature on results of transsphenoidal surgery, both microscopic and endoscopic from 1990 to 2011. Series with less than 10 patients were excluded. Pooled data were analysed using meta-analysis techniques to obtain estimate of death, complication rates and extent of tumour removal. Complications evaluated included cerebrospinal fluid leak, meningitis, vascular complications, visual complications, diabetes insipidus, hypopituitarism and cranial nerve injury. Data were also analysed for tumour size and sex. 38 studies met the inclusion criteria yielding 24 endoscopic and 22 microscopic datasets (eight studies included both endoscopic and microscopic series). Meta-analysis of the available literature showed that the endoscopic transsphenoidal technique was associated with a higher incidence of vascular complications (pmicroscopic technique and the incidence of reported vascular complications was higher with endoscopic than with microscopic removal of pituitary adenomas. While we recognise the limitations of meta-analysis, our study suggests that a multicentre, randomised, comparative effectiveness study of the microscopic and endoscopic transsphenoidal techniques may be a reasonable approach towards establishing a true valuation of these techniques.

  8. Intercellular deposits of basement membrane material in active human pituitary adenomas detected by immunostaining for laminin and electron microscopy

    DEFF Research Database (Denmark)

    Holck, S; Wewer, U M; Albrechtsen, R

    1986-01-01

    Thirty-eight human pituitary adenomas (24 endocrine active and 14 endocrine inactive tumors) were studied immunohistochemically for the presence of the basement membrane component, laminin, and ultrastructurally for the presence of basement membrane. Immunoreactivity of laminin delineated staining...... and one patient with Cushing's syndrome). Concurrently, at the ultrastructural level, bunches of basement membrane-like material intermingled between the adenoma cells were demonstrated in seven of these ten active adenomas. Furthermore, secretory granules were entrapped occasionally in this intercellular...... matrix, indicating a mutual dependence between excessive hormone extrusion and an increase of "misplaced" deposits of basement membrane components, e.g., laminin....

  9. Thyrotropin-releasing hormone provokes abnormal follicle-stimulating hormone (FSH) and luteinizing hormone responses in men who have pituitary adenomas and FSH hypersecretion.

    Science.gov (United States)

    Snyder, P J; Muzyka, R; Johnson, J; Utiger, R D

    1980-10-01

    Serum FSH ad LH concentrations after the administration of TRH were measured in 10 men who had pituitary adenomas associated with FSH hypersecretion. Similar measurements were made in 12 men who had pituitary adenomas but no FSH hypersecretion, in 10 age-matched, normal men, and in 5 men who had primary hypergonadism. The mean serum LH concentration in the men who had pituitary adenomas and FSH hypersecretion increased 136% after TRH administration, significantly greataer (P < 0.005) than the 48% increase in the normal men or the 51% increase in the men who had pituitary adenomas without FSH hypersecretion. Serum LH did not increase at all in the men who had primary hypoganadism. The serum FSH concentration did not increase in any of the normal men, in the men who had pituitary adenomas without FSH hypersecretion, or in the men who had primary hypogonadism, but did increase in 5 of the 10 men who had FSH hypersecretion; the mean increase in these 5 men was 38%. The exaggerated LH responses and the nonspecific FSH responses to TRH of the men who had pituitary adenomas associated with FSH hypersecretion suggest that control of both FSH and LH secretion by these adenomas is abnormal and, therefore, that these adenomas are likely gonadotroph cell adenomas.

  10. Microarray technology reveals potentially novel genes and pathways involved in non-functioning pituitary adenomas

    Science.gov (United States)

    Qiao, X; Wang, H; Wang, X; Zhao, B

    2016-01-01

    Abstract Microarray data of non-functioning pituitary adenomas (NFPAs) were analyzed to disclose novel genes and pathways involved in NFPA tumorigenesis. Raw microarray data were downloaded from Gene Expression Omnibus. Data pre-treatment and differential analysis were conducted using packages in R. Functional and pathway enrichment analyses were performed using package GOs-tats. A protein-protein interaction (PPI) network was constructed using server STRING and Cytoscape. Known genes involved in pituitary adenomas (PAs), were obtained from the Comparative Toxicogenomics Database. A total of 604 differentially expressed genes (DEGs) were identifed between NFPAs and controls, including 177 up- and 427 down-regulated genes. Jak-STAT and p53 signaling pathways were significantly enriched by DEGs. The PPI network of DEGs was constructed, containing 99 up- and 288 down-regulated known disease genes (e.g. EGFR and ESR1) as well as 16 up- and 17 down-regulated potential novel NFPAs-related genes (e.g. COL4A5, LHX3, MSN, and GHSR). Genes like COL4A5, LHX3, MSN, and GHSR and pathways such as p53 signaling and Jak-STAT signaling, might participate in NFPA development. Although further validations are required, these findings might provide guidance for future basic and therapy researches. PMID:28289583

  11. Metabolic abnormalities in pituitary adenoma patients: a novel therapeutic target and prognostic factor

    Directory of Open Access Journals (Sweden)

    Zheng X

    2015-08-01

    Full Text Available Xin Zheng,1 Song Li,1 Wei-hua Zhang,2 Hui Yang1 1Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, People's Republic of China; 2Department of Biology and Biochemistry, University of Houston, Houston, TX, USA Abstract: Metabolic abnormalities are common in cancers, and targeting metabolism is emerging as a novel therapeutic approach to cancer management. Pituitary adenoma (PA is a type of benign tumor. Impairment of tumor cells' metabolism in PA seems not to be as apparent as that of other malignant tumor cells; however, aberrant hormone secretion is conspicuous in most PAs. Hormones have direct impacts on systemic metabolism, which in turn, may affect the progression of PA. Nowadays, conventional therapeutic strategies for PA do not include modalities of adjusting whole-body metabolism, which is most likely due to the current consideration of the aberrant whole-body metabolism of PA patients as a passive associated symptom and not involved in PA progression. Because systemic metabolic abnormalities are presented by 22.3%–52.5% PA patients and are closely correlated with disease progression and prognosis, we propose that assessment of metabolic status should be emphasized during the treatment of PA and that control of metabolic abnormalities should be added into the current therapies for PA. Keywords: metabolic abnormalities, pituitary adenoma, therapeutic target, prognostic factor 

  12. A new endoscopic surgical classification and invasion criteria for pituitary adenomas involving the cavernous sinus.

    Science.gov (United States)

    Ceylan, Savas; Anik, Ihsan; Koc, Kenan

    2011-01-01

    There are two major problems for the pituitary adenomas invading the Cavernous Sinus (CS); differentiation of extension and invasion and inability to demonstrate the medial wall via preoperative imaging methods. Two important corridors are defined in endoscopic cavernous sinus approaches; the lateral and medial corridor. A retrospective analysis was performed in 400 endoscopic transphenoidal approaches and 360 pituitary adenomas underwent endoscopic transphenoidal surgery in our department between September 1997 and December 2010. 48 patients affected by the tumours involving the cavernous sinus were included in this study. We performed an intraoperative evaluation of cavernous sinus invasion considering visualization of the medial wall defect, intracavernous ICA segments, minor tumour extensions through small focal pit holes of the medial wall of CS or confirming carotid segments of CS by micro-doppler. Cavernous sinus involvement was classified into three types according to the medial and lateral corridor extension of the tumor as 25 isolated medial corridor involvement (Type I), 5 isolated lateral corridor involvement (Type II) and 18 total involvement (Type III). Our classification depends on fully surgical endoscopic approach supported by neuroimaging techniques and anatomical studies and shows a good predictive value for all cavernous sinus involvement.

  13. DIAGNOSIS OF ENDOCRINE DISEASE: Diagnostic approach to TSH-producing pituitary adenoma.

    Science.gov (United States)

    Tjörnstrand, Axel; Nyström, Helena Filipsson

    2017-10-01

    Thyrotropin (TSH)-secreting adenomas (TSHomas) are the rarest form of pituitary adenomas, and most endocrinologists will see few cases in a lifetime, if any. In most cases, the diagnostic approach is complicated and cases may be referred after being presented as a syndrome of inappropriate TSH secretion or as a pituitary mass. This review aims to cover the past, present and possible future diagnostic approaches to TSHomas, including different clinical presentations, laboratory assessment and imaging advances. The differential diagnoses will be discussed, as well as possible coexisting disorders. By evaluating the existing reports and reviews describing this rare condition, this review aims to present a clinically practical suggestion on the diagnosic workup for TSHomas, Major advances and scientific breakthroughs in the imaging area in recent years, facilitating diagnosis of TSHomas, support the belief that future progress within the imaging field will play an important role in providing methods for a more efficient diagnosis of this rare condition. © 2017 European Society of Endocrinology.

  14. In situ PCR and immunohistochemical studies on p16 gene in pituitary adenomas

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    To examine the occurrence of p16 gene deletion and to analyze p16 expression on paraffin-embedded human pituitary adenoma specimens. Efforts were made to optimize the technical conditions for in situ PCR. Methods: In situ PCR techniques and inimuno-histochemistry were used. Results: Immunohistochemically, p16-positive tumor cells were observed in all cases with various proportions. The majority of the stromal cells and part of tumor cells was devoid of p16 immunostaining, but signal of in situ PCR for p16 gene, exon 2, was displayed in these cells. Conclusion: The results implied that p16 gene might not be deleted in these pituitary adenomas. It also indicated that in situ PCR, both direct and indirect methods, proved feasible and informative to the aim of DNA detection. It is critical to overcome non-specific amplification in direct in situ PCR by means of higher annealing temperature, fewer cycle, lower magnesium concentration and stringent washing. A target DNA-deleted sample as the negative control is extremely necessary. For the indirect method, the way to improve the sensitivity is to loosen the conditions for amplification and washing, so that more amplification products are subject to hybridization, and signal detection is facilitated.

  15. The anterolateral approach for the transcranial resection of pituitary adenomas: technical note.

    Science.gov (United States)

    Agazzi, Siviero; Youssef, Ashraf Sami; van Loveren, Harry R

    2010-05-01

    We sought to quantify the mean surface area of the exposed diaphragma sellae and the mean sellar volume in the subfrontal and anterolateral approaches to pituitary adenomas and to detail our expansion of the superficial and deep window in the anterolateral approach. We performed a retrospective data analysis and cadaveric study in a clinical and skull base laboratory. We studied eight patients who had anterolateral approach for transcranial resection of pituitary macroadenoma and seven cadaveric specimens. Main outcome measures were degree of tumor resection, cerebrospinal fluid (CSF) leak, cranial nerve outcome, and quantification of the exposed sella via the anterior (subfrontal) and anterolateral approach. We observed complete resection in one; visual outcome: stable in three, improved in four, worsened in one; CSF leakage in two; transient CN III palsy in three; mean surface area (mm(2)) of exposed diaphragma sellae,115.3 (subfrontal approach) versus 94.7 (anterolateral approach; p = 0.1); mean sellar volume (mm(3)) exposed, 224.8 (subfrontal approach) versus 569.3 (anterolateral approach; p < 0.0001). Our technical note supports the increased exposure of sellar volume via the anterolateral approach. Despite the relatively high complication rate, complex cranial surgeons should maintain the skills and knowledge of transcranial approaches. Indeed, the rapid expansion of transsphenoidal techniques will continue to decrease the number of cases but will also continue to increase the complexity of those adenomas that are referred for transcranial resection.

  16. Postoperative follow-up of pituitary adenomas after trans-sphenoidal resection: MRI and clinical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, O. [Servicio de Radiologia, Hospital de Cruces, Baracaldo (Spain); Mateos, B. [Servicio de Radiologia, Hospital de Cruces, Baracaldo (Spain); Pedraja, R. de la [Servicio de Endocrinologia, Hospital de Cruces, Baracaldo (Spain); Villoria, R. [Servicio de Radiologia, Hospital de Cruces, Baracaldo (Spain); Hernando, J.I. [Servicio de Radiologia, Hospital de Cruces, Baracaldo (Spain); Pastor, A. [Servicio de Radiologia, Hospital de Cruces, Baracaldo (Spain); Pomposo, I. [Servicio de Neurocirugia, Hospital de Cruces, Baracaldo (Spain); Aurrecoechea, J. [Servicio de Neurocirugia, Hospital de Cruces, Baracaldo (Spain)

    1996-11-01

    Our purpose was to correlate the morphological changes seen on MRI studies of the sellar region after trans-sphenoidal resection of pituitary adenomas with clinical and hormonal studies. Between January 1993 and March 1994, 16 patients with a pituitary adenoma (9 macroadenomas and 7 microadenomas) were subjected to trans-sphenoidal resection and included in a prospective study. The protocol consisted of MRI, hormonal and visual studies at the following times: immediately postoperative (1st week), 1st month, 4th month and 1st year after surgery. The evolution of the contents of the sella turcica (tumour remnant, packing material and gland tissue), effects on the infundibulum, optic chiasm, cavernous sinus and sphenoid sinus were correlated with the clinical and hormonal studies. Stabilisation of the postsurgical changes occurred by the 4th month. Tumour remnants were noted in the immediate postoperative period in macroadenomas. Compression of the infundibulum was the only reliable indicator of possible involvement. Optic chiasm compression, defined as close contact between the chiasm and the tumour, was the only morphological finding that indicated visual impairment. There was no standard repneumatisation pattern in the sphenoid sinus, since mucosal changes resembling sinusitis were one of the postsurgical changes. We found MRI not to be useful for follow-up of microadenomas. (orig.). With 4 figs., 4 tabs.

  17. Role of PROPELLER diffusion-weighted imaging and apparent diffusion coefficient in the evaluation of pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Mahmoud, Omar M. [Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Department of Radiology, South Egypt Cancer Institute, Assiut University, Assiut 71515 (Egypt); Tominaga, Atsushi [Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Amatya, Vishwa Jeet [Department of Pathology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551 (Japan); Ohtaki, Megu [Department of Environmetrics and Biometrics, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8551 (Japan); Sugiyama, Kazuhiko; Sakoguchi, Tetsuhiko; Kinoshita, Yasuyuki [Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Takeshima, Yukio [Department of Pathology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551 (Japan); Abe, Nobukazu; Akiyama, Yuji [Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima 734-8551 (Japan); El-Ghoriany, Ahmad I. [Department of Neurosurgery, Faculty of Medicine, Assiut University, Assiut 71515 (Egypt); Alla, Abdel Karim H. Abd; El-Sharkawy, Mostafa A.M. [Department of Radiology, Faculty of Medicine, Assiut University, Assiut 71515 (Egypt); Arita, Kazunori [Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima (Japan); Kurisu, Kaoru [Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Yamasaki, Fumiyuki, E-mail: fyama@hiroshima-u.ac.jp [Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan)

    2011-11-15

    Objective: The relationship between tumor consistency and apparent diffusion coefficient (ADC) values is controversial. We evaluated the role of the ADC using an advanced diffusion-weighted imaging (DWI) technique. We employed periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) DWI acquired on a 3-T magnetic resonance imaging (MRI) scanner to assess the consistency of pituitary adenomas and examined the relationship between the ADC and the hormone secretion status of the tumors and their MIB-1 labeling index (MIB-1 LI). Materials and methods: The study protocol was approved by our institutional review board. We retrospectively studied 24 operated patients with pituitary adenomas who had undergone PROPELLER DWI on a 3-T MRI scanner. Conventional MRI findings were expressed as the ratio of the signal intensity (SI) in the lesions to the SI of the normal white matter and the degree of contrast enhancement. Minimum-, mean-, and maximum ADC (ADC{sub min}, ADC{sub mean}, ADC{sub max}) values were calculated. The consistency of the tumors was determined by neurosurgeons. All surgical specimens were submitted for histological study to calculate the MIB-1 LI and the percent collagen content. Preoperative MRI-, intraoperative-, and histological findings were analyzed by a statistician. Results: Our study included 15 soft-, 5 fibrous-, and 4 hard tumors. Tumor consistency was strongly associated with the percent collagen content. However, neither the tumor consistency nor the percent collagen content was correlated with MRI findings or ADC values. The SI of growth hormone-producing adenomas on T2-WI was lower than of the other pituitary adenomas studied (p < 0.01); no other significant difference was found in the ADC or on conventional MRI between pituitary adenomas with different secretory functions. The MIB-1 LI of pituitary adenomas was not correlated with their appearance on conventional MRI or their ADC values. Conclusion: Using the

  18. Adenomas hipofisários: relação entre invasividade e índice proliferativo tumoral Pituitary adenomas: relationship between invasiveness and proliferative cell nuclear index

    Directory of Open Access Journals (Sweden)

    OSWALDO INÁCIO DE TELLA JR

    2000-12-01

    Full Text Available Analisamos 76 pacientes com adenomas hipofisários do ponto de vista clínico, radiológico e tratamento cirúrgico. Todos os casos foram estudados por imuno-histoquímica e em 49 pacientes foi pesquisado o anticorpo monoclonal PCNA. Os adenomas bi-hormonais foram os mais frequentes seguidos dos prolactinomas e os adenomas não secretantes. Os adenomas bi-hormonais não secretantes e os produtores de subunidade alfa foram proporcionalmente mais invasivos pelos critérios radiológicos. A maioria dos pacientes (59 foi operada por via transeptoesfenoidal, em seis casos a via transcraniana foi realizada e em 11 pacientes houve necessidade das duas abordagens. A ressecção foi total em 32 pacientes, a maioria em microadenomas, subtotal em 15 e parcial em 29. A complicação endócrina mais frequente foi diabetes insipidus. Houve tendência de associação positiva para os adenomas secretantes e PCNA mais elevado, assim como relação positiva quando analisamos os adenomas invasivos pela tomografia computadorizada ou ressonância magnética e o PCNA 3 e 4. A melhora visual foi observada em 85% dos macroadenomas, mesmo quando a ressecção foi parcial ou subtotal.We evaluated clinically, radiologically and surgically a series of 76 pituitary adenomas. All cases were assessed immunohistochemically and in 49 patients the PCNA monoclonal antibody was measured. The most frequent types found were the bihormonal adenomas, followed by prolactinomas and non secreting adenomas. The bihormonal adenomas, non secreting adenonas and the sub unit alfa producing adenomas were proportionally more invase as determined by radiological criteria (CTscan or MRI. In 59 patients a transphenoidal approach was used, six cases were operated on transcranially and in 11 patients we used a combination of both approach. Total resection were achieved in 32 cases, most of which were microadenomas, in 15 cases the resection was subtotal and partial in 29 cases. Diabetes insipidus

  19. Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery

    Science.gov (United States)

    CAO, YINGXIAO; WANG, FENGJU; LIU, ZHENBO; JIAO, BAOHUA

    2016-01-01

    Pituitary adenomas are benign intracranial endocrine tumors, accounting for ~10% of intracranial tumors. The aim of the present study was to analyze the effects of preoperative treatment with bromocriptine on the surgical treatment and postoperative complications of prolactin-secreting pituitary adenomas (prolactinomas). Data from 102 patients whose prolactinomas were surgically treated between March 2006 and March 2010 were retrospectively reviewed in the present study. The study group included 54 patients who had been treated preoperatively with bromocriptine. The patients were examined by magnetic resonance imaging (MRI) of the head and coronal computed tomography (CT) scanning, after which the pathological diagnosis of prolactinoma was confirmed. A total of 64 patients underwent total resection surgery through the nose and sphenoid sinus, and 25 patients underwent subtotal resection surgery or excision of a large portion of the tumor, leaving only a small quantity of residual tumor or tumor capsule. Patients were followed up for 1–9 months using MRI and measurements of serum prolactin levels. Seven patients were lost to follow-up. The results of the present study demonstrated that patients who were treated with large doses of bromocriptine or used bromocriptine chronically suffered from an increased rate of surgical difficulties and postoperative complications, as compared with the patents who had not been pre-treated with bromocriptine. In conclusion, oral administration of bromocriptine is important in the treatment of prolactinoma tumors. However, large doses or long-term use of bromocriptine may increase difficulties in surgery or postoperative complications, and reduce its ability to treat prolactinonas, as it can lead to hardening of the tumor tissue and capsules, and aggravate pituitary stalk adhesions. PMID:27168837

  20. Intraoperative magnetic resonance imaging during surgery for pituitary adenomas: pros and cons.

    Science.gov (United States)

    Buchfelder, Michael; Schlaffer, Sven-Martin

    2012-12-01

    Surgery for pituitary adenomas still remains a mainstay in their treatment, despite all advances in sophisticated medical treatments and radiotherapy. Total tumor excision is often attempted, but there are limitations in the intraoperative assessment of the radicalism of tumor resection by the neurosurgeon. Standard postoperative imaging is usually performed with a few months delay from the surgical intervention. The purpose of this report is to review briefly the facilities and kinds of intraoperative magnetic resonance imaging for all physician and surgeons involved in the management of pituitary adenomas on the basis of current literature. To date, there are several low- and high-field magnetic resonance imaging systems available for intraoperative use and depiction of the extent of tumor removal during surgery. Recovery of vision and the morphological result of surgery can be largely predicted from the intraoperative images. A variety of studies document that depiction of residual tumor allows targeted attack of the remnant and extent the resection. Intraoperative magnetic resonance imaging offers an immediate feedback to the surgeon and is a perfect quality control for pituitary surgery. It is also used as a basis of datasets for intraoperative navigation which is particularly useful in any kind of anatomical variations and repeat operations in which primary surgery has distorted the normal anatomy. However, setting up the technology is expensive and some systems even require extensive remodeling of the operation theatre. Intraoperative imaging prolongs the operation, but may also depict evolving problems, such as hematomas in the tumor cavity. There are several artifacts in intraoperative MR images possible that must be considered. The procedures are not associated with an increased complication rate.

  1. A review on the diagnosis and treatment of patients with clinically nonfunctioning pituitary adenoma by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

    Energy Technology Data Exchange (ETDEWEB)

    Vieira Neto, Leonardo; Gadelha, Monica R., E-mail: mgadelha@hucff.ufrj.br [Hospital Universitario Clementino Fraga Filho (HUCFF/UFRJ), Rio de Janeiro, RJ (Brazil); Boguszewski, Cesar L. [Universidade Federal do Parana (SEMPR/UFPN), Curitiba, PR (Brazil). Hospital de Clinicas; Araujo, Luiz Antonio de [Centro de Endocrinologia e Diabetes de Joinville (Endoville), Joinville, SC (Brazil); Bronstein, Marcello D.; Musolino, Nina R. de C. [Universidade de Sao Paulo (FM/USP), Sao Paulo, SP (Brazil). Servico de Endocrinologia; Miranda, Paulo Augusto C. [Santa Casa de Belo Horizonte, Belo Horizonte, MG (Brazil). Servico de Endocrinologia e Metabologia; Nave, Luciana A. [Universidade de Brasilia (UnB), Brasilia, DF (Brazil). Hospital Universitario. Servico de Endocrinologia; Vilar, Lucio [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil). Servico de Endocrinologia; Oliveira Junior, Antonio Ribeiro [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Hospital das Clinicas. Servico de Endocrinologia

    2016-11-01

    Clinically nonfunctioning pituitary adenomas (NFPA) are the most common pituitary tumors after prolactinomas. The absence of clinical symptoms of hormonal hypersecretion can contribute to the late diagnosis of the disease. Thus, the majority of patients seek medical attention for signs and symptoms resulting from mass effect, such as neuro-ophthalmologic symptoms and hypopituitarism. Other presentations include pituitary apoplexy or an incidental finding on imaging studies. Mass effect and hypopituitarism impose high morbidity and mortality. However, early diagnosis and effective treatment minimizes morbidity and mortality. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism is to provide a review of the diagnosis and treatment of patients with NFPA, emphasizing that the treatment should be performed in reference centers. This review is based on data published in the literature and the authors' experience. (author)

  2. HIF-1α Inhibition Sensitized Pituitary Adenoma Cells to Temozolomide by Regulating Presenilin 1 Expression and Autophagy.

    Science.gov (United States)

    Kun, Zhang; Yuling, Yang; Dongchun, Wang; Bingbing, Xie; Xiaoli, Li; Bin, Xu

    2016-12-01

    Pituitary adenomas usually develop temozolomide resistance, which could compromise the anticancer effects of temozolomide. Suppression of hypoxia-inducible factor 1α has been shown to sensitize glioblastoma cells to temozolomide treatment according to previous reports. However, whether and how the suppression of hypoxia-inducible factor 1α could sensitize pituitary adenomas to temozolomide treatment are still poorly understood. In the present study, using hypoxia-inducible factor 1α knockdown strategy, we demonstrated for the first time that hypoxia-inducible factor 1α knockdown could inhibit temozolomide-induced autophagy in rat pituitary adenoma GH3 cells and thus increase antitumor efficacy of temozolomide. Furthermore, we found hypoxia-inducible factor 1α knockdown could block autophagy process through neutralizing lysosomal pH value but not inhibiting autophagy induction. Finally, we found hypoxia-inducible factor 1α could regulate lysosomal pH value through regulating full length presenilin 1 expression, and exogenous reexpression of presenilin 1could restore lysosome acidic levels. Our data indicated hypoxia-inducible factor 1α knockdown could be a potential approach to improve the efficacy of temozolomide therapy for pituitary adenomas.

  3. Random walk and graph cut based active contour model for three-dimension interactive pituitary adenoma segmentation from MR images

    Science.gov (United States)

    Sun, Min; Chen, Xinjian; Zhang, Zhiqiang; Ma, Chiyuan

    2017-02-01

    Accurate volume measurements of pituitary adenoma are important to the diagnosis and treatment for this kind of sellar tumor. The pituitary adenomas have different pathological representations and various shapes. Particularly, in the case of infiltrating to surrounding soft tissues, they present similar intensities and indistinct boundary in T1-weighted (T1W) magnetic resonance (MR) images. Then the extraction of pituitary adenoma from MR images is still a challenging task. In this paper, we propose an interactive method to segment the pituitary adenoma from brain MR data, by combining graph cuts based active contour model (GCACM) and random walk algorithm. By using the GCACM method, the segmentation task is formulated as an energy minimization problem by a hybrid active contour model (ACM), and then the problem is solved by the graph cuts method. The region-based term in the hybrid ACM considers the local image intensities as described by Gaussian distributions with different means and variances, expressed as maximum a posteriori probability (MAP). Random walk is utilized as an initialization tool to provide initialized surface for GCACM. The proposed method is evaluated on the three-dimensional (3-D) T1W MR data of 23 patients and compared with the standard graph cuts method, the random walk method, the hybrid ACM method, a GCACM method which considers global mean intensity in region forces, and a competitive region-growing based GrowCut method planted in 3D Slicer. Based on the experimental results, the proposed method is superior to those methods.

  4. Interferon-alpha-2a is a potent inhibitor of hormone secretion by cultured human pituitary adenomas

    NARCIS (Netherlands)

    L.J. Hofland (Leo); W.W. de Herder (Wouter); M. Waaijers (Marlijn); J. Zuijderwijk; P. Uitterlinden (Piet); P.M. van Koetsveld (Peter); S.W.J. Lamberts (Steven)

    1999-01-01

    textabstractInterferon-alpha (IFN alpha) may exert direct inhibitory effects on cell proliferation and on the production of different peptide hormones. We investigated the effect of IFN alpha on hormone production by 15 GH-secreting pituitary adenomas, 4 clinically nonf

  5. Sellar collision tumor involving metastatic lung cancer and pituitary adenoma: radiologic-pathologic correlation and review of the literature.

    Science.gov (United States)

    Sogani, Julie; Yang, Wanhua; Lavi, Ehud; Zimmerman, Robert D; Gupta, Ajay

    2014-01-01

    Collision tumors of the sella turcica involving metastases to pituitary adenomas are rare. We report a case of a collision tumor involving metastatic lung cancer with an emphasis on the neuroimaging and histopathological studies. A review of the literature including the diagnostic and management implications as well as pathogenetic mechanisms is also discussed.

  6. Cushing's Syndrome from an Ectopic Pituitary Adenoma with Peliosis: A Histological, Immunohistochemical, and Ultrastructural Study and Review of the Literature.

    Science.gov (United States)

    Coire, Claire I.; Horvath, Eva; Kovacs, Kalman; Smyth, Harley S.; Ezzat, Shereen

    1997-01-01

    Ectopic pituitary adenoma (EPA) is rare and, to the authors' knowledge, its association with peliosis has not yet been described. The case of a 38-yr-old woman with clinical and biochemical evidence of Cushing's syndrome is reported. Magnetic resonance imaging (MRI) disclosed a normal pituitary and a separate mass in the sphenoid sinus. The surgically removed portion of the sellar pituitary contained no adenoma. There was only Crooke's hyaline change in the corticotrophs, indicating exposure to glucocorticoid excess. By histology, the mass in the sphenoid sinus was a congested, chromophobic, partly basophilic, periodic acid-Schiff (PAS)-positive pituitary adenoma composed of pleomorphic, adrenocorticotropic hormone (ACTH)-positive, corticotrophs. There was focal immunopositivity for MIB-1 and proliferating cell nuclear antigen (PCNA). Electron microscopy confirmed the diagnosis of corticotroph adenoma. A striking finding, consistent with the diagnosis of peliosis, was the presence of multiple large blood-filled spaces lacking an endothelial lining. The capillaries were dilated, but often appeared empty and the fenestrated endothelium exhibited discontinuities. The cause of peliosis is obscure. It may be that the venous outflow was impaired in this case leading to capillary dilation, congestion, hyperpermeability, rupture, and accumulation of blood in extravascular spaces.

  7. Paradoxical migrating cyst: an unusual presentation of intraventricular neurocysticercosis with a coincidental pituitary adenoma.

    Science.gov (United States)

    Ghosh, Shanchita; Al-Khalili, Rend; Liu, James K; Slasky, Shira E

    2014-06-01

    Intraventricular neurocysticercosis is an uncommon entity which may become symptomatic due to cerebrospinal fluid flow obstruction. Migration of intraventricular cysts through the ventricular spaces is a rare occurrence. This phenomenon is poorly understood but may be due to pressure changes within the ventricular cavities. We present a patient with intraventricular neurocysticercosis with paradoxical transaqueductal migration of the cyst from the cerebral aqueduct to the fourth ventricle shortly after ventricular drain placement for acute hydrocephalus. The patient also presented with a coincidental sellar and suprasellar mass, later pathologically proven to be a pituitary adenoma. The migration of this cyst resulted in spontaneous relief of obstruction at the cerebral aqueduct, thus restoring normal cerebrospinal fluid pathways and avoiding permanent shunting. We discuss the possible mechanisms and implications of cyst migration, and the diagnostic challenges of concomitant findings of a pituitary mass and neurocysticercosis. Although the presence of a sellar and suprasellar mass in a patient with known neurocysticercosis should raise clinical suspicion for the possibility of sellar neurocysticercosis, pituitary macroadenoma is a more common entity and a more likely etiology for a sellar lesion.

  8. Endoscopic Versus Microscopic Transsphenoidal Surgery in the Treatment of Pituitary Adenoma: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Li, Aijun; Liu, Weisheng; Cao, Peicheng; Zheng, Yuehua; Bu, Zhenfu; Zhou, Tao

    2017-05-01

    Inconsistent findings have been reported regarding the efficacy and safety of endoscopic and microscopic transsphenoidal surgery for pituitary adenoma. This study aimed to assess the benefits and shortcomings of these surgical methods in patients with pituitary adenoma. The electronic databases PubMed, Embase, and the Cochrane Library were systematically searched, as well as proceedings of major meetings. Eligible studies with a retrospective or prospective design that evaluated endoscopic versus microscopic methods in patients with pituitary adenoma were included. Primary outcomes included gross tumor removal, cerebrospinal fluid leak, diabetes insipidus, and other complications. Overall, 23 studies (4 prospective and 19 retrospective) assessing 2272 patients with pituitary adenoma were included in the final analysis. Endoscopic transsphenoidal surgery was associated with a higher incidence of gross tumor removal (odds ratio, 1.52; 95% confidence interval, 1.11-2.08; P = 0.009) than those with microscopic transsphenoidal surgery. In addition, endoscopic transsphenoidal surgery had no significant effect on the risk of cerebrospinal fluid leak, compared with microscopic transsphenoidal surgery. Furthermore, endoscopic transsphenoidal surgery was associated with a 22% reduction in risk of diabetes insipidus compared with microscopic transsphenoidal surgery, but the difference was not statistically significant. Endoscopic transsphenoidal surgery significantly reduced the risk of septal perforation (odds ratio, 0.29; 95% confidence interval, 0.11-0.78; P = 0.014) and was not associated with the risk of meningitis, epistaxis, hematoma, hypopituitarism, hypothyroidism, hypocortisolism, total mortality, and recurrence. Endoscopic transsphenoidal surgery is associated with higher gross tumor removal and lower incidence of septal perforation in patients with pituitary adenoma. Future large-scale prospective randomized controlled trials are needed to verify these findings

  9. Gamma-knife for treating pituitary adenomas in 501 cases: Retrospective case analysis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Gamma-knife is characterized by low risk and low death rate, without trauma, bleeding or infection. MRI has replaced CT as a method of location, and provides a good choice for treating pituitary tumors.OBJECTIVE: To analyze the effectiveness and complications of 501 cases with pituitary adenoma by using gamma-knife retrospectively.DESIGN: Case-analysis.SETTING: Gamma-knife Center, the 363 Hospital of Chinese PLA.PARTICIPANTS: A total of 501 cases were selected from Gamma-knife Center, the 363 Hospital of Chinese PLA from January 1997 to December 2002. All patients were certainly diagnosed with CT and MRI scanning. There were 186 males and 315 females. Their ages ranged from 15 to 84 years with the mean age of 39 years. All patients provided confirmed consent.METHODS: All 501 cases with pituitary adenomas were treated by gamma-knife or combined with operations: The average iso-dose curve was 50% (30% - 65%), peri-dose was 14 Gy and the average target number was 5.17. ① At 35 months after treatment, patients received follow-up including clinical symptoms,imaging symptoms and endocrine symptoms. ② Patients who received second gamma-knife treatment were analyzed and their complications were observed after operation.MAIN OUTCOME MEASURES: ① Follow-up results of clinical symptoms, image and endocrine indexes; ② second gamma-knife treatment; ③ postoperative complications.RESULTS: Among 501 accepted patients, 275 cases were involved in the follow up of clinical symptoms,154 in image symptoms and 98 in endocrine symptoms. ① Follow-up results of clinical symptoms, image and endocrine indexes: Follow up of clinical symptoms demonstrated that clinical symptoms of 169 cases were relieved, of 68 disappeared, and of 38 deteriorated. Follow-up of image symptoms indicated that pituitary tumor of 25 cases disappeared, of 84 shortened, of 42 not changed, and of 3 enlarged. Follow-up of endocrine symptoms suggested that endocrine of 50 cases was abnormal, of 29

  10. Long-Term Outcome and MGMT as a Predictive Marker in 24 Patients With Atypical Pituitary Adenomas and Pituitary Carcinomas Given Treatment With Temozolomide

    DEFF Research Database (Denmark)

    Bengtsson, Daniel; Schrøder, Henrik Daa; Andersen, Marianne

    2015-01-01

    CONTEXT/OBJECTIVE: Locally aggressive pituitary tumors (LAPT) and pituitary carcinomas respond poorly to conventional therapy and cytotoxic drugs. Temozolomide (TMZ) is an oral alkylating drug with good tolerability, approved for treatment of malignant gliomas. The experience of its use...

  11. Pituitary Adenoma With Paraganglioma/Pheochromocytoma (3PAs) and Succinate Dehydrogenase Defects in Humans and Mice

    Science.gov (United States)

    Xekouki, Paraskevi; Szarek, Eva; Bullova, Petra; Giubellino, Alessio; Quezado, Martha; Mastroyannis, Spyridon A.; Mastorakos, Panagiotis; Wassif, Christopher A.; Raygada, Margarita; Rentia, Nadia; Dye, Louis; Cougnoux, Antony; Koziol, Deloris; Sierra, Maria de La Luz; Lyssikatos, Charalampos; Belyavskaya, Elena; Malchoff, Carl; Moline, Jessica; Eng, Charis; Maher, Louis James; Pacak, Karel; Lodish, Maya

    2015-01-01

    Context: Germline mutations in genes coding succinate dehydrogenase (SDH) subunits A, B, C, and D have been identified in familial paragangliomas (PGLs)/pheochromocytomas (PHEOs) and other tumors. We described a GH-secreting pituitary adenoma (PA) caused by SDHD mutation in a patient with familial PGLs. Additional patients with PAs and SDHx defects have since been reported. Design: We studied 168 patients with unselected sporadic PA and with the association of PAs, PGLs, and/or pheochromocytomas, a condition we named the 3P association (3PAs) for SDHx germline mutations. We also studied the pituitary gland and hormonal profile of Sdhb+/− mice and their wild-type littermates at different ages. Results: No SDHx mutations were detected among sporadic PA, whereas three of four familial cases were positive for a mutation (75%). Most of the SDHx-deficient PAs were either prolactinomas or somatotropinomas. Pituitaries of Sdhb+/− mice older than 12 months had an increased number mainly of prolactin-secreting cells and several ultrastructural abnormalities such as intranuclear inclusions, altered chromatin nuclear pattern, and abnormal mitochondria. Igf-1 levels of mutant mice tended to be higher across age groups, whereas Prl and Gh levels varied according to age and sex. Conclusion: The present study confirms the existence of a new association that we termed 3PAs. It is due mostly to germline SDHx defects, although sporadic cases of 3PAs without SDHx defects also exist. Using Sdhb+/− mice, we provide evidence that pituitary hyperplasia in SDHx-deficient cells may be the initial abnormality in the cascade of events leading to PA formation. PMID:25695889

  12. Therapy for non-functional pituitary adenoma. Residual tumor and radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Toshio; Ito, Satoshi; Shimamura, Norihito; Sekiya, Tetsuharu; Tanaka, Masahiko; Suzuki, Shigeharu [Hirosaki Univ., Aomori (Japan). School of Medicine

    1997-01-01

    Effects and complication of radiotherapy after surgery of non-functional pituitary adenoma were evaluated with consideration on findings in recent literatures. On 44 cases of 64 patients (36 males and 28 females), the mean age of 48.9y, with macroadenoma, a comparison was made on their recurrence and complication between irradiated and non-irradiated groups after surgery. The follow-up period was >1 year (5y4m in a mean). The total radiation dose was in the range of 40-60 (average 47.3) Gy. Recurrence was seen in 1/31 cases in irradiated group, and 5/13 in non-irradiated group. Reduction of visual acuity and hypopituitarism were observed in 1 and 2 cases, respectively, in irradiated group. Radiotherapy for residual tumor was confirmed useful for preventing recurrence. (K.H.)

  13. Archetype based patient data modeling to support treatment of pituitary adenomas.

    Science.gov (United States)

    Chalopin, Claire; Lindner, Dirk; Kropf, Stefan; Denecke, Kerstin

    2015-01-01

    The treatment of patients with pituitary adenoma requires the assessment of various patient data by the clinician. Because of their heterogeneity, they are stored in different sub-information systems, limiting a fast and easy access. The objective of this paper is to apply and test the tools provided by the openEHR Foundation to model the patient data relevant for diagnosis and treatment of the disease with the future intention to implement a centralised standard-based information platform. This platform should support the clinician in the treatment of the disease and improve the information exchange with other healthcare institutions. Some results of the domain modeling, so far obtained, are presented, and the advantages of openEHR emphasized. The free tools and the large database of existing structured and standard archetypes facilitated the modeling task. The separation of the domain modeling from the application development will support the next step of development of the information platform.

  14. Delayed radiation necrosis of the brain following radiotherapy for a pituitary adenoma; A case report

    Energy Technology Data Exchange (ETDEWEB)

    Miyata, Samon; Demachi, Hiroshi; Terabayashi, Tadashi; Sugiyama, Yoshiaki; Miwa, Atsuo (Toyama Prefectural Central Hospital (Japan))

    1992-10-01

    The authors report a case of a 37-year-old woman who was given a surgical resection, using a transsphenoidal approach, for a pituitary chromophobe adenoma (a prolactinoma) and postoperative radiotherapy with parallel-opposed lateral portals (a total dose of 50.8 Gy/26 fractions/37 days; TDF: 81). Seventeen months after this radiotherapy, however, she experienced vertigo and nausea, and a CT scan revealed decreased attenuation in the white matter of the bilateral temporal lobes, although cerebral angiograms showed no abnormalities. Delayed radiation necrosis of the temporal lobes was diagnosed and these clinical symptoms improved with the administrations of steroids and glyceol. Ten years after this radiation, the patient is alive and shows no neurological abnormalities. (author).

  15. Neurocysticercosis, Meningioma, and Silent Corticotroph Pituitary Adenoma in a 61-Year-Old Woman

    Directory of Open Access Journals (Sweden)

    Maria del Pilar Ramirez

    2012-01-01

    Full Text Available We report here the case of a 61-year-old woman who presented with hydrocephalus and cystic and solid lesions in sella turcica, suprasellar areas, and third ventricle. After ventriculoperitoneal shunt she developed cognitive changes and the cystic lesions enlarged. Magnetic resonance imaging (MRI demonstrated multiple cysts and a solid lesion in the sella and around the anterior clinoid process. With diagnosis of neurocysticercosis she underwent craniotomy. Pathologic examination documented two different lesions: viable and dead cysticerci with inflaming infiltration and a left anterior clinoidal meningioma. At the second surgery, six weeks later via transnasal transsphenoidal approach a silent corticotroph pituitary adenoma was removed which was studied by histology, immunohistochemistry, and electron microscopy. To our knowledge, the occurrence of these three different lesions in the sellar area was not described before.

  16. Neurocysticercosis, meningioma, and silent corticotroph pituitary adenoma in a 61-year-old woman.

    Science.gov (United States)

    Ramirez, Maria Del Pilar; Restrepo, Juan E; Syro, Luis V; Rotondo, Fabio; Londoño, Francisco J; Penagos, Luis C; Uribe, Humberto; Horvath, Eva; Kovacs, Kalman

    2012-01-01

    We report here the case of a 61-year-old woman who presented with hydrocephalus and cystic and solid lesions in sella turcica, suprasellar areas, and third ventricle. After ventriculoperitoneal shunt she developed cognitive changes and the cystic lesions enlarged. Magnetic resonance imaging (MRI) demonstrated multiple cysts and a solid lesion in the sella and around the anterior clinoid process. With diagnosis of neurocysticercosis she underwent craniotomy. Pathologic examination documented two different lesions: viable and dead cysticerci with inflaming infiltration and a left anterior clinoidal meningioma. At the second surgery, six weeks later via transnasal transsphenoidal approach a silent corticotroph pituitary adenoma was removed which was studied by histology, immunohistochemistry, and electron microscopy. To our knowledge, the occurrence of these three different lesions in the sellar area was not described before.

  17. Clinical Predictors of Diabetes Insipidus After Transcranial Surgery for Pituitary Adenoma.

    Science.gov (United States)

    Wang, Songquan; Li, Deling; Ni, Ming; Jia, Wang; Zhang, Qing; He, Jue; Jia, Guijun

    2017-05-01

    Diabetes insipidus (DI) is a well-known complication of transsphenoidal pituitary adenoma surgery. However, the risk factors for DI after transcranial surgery have not been clarified. In this study, the clinical parameters for predicting DI after transcranial surgery were investigated. The perioperative records of 90 patients who underwent transcranial (TC) surgery at the authors' institution between November 2011 and March 2013 were chosen from 1657 patients with pituitary adenoma and retrospectively analyzed. The degree of deformation of the third ventricle and hypothalamus were assessed by preoperative magnetic resonance imaging. Immediate postoperative DI was found in 30 patients (33.3%). Persistent DI was noted in 11 patients (12.6%). Compared with patients in the nonpostoperative DI group, those with postoperative DI had a higher degree of deformation of the third ventricle and hypothalamus (P < 0.001). In a binary logistic regression analysis, the degree of deformation of the third ventricle and hypothalamus (odds ratio [OR], 3.079; 95% confidence interval [CI], 1.600-5.925; P = 0.001) had a significant positive correlation with immediate postoperative DI, as well as postoperative hemorrhage (OR, 6.235, 95% CI, 1.457-26.689; P = 0.014). Postoperative hemorrhage (OR, 4.363; 95% CI, 1.021-18.647; P = 0.047) showed a positive correlation with permanent DI, as well as the degree of deformation of the third ventricle and hypothalamus (OR, 2.336; 95% CI, 1.005-5.427; P = 0.049). The degree of deformation of the third ventricle and hypothalamus assessed by preoperative magnetic resonance imaging may help to predict postoperative DI. Postoperative hemorrhage might increase the incidence of postoperative DI, whether it is immediate postoperative DI or permanent DI. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Clinical applications of somatostatin analogs for growth hormone-secreting pituitary adenomas

    Science.gov (United States)

    Wang, Ji-wen; Li, Ying; Mao, Zhi-gang; Hu, Bin; Jiang, Xiao-bing; Song, Bing-bing; Wang, Xin; Zhu, Yong-hong; Wang, Hai-jun

    2014-01-01

    Excessive growth hormone (GH) is usually secreted by GH-secreting pituitary adenomas and causes gigantism in juveniles or acromegaly in adults. The clinical complications involving cardiovascular, respiratory, and metabolic systems lead to elevated morbidity in acromegaly. Control of serum GH and insulin-like growth factor (IGF) 1 hypersecretion by surgery or pharmacotherapy can decrease morbidity. Current pharmacotherapy includes somatostatin analogs (SAs) and GH receptor antagonist; the former consists of lanreotide Autogel (ATG) and octreotide long-acting release (LAR), and the latter refers to pegvisomant. As primary medical therapy, lanreotide ATG and octreotide LAR can be supplied in a long-lasting formulation to achieve biochemical control of GH and IGF-1 by subcutaneous injection every 4–6 weeks. Lanreotide ATG and octreotide LAR provide an effective medical treatment, whether as a primary or secondary therapy, for the treatment of GH-secreting pituitary adenoma; however, to maximize benefits with the least cost, several points should be emphasized before the application of SAs. A comprehensive assessment, especially of the observation of clinical predictors and preselection of SA treatment, should be completed in advance. A treatment process lasting at least 3 months should be implemented to achieve a long-term stable blood concentration. More satisfactory surgical outcomes for noninvasive macroadenomas treated with presurgical SA may be achieved, although controversy of such adjuvant therapy exists. Combination of SA and pegvisomant or cabergoline shows advantages in some specific cases. Thus, an individual treatment program should be established for each patient under a full evaluation of the risks and benefits. PMID:24421637

  19. Long-term results of radiotherapy in the treatment of pituitary adenomas in children and adolescents

    Energy Technology Data Exchange (ETDEWEB)

    Grigsby, P.W.; Thomas, P.R.; Simpson, J.R.; Fineberg, B.B.

    1988-12-01

    A retrospective review was performed of 11 children and adolescents (less than 19 years of age) with diagnosed pituitary adenomas. The patients were treated with subtotal resection and postoperative irradiation (S + R) or with irradiation alone (RT) at the Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University Medical Center, from January 1958 through December 1982. Patient conditions at diagnosis were acromegaly in one, Nelson's syndrome in one, prolactinoma in three, chromophobe adenoma in three, and Cushing's disease in three. Median follow-up was 15.6 years (range 6.3-29.5 years). Only two patients have had failure: one at 8.6 years and the other at 20.7 years following treatment. All four patients with visual field (VF) defects at diagnosis underwent S + R, with only one developing recurrent disease. The remaining seven patients, who did not have VF defects, received RT only, and there has been one failure in this group. None have suffered long-term visual complications. All have been able to continue school and/or work. Three of eight females have borne children. Hypopituitarism requiring medication occurred in all who received S + R and in four of seven who received RT only.

  20. MRI of growth hormone-secreting pituitary adenomas: factors determining pretreatment hormone levels

    Energy Technology Data Exchange (ETDEWEB)

    Saeki, N.; Iuchi, T.; Eda, M.; Yamaura, A. [Dept. of Neurological Surgery, Chiba University School of Medicine (Japan); Isono, S. [Dept. of Neurological Surgery, Anesthesiology, Chiba University School of Medicine, Chiba (Japan)

    1999-10-01

    Preoperative serum growth hormone (GH) level is one of the most important determinants of outcome. Our aim was to assess MRI findings which may correlate with pretreatment GH levels in GH-secreting adenomas. We retrospectively studied 29 patients with acromegaly caused by a pituitary adenoma. Tumor size (height, width, thickness and volume), suprasellar extension, sphenoid or cavernous sinus invasion, signal intensity and contrast enhancement were studied. Linear regression analysis or Fisher's exact probability test was used for statistical analysis. Factors related to high GH levels were the maximum dimension of the tumour (r = 0.496, P < 0.01), its volume (r = 0.439, P < 0.05), spenoid sinus invasion (P < 0.01) and intracavernous carotid artery encasement (P < 0.01). The other items were not related to serum GH levels. Since we believe surgery is the first choice of treatment and the cavernous sinus is difficult of access with a conventional surgical approach, preoperative assessment of invasion into the cavernous sinus is critical for predicting the surgical outcome. Low GH levels (5-50 ng/ml) were found with tumours medial to the intercarotid line and high levels (more than 101 ng/ml) with invasive tumours with carotid artery encasement. Variable GH levels were noted with tumours extending beyond the intercarotid line. Because functioning adenomas invading the cavernous sinus tend to have markedly high hormone levels, and only patients with carotid artery encasement showed markedly elevated GH levels, we believe carotid artery encasement a reliable MRI indicator of cavernous sinus invasion. (orig.)

  1. Long-Term Outcomes of Fractionated Stereotactic Radiation Therapy for Pituitary Adenomas at the BC Cancer Agency

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Julian O.; Ma, Roy [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver (Canada); Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver (Canada); Akagami, Ryojo [Division of Neurosurgery, University of British Columbia, Vancouver (Canada); McKenzie, Michael [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver (Canada); Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver (Canada); Johnson, Michelle [Division of Endocrinology, University of British Columbia, Vancouver (Canada); Gete, Ermias [Department of Medical Physics, British Columbia Cancer Agency, Vancouver (Canada); Nichol, Alan, E-mail: anichol@bccancer.bc.ca [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver (Canada); Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver (Canada)

    2013-11-01

    Purpose: To assess the long-term disease control and toxicity outcomes of fractionated stereotactic radiation therapy (FSRT) in patients with pituitary adenomas treated at the BC Cancer Agency. Methods and Materials: To ensure a minimum of 5 years of clinical follow-up, this study identified a cohort of 76 patients treated consecutively with FSRT between 1998 and 2007 for pituitary adenomas: 71% (54/76) had nonfunctioning and 29% (22/76) had functioning adenomas (15 adrenocorticotrophic hormone-secreting, 5 growth hormone-secreting, and 2 prolactin-secreting). Surgery was used before FSRT in 96% (73/76) of patients. A median isocenter dose of 50.4 Gy was delivered in 28 fractions, with 100% of the planning target volume covered by the 90% isodose. Patients were followed up clinically by endocrinologists, ophthalmologists, and radiation oncologists. Serial magnetic resonance imaging was used to assess tumor response. Results: With a median follow-up time of 6.8 years (range, 0.6 - 13.1 years), the 7-year progression-free survival was 97.1% and disease-specific survival was 100%. Of the 2 patients with tumor progression, both had disease control after salvage surgery. Of the 22 patients with functioning adenomas, 50% (11/22) had complete and 9% (2/22) had partial responses after FSRT. Of the patients with normal pituitary function at baseline, 48% (14/29) experienced 1 or more hormone deficiencies after FSRT. Although 79% (60/76) of optic chiasms were at least partially within the planning target volumes, no patient experienced radiation-induced optic neuropathy. No patient experienced radionecrosis. No secondary malignancy occurred during follow-up. Conclusion: In this study of long-term follow-up of patients treated for pituitary adenomas, FSRT was safe and effective.

  2. Assessment of pituitary adenoma volumetric change using longitudinal MR image registration

    Energy Technology Data Exchange (ETDEWEB)

    Ringstad, Geir Andre; Hald, John K. [Oslo University Hospital-Rikshospitalet, Clinic for Imaging and Intervention, Oslo (Norway); Emblem, Kyrre Eeg [Oslo University Hospital-Rikshospitalet, Department of Medical Physics, Oslo (Norway); Oslo University Hospital-Rikshospitalet, The Interventional Centre, Oslo (Norway); Holland, Dominic [University of California, Department of Neurosciences, San Diego, CA (United States); Dale, Anders M. [University of California, Department of Neurosciences, San Diego, CA (United States); University of California, Department of Radiology, San Diego, CA (United States); Bjornerud, Atle [Oslo University Hospital-Rikshospitalet, Department of Medical Physics, Oslo (Norway); University of Oslo, Department of Physics, Oslo (Norway)

    2012-05-15

    Change detection is a crucial factor in monitoring of slowly evolving pathologies. The objective of the study was to test a semi-automatic method applied on longitudinal MRI monitoring of volume change in pituitary macroadenomas. The proposed method is based on a visual comparison of geometrically corrected, co-registered, intensity-normalized contrast-enhanced (CE) 3D GRE T1-weighted images. Qualitative volume changes based on this applied method were compared with experts' readings of conventional pre- and post-CE 2D T1-weighted images. Magnetic resonance (MR) imaging was performed two to four times in 13 patients with a total combination of 29 time points. Compared to conventional 2D MR readings, a diagnosis of tumor growth (yes/no) was changed in 5 of 13 patients (38%) at 9 of the 29 combinations of time points (31%) using the 3D-based semi-automatic method. With manual tumor tracings as reference, McNemar's test showed a significant difference between the two methods. Visual comparison of geometrically corrected, intensity-normalized, and affine-aligned longitudinal 3D images may enable more accurate assessment of qualitative volumetric change in pituitary adenomas than conventional reading of 2D images. (orig.)

  3. Fractionated stereotactic radiosurgery using the Novalis system for the management of pituitary adenomas close to the optic apparatus.

    Science.gov (United States)

    Liao, Huang-I; Wang, Chun-Chieh; Wei, Kuo-Cheng; Chang, Cheng-Nen; Hsu, Yung-Hsin; Lee, Shih-Tseng; Huang, Yin-Cheng; Chen, Hsien-Chih; Hsu, Peng-Wei

    2014-01-01

    Radiosurgery has been proven to be an effective treatment for residual or recurrent pituitary adenomas after surgery. However, it causes severe complications when the optic apparatus is irradiated over the tolerance dose. In this study, we analyzed the feasibility of fractionated stereotactic radiosurgery to treat pituitary tumors close to the optic apparatus. Thirty-four patients from June 2006 to June 2011 with recurrent or residual pituitary adenomas close to (<3 mm) the optic apparatus were treated with fractionated stereotactic radiosurgery. Three fractions with a total dose of 2100 cGy were applied to the tumors. Imaging, examination of vision, and estimation of hormone level were regularly performed before and after radiosurgery. The mean tumor volume before fractioned stereotactic radiosurgery was 5.06±3.08 cm3 (range: 0.82-12.69 cm3). After a mean follow up of 36.8±15.7 months (range: 16-72 months), tumor size was reduced in seven (20.6%) patients and remained the same in the other 27 (79.4%) patients. Vision was improved in one patient and remained stable in the rest. Only one patient developed transient post-treatment diplopia. This study suggests that fractionated stereotactic radiosurgery is safe for treating pituitary adenomas close to the optic apparatus. Studies with more patients and longer follow-up are required to draw definite conclusions.

  4. Assessing size of pituitary adenomas: a comparison of qualitative and quantitative methods on MR.

    Science.gov (United States)

    Davies, Benjamin M; Carr, Elizabeth; Soh, Calvin; Gnanalingham, Kanna K

    2016-04-01

    A variety of methods are used for estimating pituitary tumour size in clinical practice and in research. Quantitative methods, such as maximum tumour dimension, and qualitative methods, such as Hardy and Knosp grades, are well established but do not give an accurate assessment of the tumour volume. We therefore sought to compare existing measures of pituitary tumours with more quantitative methods of tumour volume estimation. Magnetic resonance imaging was reviewed for 99 consecutive patients with pituitary adenomas awaiting surgery between 2010 and 2013. Maximal tumour diameter, Hardy and Knosp grades were compared with tumour volume estimates by the ellipsoid equation, [4/3π (a,b,c)], (i.e. ellipsoid volume) and slice-by-slice perimetry (i.e. perimeter volume). Ellipsoid and perimeter methods of tumour volume estimation strongly correlated (R(2) = 0.99, p < 0.0001). However the correlation was less strong with increasing tumour size, with the ellipsoid method slightly underestimating. The mean differences were -0.11 (95 % CI, -0.35, 0.14), -0.74 (95 % CI, -2.2, 0.74) and -1.4 (95 % CI, -6.4, 3.7) for micro-tumours, macro-tumours and giant tumours respectively. Tumour volume correlated with maximal diameter, following a cubic distribution. Correlations of tumour volume with Hardy and Knosp grades was less strong. Perimeter and ellipsoid methods give a good estimation of tumour volume, whereas Knosp and Hardy grades may offer other clinically relevant information, such as cavernous sinus invasion or chiasmal compression. Thus the different methods of estimating tumour size are likely to have different clinical utilities.

  5. Radiation Therapy for Pituitary Adenoma - Changes in Endocrine Function after Treatment-

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sei Chul; Jang, Hong Suck; Kim, Song Hwan; Shinn, Kyung Sub; Bahk, Yong Whee; Son, Ho Young; Kang, Joon Ki [Catholic University Medical College, Seoul (Korea, Republic of)

    1991-12-15

    Seventy four patients with pituitary adenoma received radiation therapy(RT) on the pituitary area using 6 MV linear accelerator during the past 7 years at the Division of Radiation Therapy, Kangnam St. mary's hospital, Catholic University Medical College. Thirty nine were men and 35 were women. The age ranged from 7 to 65 years with the mean being 37 years. Sixty five (88%) patients were treated postoperatively and 9(12%) primary RT. To evaluate the effects of RT, we analyzed the series of endocrinologic studies with prolactin(PRL), growth hormone(GH), adrenocortiotrophic hormone (ACTH), leuteinizing hormone (LH), follicular stimulating hormone(FSH) and thyroid stimulating hormone(TSH) etc after RT. All but one with Nelson's syndrome showed abnormal neuroradiologic changes in the sella turica with invasive tumor mass around supra-and/or parasella area. The patients were classified as 23(29%) prolactinomas and 20 (26%) growth hormone (GH) secreting tumors, and 6(8%) ACTH secreting ones consisting of 4 Cushing's disease and 2 Nelson's syndrome. Twenty nine(37%) had nonfunctioning tumor and four (5%) of those secreting pituitary tumors were mixed PRL-GH secreting tumors. The hormonal level in 15(65%) of 23 PRL and 3(15%) of 20 GH secreting tumors returned to normal by 2 to 3 years after RT, but five PRL and five GH secreting tumors showed high hormonal level requiring bromocriptine medication. Endocrinologic insufficiency developed by 3 years after RT in 5 of 7 panhypopituitarisms, 4 of seven hypothyroidisms and one of two hypogonadisms, respectively, Fifteen(20%) patients were lost to follow up after RT.

  6. Takotsubo cardiomyopathy in a patient with pituitary adenoma and secondary adrenal insufficiency

    Directory of Open Access Journals (Sweden)

    Georgene Singh

    2015-01-01

    Full Text Available We describe a case of Takotsubo cardiomyopathy in a case of pituitary macroadenoma in acute adrenal crisis. A 48-year-old man presented with acute onset altered sensorium, vomiting, and gasping. On admission, he was unresponsive and hemodynamically unstable. He was intubated and ventilated and resuscitated with fluids and inotropes. The biochemical evaluation revealed hyponatremia, hyperkalemia, and hypocortisolism. Hyponatremia was corrected with 3% hypertonic saline. Contrast enhanced computed tomography (CT scan of the brain revealed a sellar-suprasellar mass with hypothalamic extension with no evidence of pituitary apoplexy. A diagnosis of invasive pituitary adenoma with the Addisonian crisis was made and steroid replacement was initiated. Despite volume resuscitation, he had persistent refractory hypotension, recurrent ventricular tachycardia, and metabolic acidosis. Electrocardiogram (ECG showed ST elevation and T-wave inversion in lateral leads; cardiac-enzymes were increased suggestive of acute coronary syndrome. Transthoracic echocardiography showed severe regional wall motion abnormalities (RWMAs involving left anterior descending territory and low ejection fraction (EF. Coronary angiogram revealed normal coronaries, apical ballooning, and severe left ventricular dysfunction, consistent with a diagnosis of Takotsubo′s cardiomyopathy. Patient was managed with angiotensin-converting enzyme inhibitors and B-blockers. He improved over few days and recovered completely. At discharge, ECG changes and RWMA resolved and EF normalized to 56%. In patients with Addisonian Crisis with persistent hypotension refractory to optimal resuscitation, possibility of Takotsubo′s cardiomyopathy should be considered. Early recognition of association of Takotsubos cardiomyopathy in neurological conditions, prompt resuscitation, and supportive care are essential to ensure favorable outcomes in this potentially lethal condition.

  7. The R304X mutation of the Aryl hydrocarbon receptor Interacting Protein gene in familial isolated pituitary adenomas: mutational Hot-Spot or founder effect?

    OpenAIRE

    Occhi, G.; Jaffrain-Rea, M. L.; Trivellin, G.; Albiger, N; Ceccato, F.; De Menis, E.; Angelini, M.; Ferasin, S; Beckers, Albert; F. Mantero; Scaroni, C.

    2010-01-01

    Background: Mutations in the Aryl hydrocarbon receptor Interacting Protein (AIP) gene have been described in about 15% of kindreds with Familial Isolated Pituitary Adenomas (FIPA) and in a minority of early onset sporadic pituitary adenomas (PA). Among the AIP mutations reported so far, the R304X (AIPR304X) represents, together with the "Finnish mutation" Q14X, the most common one. Methods: Three AIPR304X Italian families, including a newly reported kindred, have been genotyped for 12 genetic...

  8. Comorbidity and cardiovascular risk factors in adult GH deficiency following treatment for Cushing's disease or non-functioning pituitary adenomas during childhood

    DEFF Research Database (Denmark)

    Ragnarsson, Oskar; Höybye, Charlotte; Jönsson, Peter J;

    2012-01-01

    Cushing's disease (CD) and non-functioning pituitary adenoma (NFPA) are rare in paediatric patients. The aim of this study was to describe long-term consequences in adults with GH deficiency (GHD) treated for CD or NFPA during childhood.......Cushing's disease (CD) and non-functioning pituitary adenoma (NFPA) are rare in paediatric patients. The aim of this study was to describe long-term consequences in adults with GH deficiency (GHD) treated for CD or NFPA during childhood....

  9. Long-term results of radiotherapy for pituitary adenomas. Evaluation of tumor control and hypopituitarism after radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchida, Emiko; Sakai, Kunio; Matsumoto, Yasuo; Sugita, Tadashi; Sasamoto, Ryuta [Niigata Univ. (Japan). School of Medicine

    1999-09-01

    To evaluate the results of conventional radiotherapy for pituitary adenomas assessed with computed tomography (CT) or magnetic resonance imaging (MRI). Endpoints include tumor control, normalization of hormone levels in functioning adenomas, and hypopituitarism after radiotherapy as an adverse effect. Forty-two patients were treated with radiotherapy from 1982 to 1995 at Niigata University Hospital. Forty patients were irradiated after surgery because of residual adenomas in 33 patients and tumor regrowth in 7 patients. One patient was treated with radiotherapy alone, and the remaining 1 patient was treated with preoperative radiotherapy. Tumor size and extension were evaluated using CT or MRI, and all tumors were macroadenomas. They consisted of 18 non-functioning and 24 functioning adenomas (growth hormone (GH)-secreting: 11, prolactinomas: 7, concomitant GH and prolactin (PRL)-secreting: 5, gonadotropin-secreting: 1). Treatment was given in 200 cGy daily fraction size and a total dose of 50 Gy was given to most patients. Sixteen patients with GH- and/or PRL-secreting adenomas received bromocriptine. Tumor progression was determined by increase in tumor size as shown by CT or MRI. Hypopituitarism after radiotherapy was evaluated using the functions of corticotropin (ACTH), thyrotropin (TSH), and gonadotropin. Median follow-up time from the end of radiotherapy was 103 months. Tumor progression occurred in 2 out of 42 patients and 10-year progression-free rate for all patients was 93.7%. Normalization of GH levels was obtained in 12 of 16 GH-secreting adenomas with a mean time of 27 months after radiotherapy, and 9 of 12 PRL-secreting adenomas achieved normalization of PRL levels with a mean time of 34 months. One gonadotropin-secreting adenoma achieved normalization of gonadotropin level at 21 months after radiotherapy. The incidence of hypopituitarism after radiotherapy increased with time, and cumulative risk of deficiencies of ACTH, TSH, and gonadotropin at 10

  10. Analysis of 137 Patients Who Underwent Endoscopic Transsphenoidal Pituitary Adenoma Resection Under High-Field Intraoperative Magnetic Resonance Imaging Navigation.

    Science.gov (United States)

    Zhang, Huaping; Wang, Fuyu; Zhou, Tao; Wang, Peng; Chen, Xiaolei; Zhang, Jiashu; Zhou, Dingbiao

    2017-08-01

    Pure endoscopic resection has become the most popular surgical approach for pituitary adenoma. Intraoperative magnetic resonance imaging (iMRI) systems have been in use for endoscopic resection of pituitary adenomas. This study aimed to evaluate the effectiveness of iMRI and neuroimaging navigation techniques during endoscopic endonasal transsphenoidal surgery of pituitary adenomas. Data from 137 patients who underwent resection of endoscopic pituitary adenoma under 1.5T iMRI navigation were collected and analyzed. Of patients, 92 underwent complete resection and 45 had residual tumor on real-time iMRI. Twenty-three patients underwent further surgery, and total resection was achieved in 19. Extent of total resection increased from 67.15% to 81.02%. iMRI revealed 3 patients with bleeding in the surgical area, which was successfully treated during the surgery. Review images obtained 3 months after surgery showed 26 patients with residual tumor; 14 patients had the same volume as intraoperatively, and 12 patients had a volume less than that observed intraoperatively. Residual tumor volume in the suprasellar region was less than that seen intraoperatively in 11 of 15 (73.3%) patients. The use of iMRI and neuronavigation not only leads to a higher rate of tumor resection but also helps in detecting and removing hematomas in the surgical area. Follow-up examinations of extent of residual tumor at 3 months postoperatively were consistent with intraoperative results. Residual tumor volume in the suprasellar region was usually less than that observed intraoperatively. Copyright © 2017. Published by Elsevier Inc.

  11. Use of DES-treated rats as an animal model for assessment of pituitary adenoma imaging agents

    Energy Technology Data Exchange (ETDEWEB)

    Otto, C.A.; Marshall, J.C.; Lloyd, R.V.; Sherman, P.S.; Fisher, S.J.; Valoppi, V.L.; Rogers, W.L.; Wieland, D.M.

    1986-01-01

    Prolactin (PRL) secreting pituitary adenomas are the most common type of pituitary tumors. An imaging agent which specifically localized in prolactinomas would be of considerable clinical value. Tritiated spiroperidol (/sup 3/HSp) was selected for initial evaluation as a possible imaging agent based on: (1) demonstrated localization in the pituitary and (2) demonstrated binding to human PRL-secreting tumor tissue. DES was implanted in Fischer F344 rats which induced prolactinoma formation. /sup 3/HSp concentrations in pituitary and other tissues of DES-treated rats were assessed in female rats and correlation studies showed that a 5-fold increase in serum PRL was associated with a 6-fold increase in both pituitary weight and % dose/organ accumulation of /sup 3/HSp. The number of pituitary D/sub 2/ receptors per mg of protein in tissue homogenates was similar in both normal and DES-treated females. A blocking study with (+)-butaclamol demonstrated a D/sub 2/ receptor-mediated component to /sup 3/HSp localization. In summary, an animal model for prolactinoma was characterized. An assessment of /sup 3/HSp accumulation indicates that radiolabelled spiroperidol shows excellent potential for detecting PRL-secreting tumors of the pituitary.

  12. Successful long-term control of Cushing’s disease after partial resection of gigantic ACTH-secreting pituitary adenoma

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    Vatroslav Čerina

    2016-03-01

    Full Text Available Only 4-9% of patients with Cushing’s disease (CD harbor pituitary macroadenomas. Clinical and biochemical features of macrocorticotropinomas are poorly understood. Some evidence exist that these tumors presents clinical features more similar to a non-functioning adenomas, being though defined silent corticotropinomas, rather than to ACTH-secreting adenomas. In this paper, we report a case of a 60-year old woman with a history of obesity, arterial hypertension and diabetes mellitus who presented with overt central hypothyroidism. Magnetic resonance imaging disclosed giant pituitary adenoma measuring 50 mm. Endocrinological evaluation confirmed CD: ACTH 50.3 pmol/L, urinary free-cortisol of 739 nmol/24h and cortisol of 639 nmol/L after 1 mg dexamethasone suppression test. Tumor mass was reduced by 50% using purely endoscopic transsphenoidal approach. Thirty-eight months after the partial resection, the patient had well controlled CD: ACTH 20.2 pmol/L, urinary free-cortisol of 238 nmol/24h, cortisol of 105 nmol/L after 1 mg dexamethasone suppression test. To the best of our knowledge, this is the largest ACTH-secreting adenoma ever reported. Our case suggests that tumor size does not necessarily correlate with aggressiveness of CD in patients with macrocorticotropinomas and that long-term control of CD may be achieved albeit incomplete surgical removal. Further studies are needed in order to determine the best treatment option for patients with macrocorticotropinomas.

  13. Asystole due to trigemino-cardiac reflex: a rare complication of trans-sphenoidal surgery for pituitary adenoma.

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    Seker, Askin; Toktas, Zafer Orkun; Peker, Selcuk; Batirel, Halit Abbas; Necmettin Pamir, M

    2009-02-01

    The trigemino-cardiac reflex (TCR) is a well-known reflexive response in which bradycardia, hypotension, and gastric hypermotility are induced by stimulation of a peripheral or central portion of the trigeminal nerve. This reflex occurs during craniofacial surgery and other operations on or near the cerebellopontine angle, petrosal sinus, orbit and trigeminal ganglion. TCR is a well-known, although not well documented, phenomenon commonly observed during trans-sphenoidal surgery for resection of pituitary adenomas. We report a case in which asystole occurred during trans-sphenoidal surgery on a pituitary adenoma that was infiltrating the right cavernous sinus. When the anesthesiologist reported asystole, the team stopped manipulation and administered intravenous atropine. Intra-operative MRI showed a small tumour remnant in the right cavernous sinus. The operation was terminated but subsequent radiosurgery was planned for the residual tumor. Although TCR is rare and usually self-limiting, this case led us to change our treatment strategy. Surgeons who perform trans-sphenoidal surgery should be aware of this potential problem. Invasive pituitary adenomas should be removed gently and the risk of triggering TCR should be kept in mind.

  14. Effects of low-dose ionising radiation on pituitary adenoma: is there a role for L-type calcium channel?

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    Soares, Marcella Araugio; Santos, Raquel Gouvea dos [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN), Belo Horizonte, MG (Brazil). Lab. de Radiobiologia]. E-mail: santosr@cdtn.br

    2005-10-15

    Pituitary adenomas constitute about 6-18% of brain tumours in adults. Activation of voltage gated calcium currents can account for growth hormone over secretion in some GH-secreting pituitary adenomas that produce an acromegaly appearance and increase mortality. Ca{sup 2+} ions, as mediators of intracellular signalling, are crucial for the development of apoptosis. However, the role of [Ca{sup 2+}] in the development of apoptosis is ambiguous. In this study, the effects of low-dose ionising gamma radiation ({sup 60} Co) on rat pituitary adenoma cells survival and proliferation and the role of calcium channels on the apoptosis radio-induced were evaluated. Doses as low as 3 Gy were found to inhibit GH3 cell proliferation. Even though there was a significant number of live cells,168 hours following irradiation, they were not able to proliferate. The results indicate that the blockade of extracellular calcium influx through these channels does not interfere in the radiation-induced apoptosis in GH3 cells. (author)

  15. Multiple intracranial aneurysms following radiation therapy for pituitary adenoma; A case report

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    Moriyama, Takumi (Fuchu Keijinkai General Hospital, Tokyo (Japan)); Shigemori, Minoru; Hirohata, Yu; Konishi, Jun; Yuge, Tatuo; Tokunaga, Takayuki; Kuramoto, Shinken

    1992-04-01

    A rare case is reported in which multiple cerebral aneurysm occurred after radiotherapy. A female aged 51 was hospitalized with a chief complaint of consciousness disorder. The patient was discharged from the hospital 1 year before, after undergoing subtotal extirpation of a tumor through the transsphenoidal sinus in a case of pituitary adenoma, and post-operative radiotherapy (topical 50 Gy). Mild hyperlipidemia associated with hypothyroidism was observed by blood biochemical test during hospitalization. Multiple cerebral infarction was observed by CT scanning and MR imaging. Conservative treatment including intensified endocrine-supplementing treatment was performed. Thyroid gland function and hyperlipidemia improved, but the consciousness disorder occurred suddenly 6 weeks after hospitalization. Subarachnoid hemorrhage and hydrocephalus were observed by CT scanning. Cerebral angiography detected a saccular aneurysm in the trifuraction of the right middle cerebral artery, 3 fusiform aneurysms in the periphery of the right middle cerebral artery, 2 fusiform aneurysms in the posterior cerebral artery. These findings were not observed at the initial hospitalization but were unexceptionally confined to all the irradiation fields. The patient died 8 weeks after hospitalization, and no autoptic findings was obtained. We presumed that radiation vasculopathy, caused by radiation therapy done one year previously, had led to the occurrence of multiple cerebral aneurysms. We think that hyperlipidemia may have acted as an exacerbating factor responsible for these aneurysms. (author).

  16. Investigation of Responsiveness to Thyrotropin-Releasing Hormone in Growth Hormone-Producing Pituitary Adenomas

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    Sang Ouk Chin

    2013-01-01

    Full Text Available Objective. The aim of this study was to investigate how the paradoxical response of GH secretion to TRH changes according to tumor volumes. Methods. Patients with newly diagnosed acromegaly were classified as either TRH responders or nonresponders according to the results of a TRH stimulation test (TST, and their clinical characteristics were compared according to responsiveness to TRH and tumor volumes. Results. A total of 41 acromegalic patients who underwent the TST were included in this study. Between TRH responders and nonresponders, basal GH, IGF-I levels, peak GH levels, and tumor volume were not significantly different, but the between-group difference of GH levels remained near significant over the entire TST time. during the TST were significantly different according to the responsiveness to TRH. Peak GH levels and during the TST showed significantly positive correlations with tumor volume with higher levels in macroadenomas than in microadenomas. GH levels over the entire TST time also remained significantly higher in macroadenomas than in microadenomas. Conclusion. Our data demonstrated that the paradoxical response of GH secretion to TRH in GH-producing pituitary adenomas was not inversely correlated with tumor volumes.

  17. Mononostril versus Binostril Endoscopic Transsphenoidal Approach for Pituitary Adenomas: A Systematic Review and Meta-Analysis.

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    Guodao Wen

    Full Text Available Over the past several decades, the endoscopic endonasal transsphenoidal approach (EETA has gradually become a preferred option of pituitary adenomas surgery because of its minimal invasiveness and high efficiency. However, some EETA operations were performed through one nostril (mononostril, while other EETA operations were performed through both nostrils (binostril. Therefore, we conducted this study to compare the pros and cons of these two methods in an attempted to confirm which method is more effective.We executed a systematic literature search of PubMed, the Cochrane Library, and the Web of Science and Medline (1992-2015. The language is limited to English and all studies should meet the inclusion criteria. Comparisons were made for postoperative outcomes, complications, and other relevant parameters between the mononostril and the binostril group. Statistical analyses of categorical variables were undertaken by the use of Stata 12.0 and SPASS 19.0.Thirty studies, involving 4805 patients, were included. The two groups had similar results in GTR rate (included GTR rate of macroadenomas, hormonal remission rate, improvement in visual function, postoperative CSF leak, permanent diabetes insipidus, meningitis, and sinusitis. The binostril group had less temporary diabetes insipidus (2.9% vs. 5.3%, p = 0.022, less anterior pituitary insufficiency (2.3% vs. 6.4%, p = 0.000 and few hospitalization days (3.2 days vs. 4.4 days, p<0.05 than the mononostril group. However, the mononostril group had less rate of epistaxis (0.4% vs. 1.5%, p = 0.008 than the binostril group. For invasive macroadenomas, the binostril group seem to demonstrate a tendency towards better outcomes though there was no subgroup analysis between the two groups.The binostril approach had less temporary diabetes insipidus, anterior pituitary insufficiency, and a shorter length of hospital stay, although they demonstrated a higher rate of epistaxis than the mononstril group

  18. Persistence of intrasellar trigeminal artery and simultaneous pituitary adenoma: description of two cases and their importance for the differential diagnosis of sellar lesions.

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    Machado, Marcio Carlos; Kodaira, Sergio; Musolino, Nina Rosa Castro

    2014-08-01

    Persistent trigeminal artery (PTA) is the most frequent embryonic communication between the carotid and vertebrobasilar systems. However, hormonal changes or the association of PTA with other sellar lesions, such as pituitary adenomas, are extremely rare. The aim of the present study was to report two patients with intrasellar PTA and simultaneous pituitary adenoma in order to emphasize the importance of differential diagnoses for sellar lesions. Case 1. A female patient, 41 years old, was admitted with a history of chronic headache (> 20 years). Pituitary magnetic resonance imaging (MRI) showed a rounded lesion in the left portion of the pituitary gland suggestive of adenoma (most likely clinically non-functioning adenoma). In addition to this lesion, the MRI demonstrated ecstasy of the right internal carotid artery and imaging suggestive of an intrasellar artery that was subsequently confirmed by an angio-MRI of the cerebral vessels as PTA. Case 2. A female patient, 42 years old, was admitted with a history of amenorrhea and galactorrhea in 1994. Laboratorial investigation revealed hyperprolactinemia. Pituitary MRI showed a small hyposignal area in the anterior portion of pituitary gland suggestive of a microadenoma initiated by a dopaminergic agonist. Upon follow-up, aside from the first lesion, the MRI showed a well delineated rounded lesion inside the pituitary gland, similar to a vessel. Angio-MRI confirmed a left primitive PTA. Failure to recognize these anomalous vessels within the sella might lead to serious complications during transsphenoidal surgery. Therefore, although their occurrence is uncommon, a working knowledge of vascular lesions in the sella turcica or pituitary gland is important for the differential diagnosis of pituitary lesions, especially pituitary adenomas.

  19. [History of pituitary surgery in humans and animals: from experiments with dogs to treatment of patients].

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    Meij, B P

    2001-12-22

    At the end of the 19th century and the start of the 20th century experimental hypophysectomy was carried out on cats and dogs, by means of the lateral temporal approach, to investigate the physiological role of the pituitary gland because there was a debate as to whether the pituitary gland was essential for life. At the same time pioneering neurosurgeons such as Harvey Cushing used animal experiments to explore the different approaches to the neurocranium and the pituitary, thereby taking the first steps towards neurosurgery in humans. Eventually the transsphenoidal route was chosen for such an operation. Veterinary medicine has benefited from these developments in the medical field. For the past few decades, hypophysectomy has been used for the treatment of pituitary adenomas in dogs and cats that are kept as pets.

  20. Analysis of Circulating Endostatin and Vascular Endothelial Growth Factor in Patients with Pituitary Adenoma Treated by Stereotactic Radiosurgery: A Preliminary Study.

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    Lee, Kyung-Min; Park, Seong-Hyun; Park, Ki-Su; Hwang, Jeong-Hyun; Hwang, Sung-Kyoo

    2015-10-01

    The purpose of this study was to investigate plasma levels of endostatin and vascular endothelial growth factor (VEGF) in normal subjects and in patients with pituitary adenoma and to evaluate change in these levels following stereotactic radiosurgery (SRS) for pituitary adenoma. Peripheral venous blood was collected from five patients with pituitary adenoma before SRS using Gamma Knife and at the 1 week and 1 month follow-up visits. Plasma endostatin and VEGF levels were measured using commercially available enzyme-linked immunosorbent assay kits. Peripheral blood samples were obtained from 10 healthy volunteers as controls. Mean baseline plasma endostatin level (105.3 ng/mL, range, 97.0-120.2 ng/mL) in patients with pituitary adenoma was higher than that of the healthy controls (86.6 ng/mL, range, 71.3-98.2 ng/mL) (p=0.001). Mean plasma VEGF level was 89.5 pg/mL (range, 24.1-171.8 pg/mL) in patients with pituitary adenoma at baseline and 29.3 pg/mL (range, 9.2-64.3 pg/mL) in the control group (p=0.050). Plasma endostatin level changed to 106.6 ng/mL 1 week after SRS and decreased to 95.9 ng/mL after 1 month. Plasma VEGF level following SRS decreased to 74.1 pg/mL after 1 week and 79.0 pg/mL after 1 month. There was a trend toward decreased plasma endostatin and VEGF concentrations 1 month after SRS compared to baseline levels (p=0.195, p=0.812, respectively). Plasma endostatin and VEGF levels in patients with pituitary adenoma were significantly elevated over controls at baseline, which decreased from baseline to 1 month after SRS for pituitary adenomas.

  1. Somatotroph Pituitary Adenoma with Acromegaly and Autosomal Dominant Polycystic Kidney Disease – SSTR5 polymorphism and PKD1 mutation

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    Syro, Luis V.; Sundsbak, Jamie L.; Scheithauer, Bernd W.; Toledo, Rodrigo A.; Camargo, Mauricio; Heyer, Christina M.; Sekiya, Tomoko; Uribe, Humberto; Escobar, Jorge I.; Vasquez, Martin; Rotondo, Fabio; Toledo, Sergio P. A.; Kovacs, Kalman; Horvath, Eva; Babovic-Vuksanovic, Dusica; Harris, Peter C.

    2014-01-01

    A 39-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) presented with acromegaly and a pituitary macroadenoma. There was a family history of this renal disorder. She had undergone surgery for pituitary adenoma 6 years prior. Physical examination disclosed bitemporal hemianopsia and elevation of both basal growth hormone (GH) 106 ng/mL (normal 0–5) and insulin-like growth factor (IGF-1) 811 ng/mL (normal 48–255) blood levels. A magnetic resonance imaging scan disclosed a 3.0 cm sellar and suprasellar mass with both optic chiasm compression and left cavernous sinus invasion. Histologic, immunohistochemical and ultrastructural studies of the lesion disclosed a sparsely granulated somatotroph adenoma. Standard chromosome analysis on the blood sample showed no abnormality. Sequence analysis of the coding regions of PKD1 and PKD2 employing DNA from both peripheral leukocytes and the tumor revealed the most common PKD1 mutation, 5014_5015delAG. Analysis of the entire SSTR5 gene disclosed the variant c.143C>A (p.L48M, rs4988483) change in the heterozygous state in both blood and tumor, while no pathogenic mutations were noted in the MEN1, AIP, p27Kip1 and SSTR2 genes. To our knowledge, this is the fourth reported case of a GH-producing pituitary adenoma associated with ADPKD, but the first subject to extensive morphological, ultrastructural, cytogenetic and molecular studies. The question arises whether the physical proximity of the PKD1 and SSTR5 genes on chromosome 16 indicates a causal relationship between ADPKD and the somatotroph adenoma. PMID:21744088

  2. Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas.

    Science.gov (United States)

    Hensen, J; Henig, A; Fahlbusch, R; Meyer, M; Boehnert, M; Buchfelder, M

    1999-04-01

    Disturbances of osmoregulation, leading to diabetes insipidus and hyponatraemia are well known complications after surgery in the sella region. This study was performed to examine the prevalence and predictors of polyuria and hyponatraemia after a complete and selective removal of pituitary adenomas was attempted via the transnasal-transsphenoidal approach. 1571 patients with pituitary adenomas (238 Cushing's disease, 405 acromegaly, 534 hormonally inactive adenomas, 358 prolactinoma, 23 Nelson's syndrome, and 13 thyrotropinoma) were daily examined within a 10-day postoperative inpatient observation period. Prevalence of patterns of polyuria (> 2500 ml) and oliguria/hyponatraemia (< 132 mmol/l) were surveyed as well as predictors of postoperative morbidity. 487 patients (31%) developed immediate postoperative hypotonic polyuria, 161 patients (10%) showed prolonged polyuria and 37 patients (2.4%) delayed hyponatraemia. A biphasic (polyuria-hyponatraemia) and triphasic (polyuria-hyponatraemia-polyuria) pattern was seen in 53 (3.4%) and 18 (1.1%) patients, respectively. Forty-one patients (2.6%) displayed immediate postoperative (day 1) hyponatraemia. Altogether, 8.4% of patients developed hyponatraemia at some time up to the 10th day postoperative, with symptomatic hyponatraemia in 32 patients (2.1%). Risk analysis showed that patients with Cushing's disease had a fourfold higher risk of polyuria than patients with acromegaly and a 2.8-fold higher risk for postoperative hyponatraemia. Younger age, male sex, and intrasellar expansion were associated with a higher risk of hypotonic polyuria, but this was not considered clinically relevant. The analysis illustrates that disturbances in osmoregulation resulting in polyuria and pertubations of serum sodium concentration are of very high prevalence and need observation even after selective transsphenoidal surgery for pituitary adenomas, especially in patients with Cushing's disease.

  3. Case report: ACTH-secreting pituitary carcinoma metastatic to the liver in a patient with a history of atypical pituitary adenoma and Cushing's disease.

    Science.gov (United States)

    Joehlin-Price, Amy S; Hardesty, Douglas A; Arnold, Christina A; Kirschner, Lawrence S; Prevedello, Daniel M; Lehman, Norman L

    2017-04-18

    Pituitary carcinoma is a rare entity requiring the presence of metastasis to confirm its malignant potential. We report a case of pituitary carcinoma and discuss the diagnosis and management of this lesion in relation to the existing literature. The patient is a 51-year-old woman with Cushing's disease and intact adrenal glands who was diagnosed with metastatic pituitary carcinoma to the liver, 29 months after initial resection of an ACTH-secreting primary atypical pituitary adenoma (APA). Prior to detection of this metastasis the patient underwent repeat resection and radiotherapy for residual cavernous sinus disease. The metastatic lesion was detected by interval surveillance of serum ACTH and 24-hour urine cortisol, which despite stable pituitary MRI, were significantly elevated. These abnormalities prompted a PET scan that demonstrated hypermetabolic liver parenchyma, which was suspicious for metastasis on abdominal MRI. An ultrasound-guided liver biopsy demonstrated nests of moderately-differentiated cells with intermediate-sized, monotonous nuclei, distinct nucleoli, and abundant basophilic cytoplasm, confirmed by immunohistochemistry to represent metastatic pituitary carcinoma. The liver lesion was subsequently successfully removed by wedge resection. One year later, the patient's residual cavernous sinus disease grew markedly, and she was placed on dual-agent chemotherapy consisting of oral temozolomide and capecitabine, with stabilization of her intracranial disease to present, although liver metastases recurred. Pituitary carcinoma is a rare entity impossible to recognize as a primary tumor because its diagnosis by definition requires the presence of metastasis. Maintaining awareness of the entity and its precursor lesion APA is essential for its accurate pathologic diagnosis and appropriate management.

  4. Demographic study of pituitary adenomas undergone trans-sphenoidal surgery in Loghman Hakim Hospital, Tehran, Iran 2001–2013

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    Farahnaz Bidari Zerehpoosh

    2015-01-01

    Full Text Available Background: Pituitary adenomas (PAs are abnormal benign tumors that develop in the pituitary gland. This study aimed to assess the prevalence of different types of PAs with an indication for trans-sphenoidal surgery in a well-defined population referred to Loghman Hakim Hospital during 2001–2013. Subjects and Methods: In this retrospective study, the prevalence rate and symptoms associated with pituitary mass and hormone excess in operated patients were investigated. The diagnosis was verified after retrieval of clinical, hormonal, radiological, and pathological data. Demographic data were collected in all cases. Descriptive analysis, t-test, one-way analysis of variance and Fischer exacts test were used. Results: A total of 278 patients with PAs who underwent surgical interventions were evaluated. Most of the patients were aged 40–50 years with an average of 41 ± 14. The most prominent complaint was pressure effect, which was detected in 153 cases (55.2%. At the second place, hormonal disorders were observed in 125 cases (44.8%. Type of pituitary tumors were: Prolactinomas (29.1%, growth hormone (GH-producing tumors (25%, nonfunctioning PAs (28.4%, adrenocorticotropic hormone (ACTH-producing tumors (2.1%, thyroid stimulating hormone (TSH-producing tumors (0.7%, GH/prolactin (13.6%, GH/ACTH (0.3%, and TSH/ACTH (0.3%. Fifty-seven patients presented with recurrent adenomas. Pituitary apoplexy was found in 11 patients. One case of Sheehan syndrome was recorded among these. The correlations between clinical symptoms and patients, age and sex were not significant. Conclusion: The overview of demographic characteristics in Iranian patients with PAs with surgical indication has been discussed in the present investigation. The prevalence of different types of PAs and the most common clinical symptoms have been demonstrated.

  5. 让垂体瘤的治疗更趋完善%Reducing the imperfection of pituitary adenoma treatment

    Institute of Scientific and Technical Information of China (English)

    郭晓蕙

    2012-01-01

    The assessment of pituitary function makes hormone replacement more timely for hypopituitarism after surgical procedure in patients with pituitary adenoma.However,there were only less than 50% patients receiving this assessment in the current clinical practice.Only by means of the cooperation between endocrinologists and neurosurgeons and the close contact between doctors from both tertiary and primary hospitals will reach the goal of the patient-centered treatment and appropriately improve the defective therapy of the pituitary adenoma.%垂体瘤患者术后进行垂体功能的评估可以及时地对垂体功能减退者进行合适的替代治疗.但我们当前的临床现实是能够接受恰当的术后评估的患者还不到50%.只有加强内分泌科与神经外科医师的技术互补协作以及三级医院医师和基层医院医师的密切联系,提供以患者为中心的治疗才能弥补当前垂体瘤治疗存在的缺陷.

  6. A novel truncating AIP mutation, p.W279*, in a familial isolated pituitary adenoma (FIPA) kindred.

    Science.gov (United States)

    Cansu, Güven Barış; Taşkıran, Bengür; Trivellin, Giampaolo; Faucz, Fabio R; Stratakis, Constantine A

    2016-07-01

    Familial isolated pituitary adenomas (FIPA) constitute 2-3% of pituitary tumours. AIP is the most commonly mutated gene in FIPA. We herein report a novel germline mutation of the AIP gene in a family with FIPA. We present two patients, a father and his 12-year-old daughter, diagnosed clinically and using laboratory measures with acromegaly-gigantism. Both underwent transsphenoidal hypophyseal surgery for macroadenomas. We initially detected a novel heterozygous germline AIP mutation, c.836G>A (p.W279*), in the father's DNA. We then found the same mutation in his affected daughter. Pituitary adenomas associated with AIP mutations mostly present as FIPA (68%) at an early age (78% occur at <30 years old). They are often growth hormone (GH) - or prolactin - secreting macroadenomas (88%) that have already extended beyond the sella at the time of diagnosis. Acromegalic cases are resistant to somatostatin analogues and multimodal management is frequently essential to control the disease. Our patients had normalized GH/IGF-1 values soon after surgery, although enough time may not have elapsed to reach final cure. While penetrance of the disease can be as low as 10% in FIPA, especially children and young patients with somatotropinoma and prolactinoma should be surveyed for inactivating mutations or deletions in AIP. Determining the causative mutations may be of assistance in early diagnosis, treatment success, and genetic counseling.

  7. EFFECT OF PREOPERATIVE USE OF LONG-ACTING OCTREOTIDE ON GROWTH HORMONE SECRETING PITUITARY ADENOMA AND TRANSSPHENOIDAL SURGERY

    Institute of Scientific and Technical Information of China (English)

    Jian Yin; Chang-bao Su; Zhi-qin Xu; Yi Yang; Wen-bin Ma; Wei Tao; Zhong Yang; Xue-wei Xia

    2005-01-01

    Objective To investigate whether somatostatin analog octreotide long acting release (LAR) shrinks growth hormone (GH) secreting adenomas, and improves the results of subsequent transsphenoidal surgery.Methods Seventeen previously untreated active acromegalic patients with pituitary adenomas were treated with LAR (30 mg intramuscular injection every 28 days) for 3 months prior to transsphenoidal surgery. Clinical reaction, mean GH secretion, and tumor volume were measured under basal conditions and after LAR treatment.Results Presurgical treatment improved acromegaly symptoms and induced a significant reduction of GH under the 5 ng/mL limit in microadenoma (P < 0.05), while only 18.2% (2/11) in macroadenoma. Meanwhile, tumor shrinkage occurred in 58.8% (10/17) patients, with 1 case in the microadenoma group. All marked shrinkage (> 25%) occurred in the macroadenoma group. Statistical analysis showed tumor shrinkage caused by LAR was greater in macroadenoma group than that in microadenoma group (P < 0.05). During operation, adenoma was soft in 15 cases, with the exception of 2cases in which the soft rumor was divided by fibrous septa, but all tumor removal was smooth.Conclusions A short term administration of preoperative LAR may induce a significant decrease in GH-secretion level and adenoma volume. Presurgical use of octreotide LAR improves surgical results especially in macroadenomas.

  8. ZAC1 and SSTR2 are downregulated in non-functioning pituitary adenomas but not in somatotropinomas.

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    Leonardo Vieria Neto

    Full Text Available INTRODUCTION: There are few data regarding ZAC1 expression in clinically non-functioning pituitary adenomas (NFPA. Because somatotropinomas and NFPA behave differently with respect to tumor shrinkage during somatostatin analogs (SA therapy, we sought to compare the ZAC1 and somatostatin receptor (sstr types 1, 2, 3 and 5 mRNA expression in these two pituitary adenoma subtypes and in normal human pituitaries. METHODS: ZAC1 and SSTR mRNA expression levels were evaluated using real-time RT-PCR (TaqMan in 20 NFPA and compared with the expression levels in 23 somatotropinomas and five normal pituitaries. The NFPA invasiveness was evaluated using magnetic resonance imaging with Hardy's modified criteria. Ki-67 and p53 were evaluated using immunohistochemistry. RESULTS: A total of 20 patients with NFPA [6 males, median age 56 years (range: 30-78], 23 with acromegaly [12 males, median age 43 years (range: 24-57] and five normal pituitaries [4 males, median age 48 years (range: 36-54] were included. Four of the patients (20% had Hardy's grade 2 tumors; all of the others had Hardy's grade 3 tumors. The Ki-67 median expression was 2.35 (range: 0.2-9.23, and only four of the tumors (20% were positive for p53. The ZAC1 mRNA expression was significantly lower in NFPA than in somatotropinomas and in normal pituitaries (p<0.001 for both, as well as the SSTR2 (p=0.001 and 0.01, respectively. The SSTR3 expression was higher in the NFPA than in the somatotropinomas and in the normal pituitaries (p=0.03 and 0.02, respectively. No correlation was found between the ZAC1 mRNA expression and the tumor invasiveness, Ki-67 and p53. CONCLUSION: ZAC1 and SSTR2 are underexpressed and SSTR3 is overexpressed in NFPA compared to those in somatotropinomas and in normal pituitaries, which might explain the lack of tumor shrinkage that is observed in response to commercially available SA therapy in patients with NFPA.

  9. Endoscopic Versus Microscopic Transsphenoidal Approach for Pituitary Adenomas: Comparison of Outcomes During the Transition of Methods of a Single Surgeon.

    Science.gov (United States)

    Eseonu, Chikezie I; ReFaey, Karim; Rincon-Torroella, Jordina; Garcia, Oscar; Wand, Gary S; Salvatori, Roberto; Quinones-Hinojosa, Alfredo

    2017-01-01

    The transition from microscopic to fully endoscopic transsphenoidal surgery requires a surgeon to assess how the change in technique will affect the extent of tumor resection (EOR), outcomes, and complications. We compared a single surgeon's experience transitioning from one technique to the other and examined the operative outcomes and EOR between microscopic versus endoscopic transsphenoidal surgery. Retrospective data analysis of adult patients who were treated surgically for a pituitary adenoma between August 2005 and May 2015 by a single neurosurgeon, who was originally trained and practiced in the microscopic transsphenoidal approach. Patient demographics, perioperative conditions, tumor characteristics, operative times, volumetric EOR, postoperative outcome, and the endoscopic learning curve were evaluated. One hundred and nine patients underwent microscopic transsphenoidal surgery and 275 patients underwent a fully endoscopic approach. The patient characteristics were similar in the 2 groups. Operative room time was significantly shorter in the endoscopic group than in the microscopic group (180.2 vs. 215.6 minutes; P microscopic groups had similar volumetric EOR (85.1% vs. 82.8%; P = 0.371) as well as residual tumor volume (1.06 cm(3) vs. 1.15 cm(3); P = 0.765). The mean length of hospital stay was 2.4 days in the endoscopic group and 3.2 days in the microscopic group (P = 0.03). During the transition from the microscopic to the endoscopic approach, similar surgical outcomes and EOR were achieved in the 2 cohorts. In our experience, the endoscopic approach offers the advantage of shorter operative times and lengths of hospital stays after the surgeon has developed more experience with the technique. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. PITUITARY ADENOMA- VISUAL FIELDS, RETINAL NERVE FIBRE LAYER AND GANGLION CELL-INNER PLEXIFORM LAYER THICKNESS ANALYSIS- A CORRELATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Jyoti Shetty

    2017-07-01

    Full Text Available BACKGROUND Pituitary adenoma is a benign and most common tumour of the pituitary gland. It is also the most common parachiasmal tumour and accounts for approximately 10-15% of primary intracranial neoplasms. It has an annual incidence rate of 0.8–8 per 1,00,000 population. Pituitary adenomas are classified as functional and non-functional based on their hormonal activity. Functional adenomas are usually detected earlier due to clinical manifestations produced by excess of hormones. The aim of the study is to analyse visual acuity, visual fields, RNFL thickness and GCIPL thickness on optical coherence tomography (OCT and to find a correlation between these parameters and tumour volume in patients diagnosed with pituitary adenoma. MATERIALS AND METHODS 48 patients diagnosed with pituitary adenoma confirmed by MRI scan underwent complete ophthalmic evaluation (visual acuity, slit-lamp examination, fundus evaluation, perimetry using 30-2 SITA FAST strategy, (Humphrey Field Analyzer; Carl-Zeiss Meditec, Dublin, CA, and OCT of disc (for retinal nerve fibre layer- RNFL thickness and macula (for ganglion cell-inner plexiform layer (GCIPL thickness using Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA at Bangalore West Lions Super Speciality Eye Hospital, between June 2014 to June 2016. Various parameters like Mean Deviation (MD, Pattern Standard Deviation (PSD and RNFL and GCIPL thickness on OCT were analysed and correlated with each other. RESULTS Mean tumour volume in patients was 12.26 ± 15.8 cm3 . Most of the patients had visual acuity 6/18 or better. Bitemporal hemianopia was seen in only 5 (12.2% patients. Superotemporal quadrantanopia, arcuate defects, tubular fields and homonymous hemianopia were the other field defects seen. Total and pattern deviation plot of visual fields correlated well with tumour volume and visual acuity. On visual field analysis, the MD (-8.18 ± 8.65 dB was depressed compared to the control group (-2.0 ± 1.8 dB, and

  11. 3D volumetry comparison using 3T magnetic resonance imaging between normal and adenoma-containing pituitary glands

    Directory of Open Access Journals (Sweden)

    Ernesto Roldan-Valadez

    2011-01-01

    Full Text Available Background: Computed-assisted three-dimensional data (3D allows for an accurate evaluation of volumes compared with traditional measurements. Aims: An in vitro method comparison between geometric volume and 3D volumetry to obtain reference data for pituitary volumes in normal pituitary glands (PGs and PGs containing adenomas. Design: Prospective, transverse, analytical study. Materials and Methods: Forty-eight subjects underwent brain magnetic resonance imaging (MRI with 3D sequencing for computer-aided volumetry. PG phantom volumes by both methods were compared. Using the best volumetric method, volumes of normal PGs and PGs with adenoma were compared. Statistical analysis used the Bland-Altman method, t-statistics, effect size and linear regression analysis. Results: Method comparison between 3D volumetry and geometric volume revealed a lower bias and precision for 3D volumetry. A total of 27 patients exhibited normal PGs (mean age, 42.07 ± 16.17 years, although length, height, width, geometric volume and 3D volumetry were greater in women than in men. A total of 21 patients exhibited adenomas (mean age 39.62 ± 10.79 years, and length, height, width, geometric volume and 3D volumetry were greater in men than in women, with significant volumetric differences. Age did not influence pituitary volumes on linear regression analysis. Conclusions: Results from the present study showed that 3D volumetry was more accurate than the geometric method. In addition, the upper normal limits of PGs overlapped with lower volume limits during early stage microadenomas.

  12. Effects of low-dose ionising radiation on pituitary adenoma: is there a role for L-type calcium channel?

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    Marcella Araugio Soares

    2005-10-01

    Full Text Available Pituitary adenomas constitute about 6-18% of brain tumours in adults. Activation of voltage gated calcium currents can account for growth hormone oversecretion in some GH-secreting pituitary adenomas that produce an acromegaly appearance and increase mortality. Ca2+ ions, as mediators of intracellular signalling, are crucial for the development of apoptosis. However, the role of [Ca2+] in the development of apoptosis is ambiguous. In this study, the effects of low-dose ionising gamma radiation (60Co on rat pituitary adenoma cells survival and proliferation and the role of calcium channels on the apoptosis radio-induced were evaluated. Doses as low as 3 Gy were found to inhibit GH3 cell proliferation. Even though there was a significant number of live cells,168 hours following irradiation, they were not able to proliferate. The results indicate that the blockade of extracellular calcium influx through these channels does not interfere in the radiation-induced apoptosis in GH3 cells.Adenomas de pituitária constituem cerca de 6-18% dos tumores cerebrais em adultos. A ativação de correntes de cálcio dependentes de voltagem podem levar à super-excreção de hormônio do crescimento produzindo acromegalia e aumentando a mortalidade. Íons Ca2+ como mediadores de sinalização intracelular são cruciais no desenvolvimento da apoptose. No entanto, o papel da [Ca 2+] no desenvolvimento da apoptose é ambíguo. Neste estudo nós avaliamos os efeitos de baixas doses de radiação gama (60Co na sobrevivência e proliferação de células de adenoma de pituitária de rato e o papel do cálcio na apoptose radio-induzida. Nossos resultados mostraram que a dose de 3Gy foi suficiente para inibir a proliferação das células GH3. Apesar de existir um número significativo de células vivas após 168 horas do tratamento com radiação, elas não estavam aptas a proliferar. Nossos resultados também indicaram que bloqueio do influxo de cálcio extracelular n

  13. Fatal hemorrhage following trans--sphenoidal resection of a pituitary adenoma: a case report and review of the literature.

    Science.gov (United States)

    Kepron, C; Cusimano, M; Pollanen, M S

    2010-12-01

    A 58-year-old woman with acromegaly developed massive epistaxis 7 days following trans-sphenoidal resection of a growth hormone-secreting pituitary adenoma. At autopsy, it was determined that the source of the hemorrhage was a rupture of the intracavernous segment of the internal carotid artery secondary to a bacterial arteritis. We describe the gross dissection and histologic examination undertaken in this unusual case, discuss the possible etiology of the infection and review the potential complications of this surgical approach with a view to improving forensic examination of these patients.

  14. Resection of large invasive pituitary adenomas with individualized approach under neuronavigator guidance:a report of 17 cases

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    Jing-min CHENG

    2011-05-01

    Full Text Available Objective To explore the operative method and therapeutic efficacy of surgical resection of large invasive pituitary adenomas with individualized approach under neuronavigator guidance.Methods Seventeen patients(10 males and 7 females,aged from 22 to 78 years with a mean of 39.2±9.2 years suffering from large invasive pituitary adenoma of higher than Hardy IV grade hospitalized from 2004 to 2009 were involved in the present study.All procedures were performed with the assistance of neuronavigator via individualized pterion approach,subfrontal extradural approach,trans-sphenoidal approach,or combined approach.The dispersedly invasive pituitary adenomas were resected under the guidance of neuronavigator by fully utilizing the natural anatomical cleavages.All the patients received follow-up CT scanning 3 days after operation,MRI scanning 1 to 3 months after operation,and clinical follow-up ranged from 6 to 72 months.The resection extent and outcome were assessed by imaging examination and clinical results.Results Total tumor removal was achieved in 15 cases,subtotal removal in 1 case,and extensive partial removal in 1 case.The visual impairment and headache were ameliorated in most cases,but in 1 patient they were worsened.Transient diabetes insipidus occurred in 8 cases,electrolyte disturbances were observed in 2 cases,leakage of cerebrospinal fluid appeared in 2 cases,hyposmia in 2 cases,visual impairment aggravated in 1 case,oculomotor nerve and abducens nerve paralysis on the operative side in 1 case,epidural hematoma in occipital and parietal regions in 1 case.No patient died during the follow-up period.Conclusions Individualized surgical approach designed according to the growth direction of tumor under neuronavigator guidance is helpful for the operators to identify the vessels and nerves in the operative field distinctly during the operation,thus the total removal rate is improved,safely of the operation to remove large invasive pituitary

  15. Reproductive Function in Patients with Non-functioning Pituitary Adenoma According to the Register of the Republic of Uzbekistan

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    Dinara A. Alieva

    2016-06-01

    Full Text Available The main aim of our study was to evaluate the reproductive system status and gonadotropic pituitary function in patients with non-functioning pituitary adenoma (NFPA according to the register data. Depending on the state of the reproductive system at the time of NFPA diagnosis, men and women can be classified into three groups: secondary hypogonadism (40.7%; normal state of the sexual system (22.0%; and PCOS in women (36.5% and reduced testicular size in men (11.2%. Menstrual irregularities took place in 77.8% NFPA women of reproductive age (41.3% of them had galactorea-oligo/amenorrhea combined with moderate hyperprolactinemia, and sexual dysfunction occurred in 42.0% of male patients with NFPA.

  16. Clinical application of [sup 11]C-NMSP to the patients with pituitary adenoma other than prolactinoma

    Energy Technology Data Exchange (ETDEWEB)

    Momose, Toshimitsu; Teramoto, Akira; Nishikawa, Junichi; Inoue, Yusuke; Watanabe, Toshiaki; Sasaki, Yasuhito (Tokyo Univ. (Japan). Faculty of Medicine)

    1993-06-01

    The existence of dopamine D[sub 2] receptors in the pituitary adenoma (PA) is an important factor for bromocriptine therapy. In order to evaluate the D[sub 2] receptors in PA, [sup 11]C-N-methylspiperone (NMSP) and positron emission tomography was performed in a variety of pituitary adenomas other than prolactinoma. Eight patients with PA including four non-functioning adenomas, two growth hormone (GH) secreting adenomas, one adrenocorticotrophic hormone (ACTH) secreting adenoma and one thyroid stimulating hormone (TSH) secreting adenoma and ten normal healthy volunteers were examined. Seventy hundred and forty MBq of [sup 11]C-NMSP was injected and dynamic scan was performed from the time of injection to 80 min postinjection. The time dependent regional radioactivity in the striatum (st) and in the tumor tissue (tm) was measured and the binding rate, [alpha], was calculated according to the following equation: Cst, tm/Ccbl=[alpha]x[integral][sub 0][sup t]Ccbl dt/Ccbl+1. The ratio of total radioactivity in the striatum or tumor over total activity in the cerebellum was plotted versus 'normalized time', which was obtained by dividing integrated cerebellar radioactivity by actual cerebellar radioactivity for each timepoint. In three patients with PA, two scans were performed before and three hours after oral intake of 2.5 mg of bromocriptine. The [alpha] values for PA and normal striatum were 0.031[+-]0.023 (0.017-0.088) and 0.042[+-]0.006 (0.034-0.049), respectively. Bromocriptine reduced [alpha] value to various degree in PA (13-56%) but not in striatum (-3.7-3.3%). Our data suggest that in some of PA other than prolactinoma, dopamine D[sub 2] receptors existed but that nonspecific binding also contributed to the radioactivity in the tumor tissue. And it also supports the idea that in PA, bromocriptine directly combines with D[sub 2] receptor but in striatum, it might affect receptors other than D[sub 2] receptor itself. (author).

  17. 垂体腺瘤的综合治疗进展%Advances in the comprehensive treatment of pituitary adenomas

    Institute of Scientific and Technical Information of China (English)

    陈子金; 张刚利

    2016-01-01

    Pituitary adenoma,which originates from the pituitary gland,is a common tumor of the nervous and endocrine system,accounting for about 8% to 15% of the brain tumor.The peak incidence of pituitary tumor is 30 to 60 years old.Most of them show slow and limited growth,but 30% to 40% of them show aggressive growth.Surgical treatment has been the first choice so far(except for the prolactinoma),and at present,the domestic scholars advocate that the whole tumor should be cut as far as possible in the case of the most important structure,and carries on the comprehensive treatment.In this study,the comprehensive treatment of pituitary adenomas has been reviewed.%垂体腺瘤起源于腺垂体的细胞,是神经和内分泌系统的常见肿瘤,约占颅内肿瘤的8%~15%。30~60岁是垂体瘤的发病高峰期。大部分呈缓慢、局限性生长,但有30%~40%呈侵袭性生长。手术治疗是目前首选方法(泌乳素瘤除外),目前国内学者多主张在最大程度保护周围重要结构的情况下尽可能全切肿瘤,并进行综合治疗。本研究对垂体腺瘤的综合治疗进展进行综述。

  18. Intra and latero-sellar carotid aneurysm mimicking a pituitary adenoma

    African Journals Online (AJOL)

    ... ago, without functional signs of anterior pituitary deficiency or signs of intracranial ... Hypothalamic-pituitary magnetic resonance imaging (MRI) shows a round ... The magnetic resonance angiography is in favor of an unruptured aneurysm ...

  19. Effect of treatment modality on the hypothalamic-pituitary function of patients treated with radiation therapy for pituitary adenomas: Hypothalamic dose and endocrine outcomes.

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    Andrew eElson

    2014-04-01

    Full Text Available Background: Both fractionated external beam radiotherapy and single fraction radiosurgery for pituitary adenomas are associated with the risk of hypothalamic-pituitary (HP axis dysfunction.Objective: To analyze the effect of treatment modality (Linac, TomoTherapy, or Gamma Knife on hypothalamic dose and correlate these with HP-Axis deficits after radiotherapy.Methods:Radiation plans of patients treated postoperatively for pituitary adenomas using Linac-based 3D Conformal Radiotherapy (CRT (n=11, TomoTherapy-based Intensity Modulated Radiation Therapy (IMRT (n=10, or Gamma Knife Stereotactic Radiosurgery (SRS(n=12 were retrospectively reviewed. Dose to the hypothalamus was analyzed and postradiotherapy hormone function including growth hormone (GH, thyroid (TSH, adrenal (ACTH, prolactin (PRL, and gonadotropins (FSH/LH were assessed. Results:Post-radiation, 13 of 27 (48% patients eligible for analysis developed at least one new hormone deficit, of which 8 of 11 (72% occurred in the Linac group, 4 of 8 (50% occurred in the TomoTherapy group, and 1 of 8 (12.5% occurred in the Gamma Knife group. Compared with fractionated techniques, Gamma Knife showed improved hypothalamic sparing for DMax Hypo, and V12Gy. For fractionated modalities, TomoTherapy showed improved dosimetric characteristics over Linac-based treatment with hypothalamic DMean (44.8 Gy vs. 26.8 Gy p=0.02, DMax (49.8 Gy vs. 39.1 Gy p=0.04, and V12Gy (100% vs. 76% p=0.004.Conclusion:Maximal dosimetric avoidance of the hypothalamus was achieved using Gamma Knife-based radiosurgery followed by TomoTherapy-based IMRT, and Linac-based 3D conformal radiation therapy, respectively.

  20. Ectopic ACTH-secreting pituitary adenoma of the sphenoid sinus: case report of endoscopic endonasal resection and systematic review of the literature.

    Science.gov (United States)

    Seltzer, Justin; Lucas, Joshua; Commins, Deborah; Lerner, Olga; Lerner, Alexander; Carmichael, John D; Zada, Gabriel

    2015-02-01

    Ectopic pituitary adenomas are exceedingly rare entities that are often misdiagnosed. The resulting delay in diagnosis may be particularly concerning in the case of Cushing syndrome caused by an ectopic adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma. Although the total resection of ectopic adenomas results in rapid and durable remission, persistent Cushing syndrome is often associated with permanently damaging invasive procedures and significantly higher risk of mortality. The authors report the case of a 48-year-old man with ACTH-dependent Cushing syndrome. On the morning before surgery, his serum cortisol measured 51 μg/dl, his ACTH level was 195.7 pg/ml, and his urinary free cortisol level was 2109 μg/day. Serum cortisol was not suppressed with the administration of high-dose dexamethasone. Imaging showed separate masses in both the sphenoid sinus and the pituitary gland, complicating the diagnostic process and requiring pathological assessment of both masses. No other abnormalities were found on thoracic, abdominal, or pelvic scans. Gross-total resection of both lesions was accomplished via an endoscopic endonasal transsphenoidal approach. Pathology confirmed an ectopic ACTH pituitary adenoma of the sphenoid sinus and a Crooke hyaline change of the pituitary gland. The patient achieved stable hormonal remission without significant postoperative complications, returned to full activity within 3 months, and remained disease free nearly 1 year after tumor resection. In a systematic literature review, the authors identified 41 cases of ectopic ACTH-secreting pituitary adenomas, including 18 arising in the sphenoid sinus without direct involvement of the sella. Including the case described here, the total number of ectopic ACTH pituitary adenomas arising in the sphenoid sinus was 19, and the total number of ectopic ACTH pituitary adenomas without regard to location was 42. For the 19 patients with adenomas found in the sphenoid sinus, ages ranged

  1. Prevalence and incidence of pituitary adenomas: a population based study in Malta.

    Science.gov (United States)

    Gruppetta, Mark; Mercieca, Cecilia; Vassallo, Josanne

    2013-12-01

    Epidemiological data is important to correctly quantify the extent of disease and needed health care resources. The aim of the study was to establish the prevalence and incidence of pituitary adenomas (PAs) in the same well defined population, with in-depth analysis of the various subtypes. The design involved a retrospective cross-sectional analysis of PA patients diagnosed prior to 31 July 2011 for prevalence estimates and those diagnosed between July 2000 and July 2011 for incidence estimation. A thorough search for patients with PAs was carried out in central hospital registries including outpatients departments, surgical registries, radiological department and specialty clinic databases. Prevalence rates/100,000 and Standardised incidence ratios (SIR)/100,000/year were worked out. The respective prevalence rates and SIR for PAs overall were 75.7/100,000, and 4.27/100,000/year, for Prolactinomas 35.0/100,000 and 2.05/100,000/year, for nonfunctioning PA 25.9/100,000 and 1.79/100,000/year and for GH-secreting PAs 12.5/100,000 and 0.31/100,000/year. The overall prevalence for macroadenomas was 32.8/100,000 and SIR was 1.49/100,000/year. The prevalence rate in males for PAs overall was 46.3/100,000 and SIR was 2.08/100,000/year and in females 104.8/100,000 and SIR was 6.58/100,000/year. Females had a lower proportion of macroadenomas than males (29.5 vs. 75.0%; P < 0.001) and macroadenomas tended to present at a later age compared to microadenomas (48 vs. 34.5; P < 0.001). The highest SIR was reached in the 30-39 age group at 7.42/100,000/year. Our data confirm the considerable disease burden that PAs bear on health care resources. Males and females have similar prevalence and SIR rates for macroadenomas but there is a significant increase in SIR in females of child bearing age compared to males. These observations may have important implications in terms of the economic burden and need for early intervention.

  2. Comparative evaluation of several parameters of glycemic homeostasis in patients with functional pituitary adenomas

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    Miroslava Rostislavovna Mikityuk

    2014-03-01

    Full Text Available Aim. To investigate glycemic homeostasis in patients with acromegaly and hyperprolactinaemia due to functional pituitary adenoma.Materials and Methods. We enrolled 48 patients with somatotropinoma (Group 1, 19 patients with somatomammotropinoma (Group 2 and 24 patients with prolactinoma (Group 3 with no history of glycemic disorders. Median age was 48.63±9.98 years; median disease duration was 13.1±6.9 years. The comparison group was composed of overweight or obese patients (n=75. We conducted a comparative analysis of glycemic parameters (Glc0, immunoreactive insulin, HOMA2_S%, HOMA2_B% и HOMA2_IR, Ssum and S under isolated segments of the glycemic curve. We also tested their correlation with plasma levels of growth hormone, prolactin and IGF-1.Results. We detected hyperinsulinemia (>20 μU/mL in 35.1% of participants from Group 1, 33.3% and 25% from groups 2 and 3, respectively. There was no statistically significant difference between glycemic parameters of the study groups, though patients were mildly insulin resistant (HOMA2_IR 1.88 to 2.38 units independantly from tumour secretory activity. Groups 1 and 2 were characterized by significantly higher fasting blood glucose levels vs. comparison group (though still within the reference values, and glucose homeostasis was maintained with lower activity of pancreatic β-cells. Average Ssumanalysis showed lower glucose tolerance in groups 1 and 2 vs. Group 3. Median S values under isolated glycemic curve segments were significantly higher than in comparison group. Plasma levels of growth hormone did not correlate with Ssum and S parameters in groups 1 and 2. There was a linear correlation between Ssum and plasma IGF-1 levels in patients from Group 1 (r=0.45; p=0.006. We also noted that Ssum had a non-linear correlation with plasma prolactin levels in patients from Group 3 (r=0.41; p<0.05.Conclusion. Postprandial area under the glycemic curve has positive linear association with

  3. A patient with recurrent hypercortisolism after removal of an ACTH-secreting pituitary adenoma due to an adrenal macronodule.

    Science.gov (United States)

    Timmers, H J L M; van Ginneken, E M; Wesseling, P; Sweep, C G J; Hermus, A R M M

    2006-11-01

    A 41-yr-old female was referred for signs and symptoms of Cushing's syndrome. Cortisol was not suppressed by 1 mg dexamethasone (0.41 micromol/l). Midnight cortisol and ACTH were 0.44 micromol/l and 18 pmol/l, respectively. Urinary cortisol excretion was 250 nmol/24 h (normal between 30 and 150 nmol/24 h). A magnetic resonance imaging (MRI) revealed a pituitary lesion of 7 mm. ACTH and cortisol levels were unaltered by administration of human CRH and high-dose dexamethasone. Inferior sinus petrosus sampling showed CRH-stimulated ACTH levels of 128.4 (left sinus) vs a peripheral level of 19.2 pmol/l, indicating Cushing's disease. After 4 months of pre-treatment with metyrapone and dexamethasone, endoscopic transsphenoidal resection of an ACTH-positive pituitary adenoma was performed. ACTH levels decreased to 2.6 pmol/l and fasting cortisol was 0.35 micromol/l. Despite clinical regression of Cushing's syndrome and normalization of urinary cortisol, cortisol was not suppressed by 1 mg dexamethasone (0.30 micromol/l). Ten months post-operatively, signs and symptoms of Cushing's syndrome reoccurred. A high dose dexamethasone test according to Liddle resulted in undetectable ACTH, but no suppression of cortisol levels, pointing towards adrenal-dependent Cushing's syndrome. Computed tomography (CT)-scanning showed a left-sided adrenal macronodule. Laparoscopic left adrenalectomy revealed a cortical macronodule (3.5 cm) surrounded by micronodular hyperplasia. Fasting cortisol had decreased to 0.02 micromol/l. Glucocorticoid suppletion was started and tapered over 12 months. Symptoms and signs of hypercortisolism gradually disappeared. This case illustrates, that longstanding ACTH stimulation by a pituitary adenoma can induce unilateral macronodular adrenal hyperplasia with autonomous cortisol production.

  4. Analysis of complications of transsphenoidal surgery for pituitary adenomas%经蝶窦入路垂体腺瘤手术并发症分析

    Institute of Scientific and Technical Information of China (English)

    刘爱贤; 张文毅; 郭辉; 林贵军

    2011-01-01

    Objective To analyze the complications of transsphenoidal operation for pituitary adenomas.Method Postoperative complications of 323 patients underwent transphenoidal surgery for pituitary adenoma between January 2001 and December 2009 in our department were retrospectively reviewed.Results Insipidus was the most common complication after the operation with the incidence of 52%.The other complications were visual deterioration( 2%), cerebrospinal fluid rhinorrhea( 6%),intracranial infection ( 3%), pituitary insufficiency( 2.4%), pituitary articulo ( 0.6%).Conclusions Better understanding of the indications for transsphenoidal surgery and familiarity with the regional anatomy should further lower the rates of death and complications.Skill surgical technique and clinical experience are also very important to improve the therapeutic efficacy.%目的 分析单鼻孔蝶窦入路并结合神经内镜切除垂体腺瘤的手术并发症.方法 回顾性分析经蝶窦切除垂体腺瘤323例患者的术后并发症.结果 本组尿崩症病例发生率为52%,脑脊液漏19例(6%),迟发2例,2例行手术修补.颅内感染发生率3%(11例),其中1例因感染反复发作死亡.垂体功能低下8例,有2例患者因为感染和饮食不佳出现垂体危象,视力减退发生率2%(6例).结论 熟悉手术局部解剖,把握手术适应证,熟练掌握手术技能、不断总结临床实践经验,才能降低手术并发症和病死率,提高治疗效果.

  5. Gonadotropin-secreting pituitary adenoma with concomitant hypersecretion of testosterone and elevated sperm count. Treatment with LRH agonist.

    Science.gov (United States)

    Zárate, A; Fonseca, M E; Mason, M; Tapia, R; Miranda, R; Kovacs, K; Schally, A V

    1986-09-01

    Hypersecretion of both FSH and LH was demonstrated in a man with pituitary macroadenoma, who also presented elevated levels of blood testosterone and an increased sperm count. The patient underwent transsphenoidal surgery followed immediately by cranial irradiation. Immunocytochemical analysis of the tumour revealed the presence of FSH, LH, TSH and the alpha-subunit. Gel chromatography of the serum on Sephadex G-100 revealed immunoactive FSH, LH and the alpha-subunit which coeluted with the labelled standards of corresponding hormones. Blood levels of both gonadotropins and testosterone remained persistently elevated up to one year following surgical decompression of the tumour and radiotherapy. It was decided to treat this patient with sc administration of 100 micrograms D-Trp6-LRH biweekly. After 20 weeks, LRH-analogue treatment resulted in the reduction of serum FSH and LH levels and a diminishing in tumour size as assessed by computed tomography scan of the pituitary. This report shows that in a patient with clinically and biochemically documented gonadotropin-secreting adenoma, inducing a state of persistent gonadal hyperfunction, pituitary surgery and cranial irradiation failed to normalize the biochemical abnormality; however, therapy with D-Trp6-LRH agonist induced clinical, biochemical and radiologic improvement.

  6. Pituitary tumors containing cholecystokinin

    DEFF Research Database (Denmark)

    Rehfeld, J F; Lindholm, J; Andersen, B N

    1987-01-01

    We found small amounts of cholecystokinin in the normal human adenohypophysis and therefore examined pituitary tumors from 87 patients with acromegaly, Cushing's disease, Nelson's syndrome, prolactinoma, or inactive pituitary adenomas. Five adenomas associated with Nelson's syndrome contained...

  7. Temozolomide treatment in aggressive pituitary tumors and pituitary carcinomas: a French multicenter experience.

    Science.gov (United States)

    Raverot, Gérald; Sturm, Nathalie; de Fraipont, Florence; Muller, Marie; Salenave, Sylvie; Caron, Philippe; Chabre, Olivier; Chanson, Philippe; Cortet-Rudelli, Christine; Assaker, Richard; Dufour, Henry; Gaillard, Stephan; François, Patrick; Jouanneau, Emmanuel; Passagia, Jean-Guy; Bernier, Michèle; Cornélius, Aurélie; Figarella-Branger, Dominique; Trouillas, Jacqueline; Borson-Chazot, Françoise; Brue, Thierry

    2010-10-01

    To date only 18 patients with aggressive pituitary tumors or carcinomas treated with temozolomide have been reported. Increased expression of O6-methylguanine-DNA-methyltranferase (MGMT) has been suggested to predict resistance to temozolomide. The objective of the study was to describe the antitumoral efficacy and toxicity of temozolomide in patients with aggressive pituitary tumors or carcinomas and evaluate the possible prognostic value of MGMT promoter methylation and protein expression. Eight patients, five with pituitary carcinomas (three prolactin (PRL) and two ACTH) and three with aggressive pituitary tumors (one PRL and two ACTH), all treated with temozolomide administered orally for four to 24 cycles, were included in our French multicenter study. MGMT expression was assessed by immunohistochemistry and MGMT promoter methylation by pyrosequencing. Three of the eight patients (two ACTH adenomas and one PRL carcinoma) responded to temozolomide as demonstrated by significant tumor shrinkage and reduced hormone secretion. Three cycles of temozolomide were sufficient to identify treatment-responsive patients. Additional cycles did not improve treatment efficacy in those not responding, even when associated with carboplatin and vepeside. MGMT expression did not predict tumoral response to temozolomide because it was positive in one responder and negative in two nonresponders. Similarly, MGMT promoter methylation (three of seven tumors) did not predict clinical response. Toxicity remained mild in all patients. Temozolomide treatment may be an effective option for some aggressive pituitary tumors or carcinomas. Response to a trial of three cycles of treatment seems sufficient to identify responders and more reliable than patient MGMT status.

  8. Lack of Ubiquitin Specific Protease 8 (USP8) Mutations in Canine Corticotroph Pituitary Adenomas

    NARCIS (Netherlands)

    Sbiera, Silviu; Tryfonidou, Marianna A; Weigand, Isabel; Grinwis, Guy C M; Broeckx, Bart; Herterich, Sabine; Allolio, Bruno; Deutschbein, Timo; Fassnacht, Martin; Meij, Björn P

    2016-01-01

    PURPOSE: Cushing's disease (CD), also known as pituitary-dependent hyperadrenocorticism, is caused by adrenocorticotropic hormone (ACTH)-secreting pituitary tumours. Affected humans and dogs have similar clinical manifestations, however, the incidence of the canine disease is thousand-fold higher. T

  9. Increased micronucleus, nucleoplasmic bridge, nuclear bud frequency and oxidative DNA damage associated with prolactin levels and pituitary adenoma diameters in patients with prolactinoma.

    Science.gov (United States)

    Bitgen, N; Donmez-Altuntas, H; Bayram, F; Cakir, I; Hamurcu, Z; Diri, H; Baskol, G; Senol, S; Durak, A C

    2016-01-01

    Prolactinoma is the most common pituitary tumor. Most pituitary tumors are benign, but they often are clinically significant. We investigated cytokinesis-block micronucleus cytome (CBMN cyt) assay parameters and oxidative DNA damage in patients with prolactinoma to assess the relations among age, prolactin level, pituitary adenoma diameter and 8-hydroxy-2'-deoxyguanosine (8-OHdG) level in patients with prolactinoma. We investigated 27 patients diagnosed with prolactinoma and 20 age- and sex-matched healthy controls. We measured CBMN cyt parameters and plasma 8-OHdG levels in peripheral blood lymphocytes of patients with prolactinoma and controls. The frequencies of micronucleus (MN), nucleoplasmic bridge, nuclear bud, apoptotic and necrotic cells, and plasma 8-OHdG levels in patients with prolactinoma were significantly greater than controls. MN frequency was correlated positively with age, prolactin levels and pituitary adenoma diameters in patients with prolactinoma. The increased chromosomal and oxidative DNA damage, and the positive correlation between MN frequency, prolactin levels and pituitary adenoma diameters may be associated with increased risk of cancer in patients with prolactinoma, because increased MN frequency is a predictor of cancer risk.

  10. In vivo detection of somatostatin receptors in patients with functionless pituitary adenomas by means of a radioiodinated analog of somatostatin ((123I)SDZ 204-090)

    Energy Technology Data Exchange (ETDEWEB)

    Faglia, G.; Bazzoni, N.; Spada, A.; Arosio, M.; Ambrosi, B.; Spinelli, F.; Sara, R.; Bonino, C.; Lunghi, F. (Institute of Endocrine Sciences, University of Milan, Ospedale Maggiore IRCCS (Italy))

    1991-10-01

    The recent availability of a Tyr3-substituted octreotide (SDZ 204-090) for radioiodination has allowed somatostatin (SRIH) receptor binding to be studied in vivo, and receptor-positive tumors of different origins to be visualized with a gamma-camera. This prompted us to investigate whether this compound could be used for external imaging of functionless pituitary adenomas displaying SRIH receptors. Eight patients with functionless pituitary adenomas, three patients with acromegaly, and three with macroprolactinoma were injected iv with 123I-labeled Tyr3-octreotide and then scanned with a gamma-camera. Positive scans were obtained in the three acromegalics and in two of the eight patients with functionless pituitary tumors. The patients with macroprolactinoma had negative scans. The diagnosis of functionless pituitary adenomas was confirmed by light and electron microscopic examination as well as immunocytochemical studies. In vitro binding of (125I)Tyr11-SRIH to cell membranes was evaluated in four functionless and three GH-secreting adenomas removed from seven of the patients. All of the GH-secreting as well as one of the four functionless adenomas had high affinity SRIH-binding sites, without differences in number or affinity, whereas SRIH-binding sites were not detected in the others. Positive scans were observed only in patients bearing tumors with high affinity SRIH-binding sites. In conclusion, (123I)Tyr3-octreotide appears to be a promising tool for singling out, in vivo, patients with functionless pituitary tumors displaying SRIH receptors who might potentially benefit from octreotide treatment.

  11. Microadenomas e adenomas hipersecretantes da hipófise, aspectos anátomo-radiológicos Microadenomas and hypersecreting pituitary adenomas: radiographic aspects

    Directory of Open Access Journals (Sweden)

    Jean Lorrain Vezina

    1975-06-01

    Full Text Available São apresentados os primeiros sinais radiográficos de alteração selar encontrados nos casos de adenomas hipofisários hipersecretantes. O achado de duplo contôrno selar e de pequenas bosseladuras com o auxílio da tomografia selar tem permitido o diagnóstico da localização de microadenomas, a partir do que tem sido possível operar os pacientes no estágio inicial, quando o tumor não causou ainda lesões irreversíveis nos tecidos circunjacentes, o que facilita sobremaneira a cirurgia sem lesar o tecido hipofisário sadio, dando maiores possibilidades para o restabelecimento das funções hipofisárias ao normal. É feita uma classificação anátomo-radiológica da sela túrcica em 4 estágios, que é de grande utilidade para o prognóstico cirúrgico pois observa-se a cura em mais de 90% dos casos no estágio 1, de 75% no estágio 2, de 50% no estágio 3 e de menos de 10% no estágio 4, na primeira cirurgia.The early radiographic changes of the sella turcica in the cases of hypersecreting pituitary adenomas (Cushing disease, acromegaly, amenorrhea-galac- torrhea are reported and discussed. The finding of the double contour of the sellar floor and the small crescentic bulging of its antero-inferior wall, with the aid of the tomographic cuts of the sella, has permited the diagnosis of the microadenoma's localization. With this it is possible the achievement of a seletive excision of the lesion in the initial stage, when the tumor has not caused yet irreversible damage to the inside normal pituitary tissue. This surgery is perfomed in the precocious stage with the primary goal to preserve the normal gland, without hurt it to avoid postoperative hipopituitarism. A anatomo-radiologic classification of the alterations sella turcica in 4 grades is made, which is of great utility for the surgical prognostic, since we have observed clinical and biological cure over 90% in the grade 1, 75% in the grade 2, 50% in the grade 3 and up to 10% in the

  12. Single-Cell Phenotypic Characterization of Human Pituitary GHomas and Non-Functioning Adenomas Based on Hormone Content and Calcium Responses to Hypothalamic Releasing Hormones.

    Science.gov (United States)

    Senovilla, Laura; Núñez, Lucía; de Campos, José María; de Luis, Daniel A; Romero, Enrique; García-Sancho, Javier; Villalobos, Carlos

    2015-01-01

    Human pituitary tumors are generally benign adenomas causing considerable morbidity due to excess hormone secretion, hypopituitarism, and other tumor mass effects. Pituitary tumors are highly heterogeneous and difficult to type, often containing mixed cell phenotypes. We have used calcium imaging followed by multiple immunocytochemistry to type growth hormone secreting (GHomas) and non-functioning pituitary adenomas (NFPAs). Individual cells were typed for stored hormones and calcium responses to classic hypothalamic releasing hormones (HRHs). We found that GHomas contained growth hormone cells either lacking responses to HRHs or responding to all four HRHs. However, most GHoma cells were polyhormonal cells responsive to both thyrotropin-releasing hormone (TRH) and GH-releasing hormone. NFPAs were also highly heterogeneous. Some of them contained ACTH cells lacking responses to HRHs or polyhormonal gonadotropes responsive to LHRH and TRH. However, most NFPAs were made of cells storing no hormone and responded only to TRH. These results may provide new insights on the ontogeny of GHomas and NFPAs.

  13. Predictive value of PWI for blood supply and T1-spin echo MRI for consistency of pituitary adenoma

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    Ma, Zengyi; He, Wenqiang; Zhao, Yao; Zhang, Qilin; Li, Shiqi; Wang, Yongfei [Fudan University, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Shanghai (China); Shanghai Pituitary Tumor Center, Shanghai (China); Yuan, Jie; Wu, Yue; Yao, Zhenwei [Fudan University, Department of Radiology, Huashan Hospital, Shanghai Medical College, Shanghai (China); Chen, Hong [Fudan University, Department of Neuropathology, Huashan Hospital, Shanghai Medical College, Shanghai (China)

    2016-01-15

    It is a common view that consistency and blood supply of pituitary adenoma (PA) can influence the surgical effect. The aim of this study was to determine whether MRI signal intensity (SI) was correlated to the consistency or blood supply of pituitary macroadenoma. Forty eight pituitary macroadenoma patients were underwent preoperative MRI, including precontrast and contrast-enhanced (CE) T1-spin echo (T1-SE) imaging, CE-sampling perfection with application-optimized contrasts by using different flip angle evolutions (SPACE) imaging, and perfusion-weighted imaging (PWI). The tumor consistency and blood supply were determined by neurosurgeons. The expression of collagen IV and MIB-1 was detected with immunohistology. The correlation of the relative SI (rSI) values (tumor to normal frontal white matter SI) and PWI data to the tumor consistency, blood supply, and the expression level of collagen IV and MIB-1 was statistically studied by Kruskal-Wallis rank test (K-W test). A significant correlation was observed between the tumor consistency and the rSI on precontrast T1-SE imaging (P = 0.004) but not on CE T1-SE and CE SPACE imaging. The expression of collagen IV was also significantly associated with rSI on T1-SE imaging (P = 0.010). The blood supply was correlated with the relative CBV (rCBV) (P = 0.030). In addition, the expression of MIB-1 was correlated with rSI of CE T1-SE imaging (P = 0.007). Our results suggest that T1-SE imaging may be a simple and useful method for predicting consistency of PA. CBV value can provide helpful information for assessing the blood supply of pituitary macroadenoma. (orig.)

  14. Effects of bromocriptine on CSF proteins and amines in patients with empty sella syndrome, acromegaly and prolactin producing pituitary adenomas.

    Science.gov (United States)

    Brismar, K; Sidén, A; Werner, S

    1981-01-01

    The effect of the dopamine agonist bromocriptine (5-40 mg/day) on cerebrospinal fluid proteins and amines was studied in 7 hyperprolactinemic patients, 4 with empty sella syndrome and 3 patients with pituitary adenoma. Small as well as high doses of bromocriptine depressed the endogenously formed dopamine, noradrenalin and adrenalin. Five patients initially exhibited changes consistent with slight to marked blood-cerebrospinal-fluid (CSF) barrier disturbances and 5 abnormal CSF-protein fractions. One CSF-protein fraction (isolelectric points (pI) approximately 5.3 pH-units) became more prominent during bromocriptine treatment. Analyses of his fraction indicated that it represented a transferrin component. It is stated that bromocriptine treatment besides affecting amine and trace metal metabolism also affects protein metabolism.

  15. [Prognostic implications of folliculo-stellate cells in pituitary adenomas: relationship with tumoral behavior].

    Science.gov (United States)

    Tortosa, F; Pires, M; Ortiz, S

    2016-10-01

    Introduccion. A pesar del progreso en la comprension de su patogenia, no se ha encontrado ningun marcador predictivo independiente del comportamiento agresivo de los adenomas hipofisarios que facilite el tratamiento y seguimiento de pacientes afectados. Objetivo. Analizar la expresion de celulas foliculo-estrelladas, mediante inmunomarcacion con proteina S-100, en una serie de pacientes con adenomas hipofisarios seguidos durante al menos siete años. Pacientes y metodos. Estudio retrospectivo de 51 pacientes diagnosticados de adenoma hipofisario entre 2006 y 2008, segun los criterios vigentes de la Organizacion Mundial de la Salud. Se evaluo inmunohistoquimicamente la expresion de S-100 en celulas foliculo-estrelladas, y se correlaciono con parametros clinicorradiologicos e histopatologicos del tumor y la progresion/recurrencia postoperatoria. Resultados. De 51 tumores, 40 se clasificaron como adenomas hipofisarios tipicos y 11 como atipicos. La mayoria de los tipicos mostro celulas foliculo-estrelladas positivas para S-100 (media: 3,93%); los atipicos tenian pocas o ninguna celula S-100 positivas (media: 0,83%). No hubo diferencias significativas en la expresion de S-100 con respecto a la edad o sexo del paciente, tamaño, invasividad o recidiva tumoral posquirurgica. Conclusiones. En el grupo de estudio, a excepcion de los adenomas no funcionantes inmunopositivos para prolactina, con la media mas baja y mas alta de todos los subtipos en ambos grupos (tipicos, 0,25%, frente a atipicos, 9,24%; p = 0,0028), el factor predictivo de agresividad tumoral para los adenomas hipofisarios no esta representado por un bajo valor de S-100 en las celulas foliculo-estrelladas, lo que no permite seleccionar a pacientes para un tratamiento postoperatorio intensivo.

  16. 溴隐亭治疗垂体泌乳素微腺瘤和大腺瘤的疗效比较%Comparison on curative effect of bromocriptine treating pituitary prolactin micro-adenoma and large adenoma

    Institute of Scientific and Technical Information of China (English)

    吴胜华; 陈景海; 王小青

    2011-01-01

    AIM: To compare bromocriptine in the treatment of pituitary prolactin micro-adenoma and the clinical effect of large adenomas. METHODS: There were sixty cases with pituitary prolactin micro-adenoma and 30 cases with large adenoma. Two groups were orally administered bromocriptine, the amount of night began with 1. 25 mg, increased 1. 25 mg every 3 d, until 2. 5 mg, tid. The serum prolactin and pituitary magnetic resonance were detected beforetreatment and 28 weeks after treatment. RESULTS : The serum prolactin level decreased significantly in the same gender group (P<0. 01) of the two groups after 28 weeks treatment than before treatment. The serum prolactin level in micro-adenoma group returned to normal, while those in large adenoma group both men and women remained above normal. There were significantly differences between the same gender before and after treatment of the prolactin levelin the two groups (P<0. 05). After 28 weeks, prolactin pituitary micro-adenoma cure rate was 16.67%, total effective rate was 75%, while non-pituitary prolactin macro-adenoma group found that the tumor disappeared, the total efficiency was only 46.67%. CONCLUSION: Bro-mocriptine treatment of pituitary prolactin micro-adenoma can return serum prolactin to normal level, pituitary prolactin adenomas shrink oreven disappear; while prolactin macroadenoma should adopt comprehensive treatment model, such as drugs or surgery combined with radiation therapy.%目的:比较溴隐亭治疗脑垂体泌乳素微腺瘤和大腺瘤的临床疗效.方法:脑垂体泌乳素微腺瘤60例;大腺瘤30例.两组均予口服溴隐亭,开始量每晚为1.25 mg,隔3d增加1.25 mg,直到2.5 mg,Tid;在治疗前及治疗后28周分别测定血清泌乳素,同时做脑垂体磁共振.结果:两组治疗28周后血泌乳素值比治疗前同性别组显著下降(P<0.01),微腺瘤组血泌乳素基本恢复正常,但大腺瘤组无论男女,血泌乳素值仍超过正常值,微腺瘤组与大腺瘤组

  17. Lycopene and beta-carotene induce growth inhibition and proapoptotic effects on ACTH-secreting pituitary adenoma cells.

    Directory of Open Access Journals (Sweden)

    Natália F Haddad

    Full Text Available Pituitary adenomas comprise approximately 10-15% of intracranial tumors and result in morbidity associated with altered hormonal patterns, therapy and compression of adjacent sella turcica structures. The use of functional foods containing carotenoids contributes to reduce the risk of chronic diseases such as cancer and vascular disorders. In this study, we evaluated the influence of different concentrations of beta-carotene and lycopene on cell viability, colony formation, cell cycle, apoptosis, hormone secretion, intercellular communication and expression of connexin 43, Skp2 and p27(kip1 in ACTH-secreting pituitary adenoma cells, the AtT20 cells, incubated for 48 and 96 h with these carotenoids. We observed a decrease in cell viability caused by the lycopene and beta-carotene treatments; in these conditions, the clonogenic ability of the cells was also significantly decreased. Cell cycle analysis revealed that beta-carotene induced an increase of the cells in S and G2/M phases; furthermore, lycopene increased the proportion of these cells in G0/G1 while decreasing the S and G2/M phases. Also, carotenoids induced apoptosis after 96 h. Lycopene and beta-carotene decreased the secretion of ACTH in AtT20 cells in a dose-dependent manner. Carotenoids blocked the gap junction intercellular communication. In addition, the treatments increased the expression of phosphorylated connexin43. Finally, we also demonstrate decreased expression of S-phase kinase-associated protein 2 (Skp2 and increased expression of p27(kip1 in carotenoid-treated cells. These results show that lycopene and beta-carotene were able to negatively modulate events related to the malignant phenotype of AtT-20 cells, through a mechanism that could involve changes in the expression of connexin 43, Skp2 and p27(kip1; and suggest that these compounds might provide a novel pharmacological approach to the treatment of Cushing's disease.

  18. An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism

    OpenAIRE

    Guadalupe Vargas; Lourdes-Josefina Balcazar-Hernandez; Virgilio Melgar; Roser-Montserrat Magriña-Mercado; Baldomero Gonzalez; Javier Baquera; Moisés Mercado

    2017-01-01

    A 19-year-old woman with a history of isosexual precocious puberty and bilateral oophorectomy at age 10 years because of giant ovarian cysts, presents with headaches and mild symptoms and signs of hyperthyroidism. Hormonal evaluation revealed elevated FSH and LH levels in the postmenopausal range and free hyperthyroxinemia with an inappropriately normal TSH. Pituitary MRI showed a 2-cm macroadenoma with suprasellar extension. She underwent successful surgical resection of the pituitary tumor,...

  19. An evaluation of the effects of somatostatin analogue therapy in non-functioning pituitary adenomas in comparison to acromegaly.

    Science.gov (United States)

    Zawada, Natalia Bożena; Kunert-Radek, Jolanta; Pawlikowski, Marek; Pisarek, Hanna; Radek, Maciej

    2016-01-01

    Non-functioning pituitary adenomas (NFPA) are often diagnosed late as invasive macroadenomas. The surgical resection is usually incomplete and about 50% of patients require additional surgery. Recent data suggest that somatostatin analogues (SSA), so important in the pharmacotherapy of acromegaly, can also be effective in the management of NFPA. We analysed data of patients who had been treated up to 10 years previously with SSA: 40 with acromegaly (23 - primary, 17 - recurrent tumours) and 22 with NFPA (4 - primary, 18 - recurrent tumours). Hormonal profile, dynamics of tumour size change, ophthalmic syndromes, somatostatin receptor (SSTR) scintigraphy, and immunohistochemistry of SSTR subtypes of operated tumours as well as side effects were investigated. Biochemical cure of acromegaly was achieved in 57.5% of patients, while reduction of tumour size was observed in 37% of patients and it was more frequent in not-operated cases. Regarding NFPA, stabilisation of tumour size was noticed in 68% of patients. Tumour shrinkage was reported in 9% of cases, but in 23% of the study group the adenoma size increased with indication for reoperation. The efficacy of SSA in NFPA is much lower in comparison to their well-established effects in the treatment of acromegaly. Stabilisation of tumour size, which is observed in the majority of NFPA, is significantly more frequent in comparison to the natural history of untreated NFPA and our previous studies as well. Analysis of SSTR subtypes is an argument in favour of introduction of novel broad-spectrum SSA that may be more effective in the treatment of NFPA. Referring to acromegaly, adenoma size decrease was reported more frequently in primary therapy. Considering recurrent tumours better outcomes were achieved in patients who were pre-treated with SSA before planned surgery. (Endokrynol Pol 2016; 67 (3): 292-298).

  20. GH-Producing Pituitary Adenoma and Concomitant Rathke’s Cleft Cyst: A Case Report and Short Review

    Directory of Open Access Journals (Sweden)

    Ryota Tamura

    2015-01-01

    Full Text Available Concomitant pituitary adenoma (PA and Rathke’s cleft cyst (RCC are rare. In some cases, such PA is known to produce pituitary hormones. A 53-year-old man was admitted to our hospital with a diagnosis of lacunar infarction in the left basal ganglia. Magnetic resonance imaging (MRI incidentally showed a suprasellar mass with radiographic features of RCC. When he consulted with a neurosurgical outpatient clinic, acromegaly was suspected based on his appearance. A diagnosis of growth hormone- (GH- producing PA was confirmed from hormonal examinations and additional MRI. Retrospectively, initial MR images also showed intrasellar mass that is compatible with the diagnosis of PA other than suprasellar RCC. The patient underwent endonasal-endoscopic removal of the PA. Since we judged that the RCC of the patient was asymptomatic, only the PA was completely removed. The postoperative course of the patient was uneventful and GH levels gradually normalized. Only 40 cases of PA with concomitant RCC have been reported to date, including 13 cases of GH-producing PA. In those 13 cases, RCC tended to be located in the sella turcica, and suprasellar RCC like this case appears rare. In a few cases, concomitant RCCs were fenestrated, but GH levels normalized postoperatively as in the cases without RCC fenestration. If radiographic imaging shows typical RCC, and PA is not obvious at first glance, the possibility of concomitant PA still needs to be considered. In terms of treatment, removal of the RCC is not needed to achieve hormone normalization.

  1. Changes in Plasma Prolactin and Growth Hormone Level and Visual Problem after radiation Therapy(RT) of Pituitary Adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sei Chul; Kwon, Hyung Chul; Oh, Yoon Kyeong; Bahk, Yong Whee; Son, Ho Young; Kang, Joon Ki; Song, Jin Un [Catholic Medical College, Seoul (Korea, Republic of)

    1985-06-15

    Twenty-four cases of pituitary adenoma, 13 males and 11 females with the age ranging from 11 to 65 years, received radiation therapy(RT) on the pituitary area with 6MV linear accelerator during past 25 months at the Division of Radiation Therapy, Kangnam St. Mary Hospital, Catholic Medical College. Of 24 case of RT, 20 were postoperative and 4 primary. To evaluate the effect of RT, we analyzed the alteration of the endocrinological tests, neurologic abnormalities, major clinical symptoms, endocrinological changes and improvement in visual problems after RT. The results were as follows ; 1. Major clinical symptoms were headache, visual defects, diabetes insipidus, hypogonadisms and general weakness in decreasing order of frequency. 2. All but the one with Nelson syndrome showed abnormal neuroradiologic changes in the sella turcica with an invasive tumor mass around supra and para-sellar area. 3. Endocrinological classifications of the patient were 11 prolactinoma, 4 growth hormonesecreting tumors, 3 ACTH-secreting tumors consisting of one Cushing disease and two Nelson syndrome, and 6 nonfunctioning tumors. 4. Eleven of 14 patients, visual problems were improved after treatment but remaining 3 were unchanged. 5. Seven of 11 prolactinomas returned to normal hormonal level after postoperative and primary RT and 3 patients are being treated with bromocriptine (BMCP) but on lost case. 6. Two of 4 growth hormone-secreting tumor returned to normal level after RT but the remaining 2 are being treated with BMCP, as well.

  2. Thyroid-stimulating hormone-secreting pituitary adenoma presenting with recurrent hyperthyroidism in post-treated Graves’ disease: a case report

    Directory of Open Access Journals (Sweden)

    Ogawa Yoshikazu

    2013-01-01

    Full Text Available Abstract Introduction The coexistence of autoimmune hyperthyroid disease and thyroid-stimulating hormone-secreting pituitary adenoma is rare. The simple presumption of coincidence of these two diseases has a calculated incidence of less than one/several hundred million, and only four cases with histological confirmation have been reported. A rapid decrease in thyroid-stimulating hormone level after pituitary tumor removal may induce subsequent activation of autoimmune responses against the thyroid gland. We report the first case of a sequential and paradoxical occurrence of Graves’ disease and a thyroid-stimulating hormone-secreting pituitary adenoma. Case presentation A 32-year-old Japanese woman had recurrent hyperthyroidism. She had a history of Graves’ hyperthyroidism, which had been successfully treated with propylthiouracil. A head magnetic resonance imaging showed a less enhanced area in the left lateral wing of her sella turcica. Transsphenoidal surgery was performed, and the diagnosis was established as thyroid-stimulating hormone-secreting plurihormonal adenoma. A rapid reduction in thyroid hormone levels was achieved, and her blood pressure was normalized after the operation. Conclusion Although incidental occurrence is the most probable etiology, long and repeated followup examinations of both thyroid and pituitary gland should be performed in patients with an atypical clinical course.

  3. Benign pituitary adenoma associated with hyperostosis of the spenoid bone and monocular blindness. Case report.

    Science.gov (United States)

    Milas, R W; Sugar, O; Dobben, G

    1977-01-01

    The authors describe a case of benign chromophobe adenoma associated with hyperostosis of the lesser wing of the sphenoid bone and monocular blindness in a 38-year-old woman. The endocrinological and radiological evaluations were all suggestive of a meningioma. The diagnosis was established by biopsy of the tumor mass. After orbital decompression and removal of the tumor, the patient was treated with radiation therapy. Her postoperative course was uneventful, and her visual defects remained fixed.

  4. Fractures in pituitary adenoma patients from the Dutch National Registry of Growth Hormone Treatment in Adults

    NARCIS (Netherlands)

    N.C. Van Varsseveld; C.C. van Bunderen (Christa); A.A.M. Franken (Anton); H.P.F. Koppeschaar (Hans); A-J. van der Lely (Aart-Jan); M.L. Drent (Madeleine)

    2016-01-01

    textabstractPurpose: The effects of growth hormone (GH) replacement therapy on fracture risk in adult GH deficient (GHD) patients with different etiologies of pituitary GHD are not well known, due to limited data. The aim of this study was to investigate characteristics and fracture occurrence at st

  5. Genetic disruption of dopamine production results in pituitary adenomas and severe prolactinemia

    Science.gov (United States)

    Dopamine release from tuberoinfundibular dopamine neurons into the median eminence activates dopamine-D2 receptors in the pituitary gland where it inhibits lactotroph function. We have previously described genetic dopamine-deficient mouse models which lack the ability to synthesize dopamine. Because...

  6. Significance of contrast enhancement with Gd-DTPA in evaluation of pituitary adenomas; Znaczenie wzmocnienia kontrastowego Gd-DTPA w ocenie gruczolakow przysadki

    Energy Technology Data Exchange (ETDEWEB)

    Paprzycki, W.; Liebert, W.; Gradzki, J.; Sosnowski, P.; Stajgis, M. [Osrodek Diagnostyki Obrazowej IR, Akademia Medyczna, Poznan (Poland)]|[Zaklad Neuroradiologii, Akademia Medyczna, Poznan (Poland)]|[Klinika Neurochirurgii, Akademia Medyczna, Poznan (Poland)

    1994-12-31

    Results of MR examinations in 136 patients with suspected pituitary adenoma were evaluated retrospectively. Presence of 40 microadenomas and 48 macroadenomas was confirmed. Contrast enhancement with Gd-DTPA increased diagnostic efficacy in 65% of cases of microadenomas. Contrast enhancement with Gd-DTPA was less useful in cases of macroadenomas and enable the more detailed evaluation of tumor margins in 31 %, tumor relation to cavernous sinus in 21% and tumor relation to optic chiasm in 6% of cases only. Authors suggest, that contrast enhancement with Gd-DTPA is indispensable and should be performed routinely in evaluation of pituitary gland in patients with suspected microadenoma. (author) 10 refs, 5 figs, 3 tabs

  7. Nuevos mecanismos involucrados en la patogénesis de adenomas hipofisarios New mechanisms involved in the pathogenesis of pituitary adenomas

    Directory of Open Access Journals (Sweden)

    D. Giacomini

    2003-04-01

    Full Text Available Analizamos molecularmente tumores formados por clones estables de la línea lactosomatotrofa GH3 Smad-4 (transductor de señales de la proteína morfogénica de hueso-4, BMP-4 dominante negativo (Smad-4dn que bloquea el transductor Smad que desarrollan tumores de menor tamaño que los controles en ratones nude, pero que presentaron un crecimiento tardío. Encontramos que en éstos la expresión/control de Smad-4dn se perdió y que sobreexpresan c-Myc. Concordantemente, BMP-4 se sobreexpresa y estimula la expresión de c-Myc en prolactinomas humanos pero no en otros adenomas o en hipófisis normales. Además en células GH3, ICI 182,780 (bloqueante de estrógenos inhibe la estimulación de c-Myc por BMP-4 y el cotratamiento BMP-4/estrógenos posee un efecto aditivo sobre la proliferación celular. Al bloquear BMP-4 con ICI y estrógenos (E2 con Smad-4dn se bloquea significativamente cada efecto estimulatorio sobre la proliferación. A su vez Smad-4 interacciona físicamente con los dos subtipos de receptores de estrógenos, ERa/ERb. Demostramos por primera vez el rol de BMP-4 en la tumorigénesis de prolactinomas, involucrando un crosstalk funcional BMP-4/estrógenos.We studied Smad-4dn tumors generated from lactosomatotrophic GH3 cells stably transfected with a dominant negative form of Smad-4 (a bone morphogenetic protein-4, BMP-4, signal co-transducer which had reduced tumorigenicity in nude mice, but had showed a late increase in tumor size. We found that they had lost in vivo the expression of Smad-4dn and had recovered c-Myc expression. In accordance, BMP-4 is overexpressed and stimulates the expression of c-Myc in human prolactinomas, but not in other human pituitary adenomas or normal pituitary. In adittion ICI 182,780 inhibited BMP-4 stimulated c-Myc expression and BMP-4 and 17b-estradiol in combination had an additive effect on GH3 cell proliferation. Their action was inhibited by blocking BMP-4 with ICI 182,780 or 17b-estradiol with

  8. Clinical features of 239 cases of pituitary adenomas%垂体肿瘤239例临床特征分析

    Institute of Scientific and Technical Information of China (English)

    陈刚; 卓雅芬; 姚瑾; 梁继兴; 黄惠彬; 李连涛; 林丽香

    2010-01-01

    Objective To study clinical feature and therapeutic choice of pituitary adenomas. Methods The clinical data of 239 cases of pituitary adenomas were analyzed. Results Total 93 male and 146 female cases were recruited. The average age was (43.8 ± 14.9 ) years old (3.9-77 years). Prolactinomas were the most common pituitary adenomas (26.8%) , 179 patients (74.9%) underwent surgery, of which 108 (60.3%) with transsphenoidal approach and 71 (39.7%) transcranial approach. The other 60 cases were treated nonsurgically. Conclusions Pituitary adenomas may present hormonal abnormalities or neurological symptoms.Some adenomas were accidently detected by MRI. Prolactinomas were the most common pituitary adenomas.%目的 探讨垂体瘤的临床特征及治疗方案.方法 回顾性分析福建省立医院自1994年1月至2007年6月间收住的239例垂体瘤患者的临床资料.结果 239例垂体腺瘤中,男性93例(38.9%),女性146例(61.1%).诊断时的平均年龄为(43.8±14.9)岁(范围为3.9~77岁).依据临床表现、影像学及内分泌检查、免疫组织化学染色所示,催乳素瘤为最常见的肿瘤(26.8%).手术治疗179例(74.9%),其中经蝶入路108例(60.3%),经额入路71例(39.7%),非手术治疗及随访者60例(25.1%).结论 垂体瘤可表现为内分泌异常、神经系统症状或其他原因行MRI意外发现;催乳素瘤为最常见的肿瘤.

  9. Diagnosis and treatment of subclinical pituitary adenoma apoplexy%亚临床型垂体腺瘤卒中的诊治

    Institute of Scientific and Technical Information of China (English)

    张风林; 应奇; 高苏慧; 骆纯; 丁学华

    2013-01-01

    Objective To investigate the clinical features,diagnosis,treatment and outcomes of 203 consecutive patients with subclinical pituitary adenoma apoplexy.Methods The clinical data of 203 patients,in whom 149 underwent transsphenoidal surgery and 54 underwent transcranial surgery were analyzed retrospectively.Preoperative and postoperative endocrinological hormone concentrations were measured in all patients.Pituitary imaging was obtained by CT scans or MRI.Results Visual disturbance,headache and pituitary function impairment improved significantly in all patients.Prolactinoma was the most frequent type of pituitary adenoma in our series.Subclinical pituitary adenoma apoplexy usually occurred in patients with large or giant adenomas.Postoperative follow-up showed the tumor recurred in 24 patients,19 of whom were treated with postoperative radiotherapy.Long-term thyroid hormone replacement was necessary in 9 patients and steroid hormone replacement in 8.Conclusions The incidence of subclinical pituitary adenoma apoplexy is relatively higher compared with that of acute pituitary apoplexy.The exact pathogenic mechanism of subclinical pituitary adenoma apoplexy remains unknown.MRI is significantly better than CT scans for detection of subclinical pituitary adenoma apoplexy.Transsphenoidal decompression is safe and effective.%目的 总结203例亚临床型垂体腺瘤卒中患者临床特点、诊断、处理与结果.方法 回顾性分析亚临床型垂体腺瘤卒中病人203例,149例行经鼻蝶垂体腺瘤切除术,54例行开颅切除手术.患者术前术后均作内分泌学检查,影像学检查为CT或MRI.结果 所有病人视觉损害、头痛或垂体功能得到不同程度改善.泌乳素腺瘤是本组病例中最常见病理类型.大腺瘤及巨腺瘤患者容易发生亚临床型垂体腺瘤卒中.术后随访有24例垂体腺瘤复发.19例接受放疗.9例术后长期服用甲状腺素替代药物,8例服用类固醇激素.结论 亚临床型垂体

  10. Diagnosis and treatment for giant pituitary adenomas%巨大垂体腺瘤的诊治

    Institute of Scientific and Technical Information of China (English)

    贺振华; 袁静敏; 李强; 张新定; 潘亚文; 史雪峰; 兰正波

    2014-01-01

    目的:探讨内镜经鼻蝶入路或联合翼点入路开颅手术分次切除巨大垂体腺瘤的治疗效果和并发症处理。方法回顾性分析45例巨大垂体腺瘤病人的临床资料,根据垂体瘤的不同生长类型,分别采取内镜经鼻蝶入路或联合翼点入路开颅手术分次切除肿瘤后,观察其临床疗效和术后并发症。结果一次手术肿瘤镜下全切除26例,次全切除12例,部分切除7例。两次手术全切除9例,次全切除6例。两次手术间隔时间为6~8周。术后并发症:一过性尿崩13例,脑脊液鼻漏5例,中枢性低钠血症2例,中枢性高热10例,垂体功能低下12例,以上均经术后对症支持治疗后好转或症状消失。蝶窦内感染3例,其中2例再次内镜下清理后好转,1例保守抗炎治疗痊愈。随访39例,时间2个月~3年,平均2.1年。复发9例,6例再次手术,余3例放弃治疗。结论对于巨大、向鞍上生长的垂体腺瘤,神经内镜和经颅手术联合分次切除肿瘤,是提高全切率、降低病死率及减少并发症的重要手段。%Objective To explore the surgical outcome and complications of limited removal in several sessions for giant pituitary adenomas via endoscopic transsphenoidal approach or in combination with pterional approach. Methods Clinical data of 45 patients with giant pituitary adenomas were analyzed retrospectively, who underwent fractional resection by craniotomy via endoscopic transsphenoidal or combined with pterional approach. The clinical outcome and postoperative complications were observed. Results In the first surgery, total removal was achieved in 26 patients, subtotal removal in 12, partial removal in 7. Nine patients got total resection and 6 got subtotal removal in the second surgery. The optimal interval between the two operations was 6 to 8 weeks. The postoperative complications included transient diabetes insipidus in 13 patients, cerebrospinal fluid nasal leakage in 5, central hyponatremia

  11. ADENOMA HIPOFISIS

    Directory of Open Access Journals (Sweden)

    Muhammad Hidayat

    2015-09-01

    Full Text Available AbstrakAdenoma hipofisis diklasifikasikan berdasarkan beberapa kriteria yaitu klinis dan endokrin, patologi, serta radiologi. Klasifikasi endokrin membedakan tumor sebagai fungsional dan nonfungsional, berdasarkan aktivitas sekretorinya in-vivo. Klasifikasi patologi berusaha untuk membatasi kelompok tumor heterogenus secara klinis dan patologis dengan kategori yaitu asidofilik, basofilik, dan kromofobik. Klasifikasi radiologi mengelompokkan tumor hipofisis berdasarkan ukuran dan karakteristik pertumbuhan, yang dapat ditemukan dari studi imaging. WHO membuat klasifikasi yang mencoba untuk mengintegrasikan semua klasifikasi yang ada dan menyediakan sinopsis praktis untuk aspek klinis dan patologis dari adenoma. Diagnosa adenoma hipofisis dibuat berdasarkan: gejala klinis dari gangguan hormon, adanya riwayat penyakit dahulu yang jelas, pemeriksaan fisik yang menunjang, pemeriksaan laboratorium yang menunjukkan disfungsi dari hormon yang terganggu, adanya pemeriksaan penunjang yang akurat seperti CTScan, MRI-Scan. Jenis, besar dan fungsi dari tumor sangat menentukan dalam mempertimbangkan penatalaksanaan dari adenoma hipofisis. Pengobatan diindikasikan pada semua pasien dengan gejala, terutama dengan hipogonadisme. Pilihan terapi termasuk kontrol dengan obat-obatan, reseksi bedah, dan terapi radiasi.AbstractPituitary adenomas are classified according to several criteria; clinical endocrine, pathology, and radiology. Endocrine classification distinguishes tumors as functional and nonfunctional, based on in-vivo secretory activity. Pathology classification seeks to restrict clinically heterogeneous group of tumors and pathological categories namely acidophilic, basophilic, and kromofobik. Radiological classification classifies pituitary tumors by size and growth characteristics, which can be found on imaging studies. WHO made a classification that attempts to integrate all existing classifications and provide practical synopsis for the clinical and

  12. Role of mTOR Inhibitors in Growth Hormone-Producing Pituitary Adenomas Harboring Different FGFR4 Genotypes.

    Science.gov (United States)

    Jalali, Shahrzad; Monsalves, Eric; Tateno, Toru; Zadeh, Gelareh

    2016-09-01

    Pituitary adenomas (PAs) are common intracranial lesions. Available medical therapies are limited in PAs, and therefore, it is essential to identify treatments that control PA growth when surgery is not an option. Fibroblast growth factor 4 is implicated in PA pathogenesis; therefore, in this study, we used an isogenic mammosomatotroph cell line (GH4C1) harboring different fibroblast growth factor receptor (FGFR)-4 genotypes to establish and characterize intracranial xenograft mouse models that can be used for preclinical drug testing. We show that proliferating GH4C1 tumors have an average latency of 3 weeks to form. Histological analysis revealed that prototypic FGFR4 (G388) tumors express increased prolactin and less GH, whereas tumors possessing the polymorphic variant of FGFR4 (R388) express increased GH relative to prolactin. All tumors show abundant mammalian target of rapamycin (mTOR) signaling as confirmed using phosphorylated (p)-S6 and p-4E-binding protein 1 as downstream regulators of this pathway. We subsequently demonstrate that the mTOR inhibitor RAD001 decreases tumor growth rate and reduces p-S6 but not p-4E-binding protein 1 activation, regardless of FGFR4 status. More importantly, GH activity was significantly reduced after mTOR inhibition in the R388 polymorphic variant tumors. This reduction was also associated with a concomitant reduction in serum IGF-1 levels in the R388 group. In summary, we demonstrate that the GH4C1 FGFR polymorphic xenograft is a useful model for examining PAs. Furthermore, we show that RAD001 can efficiently reduce tumor growth rate by a reduction in mTOR signaling and more importantly results in control of GH expression and IGF-1 secretion, providing further support for using mTOR inhibitors in PA patients, in particular GH-producing adenomas.

  13. Dopamine receptors in pituitary adenomas: PET visualization with 11C-N-methylspiperone

    Energy Technology Data Exchange (ETDEWEB)

    Muhr, C.; Bergstroem, M.L.; Lundberg, P.O.; Bergstroem, K.H.; Hartvig, P.; Lundqvist, H.; Antoni, G.; Langstroem B2

    1986-03-01

    Two patients with pituitary tumors were examined with positron emission tomography (PET) after intravenous administration of 11C-N-methylspiperone. In repeat studies the patients were given 1 mg of intravenous haloperidol prior to the administration of the radioligand to block the dopamine receptors. High uptakes of the radiolabeled ligand were seen in one of the tumors. With haloperidol pretreatment the uptake was lower, probably mainly showing the remaining unspecific binding. The most marked uptake and the largest effect of haloperidol pretreatment was seen in a patient with a hormonally active prolactinoma. Dopamine receptor binding in pituitary tumors can be demonstrated in vivo with PET, and quantification of this binding is possible using a compartmental model. This technique may be useful in improving our understanding of the variable response to medical treatment of prolactinomas with dopamine agonists as well as in the prediction of the effect of such treatment.

  14. 经单鼻孔蝶窦入路显微手术治疗垂体腺瘤%Microsurgery Therapeutics of Pituitary Adenoma through Unilateral Endonasal Transsphenoidal

    Institute of Scientific and Technical Information of China (English)

    吴文学; 李兴昌; 王方友; 尹军花; 李强峰

    2012-01-01

    目的:总结我院采用经单鼻孔蝶窦入路显微手术治疗垂体腺瘤的疗效,讨论垂体腺瘤的手术治疗及并发症。方法:对2010年1月至2011年10月我科收住的垂体腺瘤病人及相关文献资料进行分析。结果:8例病人恢复良好,头痛缓解,视力恢复,溢乳消失。结论:经单鼻孔蝶窦入路显微手术治疗垂体腺瘤安全可靠,疗效好,出血较少,脑组织损伤最小,手术时间短,并发症少,反应轻,恢复快。%Objective: To explore the operative therapy and complications on microsurgical treatment of pituitary adenoma through unilateral endonasal transsphenoidal. Methods: Clincal documents of patients who had suffered pituitary adenoma from January 2010 to October 2011 were conducted a retrospective analysis. Results: Eight patients were cured with released headache and galactorrhea absence. Conclusion: Microsurgery therapeutics of pituitary adenoma through unilateral endonasal transsphenoidal is secure, effective and with less hemorrhage and cerebral lesion, shorter surgery time, less complication, slighter postoperative response and swifter healing.

  15. Molecular biological examination of somatotroph pituitary adenomas related to clinical data from patients with acromegaly

    OpenAIRE

    2010-01-01

    Definition and epidemiology The first historical description of acromegaly could be the story of David and Goliath described both in The Old Testament and in the Koran. Goliath was a giant, but David defeated him by sneaking up on him, maybe in his visual field defect, and hitting him with a stone in the forehead using a sling. The connection between gigantism and the pituitary, hence with the possibility of visual disturbances, was not recognized until 1884, published in a book by Fritzsc...

  16. Cavernous sinus cavernous hemangioma largely extending into the sella turcica and mimicking pituitary adenoma: case report.

    Science.gov (United States)

    Hori, Satoshi; Hayashi, Nakamasa; Nomoto, Kazuhiro; Sato, Hikari; Hayashi, Tomohide; Nagai, Shoichi; Nishikata, Manabu; Endo, Shunro

    2010-01-01

    A 77-year-old female presented with a rare cavernous sinus cavernous hemangioma with extension to the sella turcica, neuroradiologically mimicking nonfunctioning pituitary macroadenoma. The lesion was partially removed via transsphenoidal surgery, and the histological diagnosis was cavernous hemangioma. After stereotactic radiosurgery using a cyber knife, the lesion decreased in size. Stereotactic radiosurgery may be a good option for cavernous sinus cavernous hemangioma with high risk of surgical bleeding.

  17. High-resolution 18F-fluorodeoxyglucose positron emission tomography and magnetic resonance imaging for pituitary adenoma detection in Cushing disease

    Science.gov (United States)

    Chittiboina, Prashant; Montgomery, Blake K.; Millo, Corina; Herscovitch, Peter; Lonser, Russell R.

    2016-01-01

    OBJECT High-resolution PET (hrPET) performed using a high-resolution research tomograph is reported as having a resolution of 2 mm and could be used to detect corticotroph adenomas through uptake of 18F-fluorodeoxyglucose (18F-FDG). To determine the sensitivity of this imaging modality, the authors compared 18F-FDG hrPET and MRI detection of pituitary adenomas in Cushing disease (CD). METHODS Consecutive patients with CD who underwent preoperative 18F-FDG hrPET and MRI (spin echo [SE] and spoiled gradient recalled [SPGR] sequences) were prospectively analyzed. Standardized uptake values (SUVs) were calculated from hrPET and were compared with MRI findings. Imaging findings were correlated to operative and histological findings. RESULTS Ten patients (7 females and 3 males) were included (mean age 30.8 ± 19.3 years; range 11–59 years). MRI revealed a pituitary adenoma in 4 patients (40% of patients) on SE and 7 patients (70%) on SPGR sequences. 18F-FDG hrPET demonstrated increased 18F-FDG uptake consistent with an adenoma in 4 patients (40%; adenoma size range 3–14 mm). Maximum SUV was significantly higher for 18F-FDG hrPET–positive tumors (difference = 5.1, 95% CI 2.1–8.1; p = 0.004) than for 18F-FDG hrPET–negative tumors. 18F-FDG hrPET positivity was not associated with tumor volume (p = 0.2) or dural invasion (p = 0.5). Midnight and morning ACTH levels were associated with 18F-FDG hrPET positivity (p = 0.01 and 0.04, respectively) and correlated with the maximum SUV (R = 0.9; p = 0.001) and average SUV (R = 0.8; p = 0.01). All 18F-FDG hrPET–positive adenomas had a less than a 180% ACTH increase and 18F-FDG hrPET–negative adenomas had a greater than 180% ACTH increase after CRH stimulation (p = 0.03). Three adenomas were detected on SPGR MRI sequences that were not detected by 18F-FDG hrPET imaging. Two adenomas not detected on SE (but no adenomas not detected on SPGR) were detected on 18F-FDG hrPET. CONCLUSIONS While 18F-FDG hrPET imaging can detect

  18. Pituitary tumors containing cholecystokinin

    DEFF Research Database (Denmark)

    Rehfeld, J F; Lindholm, J; Andersen, B N

    1987-01-01

    We found small amounts of cholecystokinin in the normal human adenohypophysis and therefore examined pituitary tumors from 87 patients with acromegaly, Cushing's disease, Nelson's syndrome, prolactinoma, or inactive pituitary adenomas. Five adenomas associated with Nelson's syndrome contained......'s disease and 7 acromegaly with adenomas containing ACTH. The cholecystokinin peptides from the tumors were smaller and less sulfated than cholecystokinin from normal pituitary glands. We conclude that ACTH-producing pituitary cells may also produce an altered form of cholecystokinin....

  19. 探讨垂体瘤患者手术前后垂体功能变化及其影响因素%Investigation of changes in pituitary functions of patients with pituitary adenoma before and after surgery and influential factors

    Institute of Scientific and Technical Information of China (English)

    张胡金

    2016-01-01

    Objective To investigate characteristics of changes in pituitary functions of patients with pituitary ade-noma before and after surgery,influential factors and sum up management experiences.Methods Changes in pituitary functions of 35 patients with pituitary adenoma before and after surgery who received pituitary adenoma resection in our hospital and were followed up over a period from 2011 to October,2014 were investigated and the influential factors were analyzed.Results After operation,6 patients had hypopituitarism,19 patients had hyperthyroidism (8 patients had normal thyroid function before operation),15 patients had adrenal insufficiency (7 patients had normal adrenal function before operation),6 patients had diabetes insipitus (all had normal urination (micturition)before operation). At the day before operation,first day after operation,the 1st month after operation and the 6th month after operation, in the serum levels of TSH,TT4,FT4,ACTH8am and COR8am,there were all significant differences among the pa-tients(all P < 0.05).The pituitary functions of 57.14% of patients recovered to normal,and among those patients whose pituitary functions had recovered,the invasiveness rate of the tumor,age of the patient and course of the disease were all lower than those whose pituitary functions hadn’t recovered and there were significant differences (all P <0.05).Conclusion The pituitary functions of the patients with pituitary adenoma change after operation,which is relat-ed to the operation directly,a part of the patients need pharmacotherapy(medication).Abnormal changes in pituitary function maybe associated with invasiveness of the tumor,age of the patient and course of the disease.%目的:分析垂体瘤患者手术前后垂体功能变化特征,探讨影响因素,总结管理经验。方法2011年-2014年10月,进行手术治疗并获得随访35例垂体瘤,对比垂体功能变化情况,并进行因素分析。结果术后6

  20. Intracranial hemorrhage from undetected aneurysmal rupture complicating transphenoidal pituitary adenoma resection.

    Science.gov (United States)

    Rustagi, Tarun; Uy, Edilfavia Mae; Rai, Mridula; Kannan, Subramanian; Senatus, Patrick

    2011-08-01

    We report a case of a 39-year-old man who presented with a nonfunctioning pituitary macroadenoma which extended into the suprasellar region. He underwent a transcranial resection of the tumor followed eight months later by transsphenoidal surgery for the residual tumor. Postoperatively he developed massive subarachnoid and intraventricular hemorrhage. A cerebral angiogram revealed a leaking anterior communicating artery aneurysm which was not seen on the computed tomography angiography and magnetic resonance angiography before the surgery. Complications of transsphenoidal surgery, particularly vascular hemorrhagic complications, and risk of rupture of undetected aneurysms are discussed.

  1. Pituitary adenoma: A clinicopathologic analysis of 180 cases%180例垂体腺瘤的临床病理观察

    Institute of Scientific and Technical Information of China (English)

    牛俊扬; 周荣妹; 王晓秋; 胡闻; 程荣璇; 宋怡诚

    2001-01-01

    研究垂体腺瘤的临床激素过多症状与腺瘤组织激素检测之间的关系以及该病的发生、生物学行为、分类。方法:对180例垂体腺瘤进行了临床病理分析,并对其中110例应用免疫组化ABC法检测了肿瘤的GH、PRL、ACTH、TSH、FSH、LH。结果:临床激素过多症状与激素检测相一致者占40%,且女性较男性相一致者多,差异有显著性。免疫组化分型以PRL和GH腺瘤多见,多激素腺瘤以GH+PRL腺瘤多见。结论:垂体腺瘤的免疫组化检测与形态功能相结合的分类方法简便易行较为实用。%To study the histogenesis, biological behaviour, classification of pituitary adenoma and the relationship between the symptoms of hormonal hypersecretion and the hormone test in pituitary adenoma. Methods One hundred and eighty cases of pituitary adenoma were investigated by clinicopatholgic analysis, and GH, PRL, ACTH, TSH, FSH, LH were examined in 110 cases by ABC immunocytochemical methods. Results Forty percent of the patients were found to have the identical results between the clinical symptoms and hormonal test. Female patients were more than male ones, and the difference was satistically significant. The results showed that PRL and GH adenoma were often found in the cases by immunocytochemical method,and mixed GH-PRL adenoma were often found in the cases with multihormono-adenoma. Conclusion The classification is practical and easy to operate, which combines the immunohistochemical examination of pituipary adenoma with the morphology and function.

  2. An Unusual Case of Cushing’s Syndrome: Coexistence of Functional Pituitary and Adrenal Adenoma

    Directory of Open Access Journals (Sweden)

    Muzaffer İlhan

    2017-03-01

    Full Text Available A case of adrenocorticotropic hormone (ACTH-independent Cushing’s syndrome, which develops in the course of ACTH-dependent Cushing’s disease, is presented in this report. A 47-year-old woman with a past history of surgery and gamma knife radiosurgery because of Cushing’s disease was admitted to the endocrinology clinic with weight gain and unregulated blood glucose levels. Hypercortisolemia was still persisting and diagnostic work-up indicated ACTH-independent Cushing’s syndrome. Along with the rare possibility of this coexistence, longstanding ACTH hypersecretion can play a role in functional transition of adrenal adenomas. Further studies are needed to clarify the underlying mechanisms.

  3. Endoscopic endonasal transsphenoidal approach for pituitary adenomas: technical aspects and report of casuistic Abordagem endoscópica endonasal para adenomas de hipófise: aspectos técnicos e relato de casuística

    Directory of Open Access Journals (Sweden)

    Américo Rubens Leite dos Santos

    2010-08-01

    Full Text Available OBJECTIVE: Analyse technical aspects, effectiveness and morbidity of the endoscopic endonasal transphenoidal approach for pituitary adenomas. METHOD: From January 2005 to September 2008, 30 consecutive patients underwent endoscopic endonasal resection of pituitary adenomas with a follow up from 3 to 36 months. Their medical charts were retrospectively analysed. RESULTS: There were 18 women and 12 men, mean age 44 years (range 17-65 yr. Among the 30 patients, 23 had macroadenomas and 7 microadenomas. Twelve patients had non-functioning tumors, 9 had ACTH-secreting tumors, 8 had GH-secreting tumors and 1 prolactinoma. Complete resection and hormonal control was achieved in all microadenomas. Macroadenomas were completely removed in 6 patients, subtotal resection in 6 and partial resection in 11. Three patients had diabetes insipidus and 5 had CSF leaks treated with lumbar drainage. CONCLUSION: The endonasal endoscopic approach for pituitary tumors is effective and has low morbidity.OBJETIVO: Analisar aspectos técnicos, eficácia e morbidade do acesso transesfenoidal endonasal endoscópico para adenomas hipofisários. MÉTODO: Estudo retrospectivo de trinta pacientes consecutivos submetidos à ressecção endoscópica endonasal de adenomas hipofisários, entre janeiro de 2005 e setembro de 2008, com seguimento pós-operatório entre três e 36 meses. RESULTADOS: Foram operados 18 mulheres e 12 homens com idades variando entre 17 e 65 anos (média 44 anos. Entre os 30 casos operados, 23 eram macroadenomas e sete microadenomas. Doze pacientes apresentavam adenomas não-funcionantes, nove tumores secretores de ACTH, oito tumores secretores de GH e um prolactinoma. Ressecção macroscópica completa e controle endócrino foram conseguidos em todos microadenomas. Ressecção dos macroadenomas foi completa em seis pacientes, subtotal em seis e parcial em seis casos. Três pacientes desenvolveram diabetes insipidus e cinco tiveram fístula liqüórica p

  4. Trigemino-cardiac reflex during transsphenoidal surgery for pituitary adenomas: methodological description of a prospective skull base study protocol.

    Science.gov (United States)

    Schaller, B J; Weigel, D; Filis, A; Buchfelder, M

    2007-05-29

    A systematic clinical neuroscience protocol is described for the use to examine the trigemino-cardiac reflex (TCR) response in humans. Target neurosurgical conditions are operations that require manipulations around the peripheral and central part of the trigeminal nerve and its branches, e.g. the cerebellopontine angle or the sellar region. To assess the hemodynamic and cardiac responses of patients after TCR initiation, anesthetic monitoring has been applied. The TCR is defined as a drop of more than 20% of the heart rate and the mean arterial blood pressure compared with the baseline values before the stimulus and coinciding with the surgical manipulation at or around any branches of the trigeminal nerve. By help of illustrative cases, we present for the first time preliminary results regarding the differentiation of the TCR in a central and a peripheral induction during transsphenoidal surgery of pituitary adenomas. Based on these results, we can conclude that we have developed a battery of preoperative examination procedures based on event-related diagnostics that was useful to differentiate different subgroups of TCR during transsphenoidal surgery. The presented protocol can be performed directly pre-, intra- and postoperatively and applied for assessment of TCR even in patients with known risk factors.

  5. Activation of RAF/MEK/ERK and PI3K/AKT/mTOR pathways in pituitary adenomas and their effects on downstream effectors.

    Science.gov (United States)

    Dworakowska, D; Wlodek, E; Leontiou, C A; Igreja, S; Cakir, M; Teng, M; Prodromou, N; Góth, M I; Grozinsky-Glasberg, S; Gueorguiev, M; Kola, B; Korbonits, M; Grossman, A B

    2009-12-01

    Raf/MEK/ERK and phosphatidylinositol 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) cascades are key signalling pathways interacting with each other to regulate cell growth and tumourigenesis. We have previously shown B-Raf and Akt overexpression and/or overactivation in pituitary adenomas. The aim of this study is to assess the expression of their downstream components (MEK1/2, ERK1/2, mTOR, TSC2, p70S6K) and effectors (c-MYC and CYCLIN D1). We studied tissue from 16 non-functioning pituitary adenomas (NFPAs), six GH-omas, six prolactinomas and six ACTH-omas, all collected at transsphenoidal surgery; 16 normal autopsy pituitaries were used as controls. The expression of phospho and total protein was assessed with western immunoblotting, and the mRNA expression with quantitative RT-PCR. The expression of pSer217/221 MEK1/2 and pThr183 ERK1/2 (but not total MEK1/2 or ERK1/2) was significantly higher in all tumour subtypes in comparison to normal pituitaries. There was no difference in the expression of phosphorylated/total mTOR, TSC2 or p70S6K between pituitary adenomas and controls. Neither c-MYC phosphorylation at Ser 62 nor total c-MYC was changed in the tumours. However, c-MYC phosphorylation at Thr58/Ser62 (a response target for Akt) was decreased in all tumour types. CYCLIN D1 expression was higher only in NFPAs. The mRNA expression of MEK1, MEK2, ERK1, ERK2, c-MYC and CCND1 was similar in all groups. Our data indicate that in pituitary adenomas both the Raf/MEK/ERK and PI3K/Akt/mTOR pathways are upregulated in their initial cascade, implicating a pro-proliferative signal derangement upstream to their point of convergence. However, we speculate that other processes, such as senescence, attenuate the changes downstream in these benign tumours.

  6. Impulse control disorders in patients with dopamine agonist-treated prolactinomas and non-functioning pituitary adenomas: a case-control study

    Science.gov (United States)

    Bancos, Irina; Nannenga, Michael R.; Bostwick, J. Michael; Silber, Michael H.; Erickson, Dana; Nippoldt, Todd B.

    2014-01-01

    Objective We aimed to assess the prevalence of impulse control disorders (ICDs) in patients with prolactin-secreting adenomas treated with dopamine agonists (DAs), to identify associated factors, and compare it with a group of patients with non-functioning pituitary adenoma. Subjects, Design and Measurement In a postal survey, 77 patients from Group A (patients with prolactinomas and present or past use of DAs) and 70 patients from Group B (patients with non-functioning pituitary adenoma and no history of DA therapy) responded to a questionnaire on compulsive shopping, pathologic gambling, hypersexuality and punding. Associated clinical information was obtained through the survey and review of medical electronic records. Results The total ICD prevalence was 24.68% in Group A and 17.1% in Group B (p=0.31). Group A had an increased rate of hypersexuality (p=0.03). Subgroup analysis revealed that men in Group A had a significantly increased frequency of total ICDs when compared to men in Group B (27.7% versus 3.7%, p=0.01). No differences in rates of total ICDs were found between women of Groups A and B (20% versus 25.6%, p=0.78). No association with type, dose, or duration of treatment with DA was noted. Conclusions Males with prolactinomas treated with DAs were 9.9 times more likely to develop an ICD than their counterparts with non-functioning pituitary adenomas. Until prospective studies on the relationship of DA use in prolactinoma patients and ICDs are available, the authors propose that prolactinoma patients be forewarned of possible ICD development with DA therapy. PMID:24274365

  7. Histopathological hoof laminar changes in horses with Pituitary Pars Intermedia Adenoma: cases report

    Directory of Open Access Journals (Sweden)

    L. M. Laskoski

    2015-10-01

    Full Text Available ABSTRACTLaminitis in horses is often associated with endocrine disorders, especially the pituitary pars intermedia dysfunction (PPID in older animals. Morphologic exams of the laminar tissue of the hoof were performed in two horses with suspected PPID, with no clinical signs of laminitis. Changes compatible with laminitis of endocrine origin were observed, such as rounding of the nuclei of the basal cells, thinning and stretching of the secondary epidermal laminae and tissue proliferation. PPID horses with no clinical signs of laminitis may be affected by lesions of the laminar tissue of the hoof that compromise the integrity of the dermal-epidermal junction and may develop clinical symptoms of the disease. It has been suggested that the development stage of endocrine laminitis is longer, but further studies should be conducted to confirm it.

  8. Clinical profile and response to treatment of patients with pituitary adenomas submitted to radiotherapy; Avaliacao do perfil e resposta ao tratamento de pacientes portadores de adenoma hipofisario submetidos a radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Moraes, Paulo Lazaro de; Freire, Geison Moreira; Dias, Rodrigo Souza; Segreto, Roberto Araujo; Segreto, Helena Regina Comodo [Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina. Setor de Radioterapia], e-mail: segreto.dmed@epm.br; Giordani, Adelmo Jose [Pontificia Univ. Catolica de Sao Paulo, SP (Brazil); Abucham Filho, Julio Zaki [Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP (Brazil). Dept. de Endocrinologia

    2008-12-15

    Objective: to evaluate the clinical profile of patients with pituitary adenoma and their response to radiotherapy. Material and method: retrospective study with 22 patients with diagnosis of pituitary adenoma which were submitted to radiotherapy between March 2004 and December 2008. Patients' characteristics such as gender, age, clinical presentation, surgical approach, immunohistochemistry profile, dose of radiation and the response to therapy were analyzed using hormonal dosages and imaging exams. Results: the median age was 51 years and equally distributed in both genders. The tumors were divided according to the Hardy's classification: 27.5% had grade II, 27.5% had grade III and 45% had grade IV. The main symptoms presented by patients at diagnosis were visual impairment in 77% of cases, headache in 68%, amenorrhea and acromegaly in 27% and galactorrhoea in 4.5%. Transphenoidal surgery was performed in 21 patients and only 1 patient was submitted to transcranial approach; 91% of cases had partial resection. Concerning to immunohistochemistry, the expression of ACTH was the most frequent, being present in 41% of cases. The patients were treated in megavoltage equipment mostly with 6 MV linear accelerator. The total radiation dose was 45 Gy in 68% of patients and a dose of 50.4 Gy in 13% of cases. Three-dimensional planning was used in 20 patients. The median follow-up was 41 months. Laboratory and imaging improvement were observed in 73% of patients, stability in 22.5%, and worsening in 4.5%. Conclusion: the results show good rates of response and control of pituitary adenomas by radiation in the first four years after treatment. Considering it has a slow response to treatment, there is a high chance of improvement in results later during the follow-up. (author)

  9. Pituitary apoplexy after gamma knife radiotherapy for pituitary adenomas%垂体腺瘤经伽玛刀治疗后并发垂体卒中12例临床分析

    Institute of Scientific and Technical Information of China (English)

    叶建平; 詹怀义; 李鸣

    2009-01-01

    目的:探讨垂体腺瘤行伽玛刀治疗后并发垂体卒中的诊断、形成原因及治疗原则.方法:回顾12例垂体腺瘤行伽玛刀治疗后并发垂体卒中临床表现、CT和MRI等影像资料以及垂体卒中的治疗方法,并讨论其形成原因. 结果:手术治疗后3例急性卒中后伴意识障碍者恢复正常.8例视力下降者视力恢复至1.0以上,视野恢复正常.一过性尿崩症3例,需激素替代治疗6例. 结论:垂体卒中为垂体腺瘤伽玛刀治疗后的重要并发症之一,诊断主要依据颅脑CT和MRI检查并结合临床症状和体征,本病以手术治疗为主,垂体功能低下者需激素替代治疗.%Objective:To discuss the diagnostic standard, treatment principle and etiology of pituitary apoplexy after gamma knife radiotherapy for pituitary adenomas. Methods:The clinical manifestation, CT and MRI of 12 cases of pituitary apoplexy after gamma knife radiotherapy for pituitary adenomas were analyzed. The treatment methods were reviewed. Results:The mental disorders of 3 cases and the impaired vision of 8 cases were recovery to normal postoperatively. There were 3 cases of transient diabetes insipidus. The hormone replacement was necessary in 6 cases. Conclusion:Pituitary apoplexy was one of main complications of pituitary adenomas after gamma knife radiotherapy. The diagnosis of pituitary apoplexy was mainly based on CT, MRI and combined with clinical manifestation and findings. The treatment should be mainly operation. Hormone replacement was necessary for cases of hypopituitarism.

  10. Down-regulation of Leucine-rich Repeats and Immunoglobulin-like Domain Proteins (LRIG1-3) in HP75 Pituitary Adenoma Cell Line

    Institute of Scientific and Technical Information of China (English)

    GUO Dongsheng; HAN Lin; SHU Kai; CHEN Jian; LEI Ting

    2007-01-01

    Three human leucine-rich repeats and immunoglobulin-like domains (LRIG) genes and proteins, named LRIG1-3, has been previously characterized and it was proposed that they may act as suppressors of tumor growth. The LRIG1 protein can inhibit the growth of tumors of glial cells and the down-regulation of the LRIG1 gene may be involved in the development and progression of the tumor. Real-time reverse transcription-polymerase chain reaction (RT-PCR) is a recently developed technique for quantitative assessment of specific RNA levels. In the current study, it was demonstrated that LRIG1-3 and EGFR mRNA was detected in human pituitary adenoma cell lines and a normal pituitary sample, with differences in the expression levels. Compared to the normal pituitary samples, the expression of LRIG1-3 in HP75 cell line was lower, but the expression of EGFR in HP75 cell line was higher. The results are consistent with LRIG1-3 being tumour suppressor genes, and LRIG genes decreasing the expression of EGFR. The ratio of EGFR/LRIG1 was increased at least 13-fold in HP75 cells compared with the normal pituitary cells, which was also the case for the ratio of EGFR/LRIG2 (14-fold increase in HP75) and EGFR/LRIG3 (11-fold increase in HP75). Further studies were needed to elucidate the explicit role of LRIG genes as negative regulators of oncogenesis in human pituitary adenoma.

  11. [Pituitary tumors: 10 years of experience].

    Science.gov (United States)

    Cecenarro, Laura Anahi; Rodrigo Fanton, Elica Tatiana; Estario, Paula; Papalini, Roque Francisco; Estario, María Éugenia

    2015-01-01

    Introducción: Los tumores hipofisarios comprenden la cuarta parte de las neoplasias intracraneales y los adenomas son el mayor porcentaje de ellos. Son de naturaleza benigna, pero pueden ser invasivos y producir impacto en la morbi-mortalidad. Objetivo: analizar las características clínicas de los pacientes con diagnóstico de adenomas hipofisarios y crear un registro computarizado para mejorar las estrategias de diagnóstico y seguimiento de estos pacientes. Metodología: Se realizó un análisis retrospectivo, descriptivo, de 102 historias clínicas sobre un total de 191 pacientes que concurrieron al servicio de endocrinología desde el año 2003 al 2014 . Las variables fueron analizadas mediante las correspondientes estadísticas descriptivas. Se utilizó el programa SPSS 11.5. Resultados: El 63% fueron mujeres, y el mayor porcentaje etario entre 25-60 años (74.4%). El 54% correspondió a adenomas no funcionantes, el 28% a prolactinomas, el 11.8% somatotropinomas y el 6.2% corticotropinomas. En todos los tipos el grupo femenino fue mayoritario, excepto en los no funcionantes. De los adenomas no funcionantes el 79% fueron macroadenomas, los prolactinomas el 52% fueron microadenomas y se realizó cirugía en el 37% de ellos. Los somatotropinomas, en el 80% fueron macroadenomas, se operó el 80% de los pacientes y radioterapia al 40%. En los corticotropinomas, tanto micro como macroadenomas se presentaron en igual porcentaje (50%) y todos ellos recibieron tratamiento quirúrgico. Conclusión: Los hallazgos coinciden con la literatura en cuanto a frecuencia y edad de presentación de los adenomas. Consideramos valioso la elaboración de un registro que nos permita optimizar el seguimiento y tratamiento de los pacientes, la investigación y divulgación científica.

  12. Gamma irradiation effects on human growth hormone producing pituitary adenoma tissue. An analysis of morphology and hormone secretion in an in vitro model system

    Energy Technology Data Exchange (ETDEWEB)

    Anniko, M. (Karolinska sjukhuset, Stockholm (Sweden). Dept. of Oto-Rhino-Laryngology); Arndt, J. (Karolinska sjukhuset, Stockholm (Sweden). Dept. of Radiophysics, Radiumhemmet); Raehn, T. (Karolinska sjukhuset, Stockholm (Sweden). Dept. of Neurosurgery); Werner, S. (Karolinska sjukhuset, Stockholm (Sweden). Dept. of Endocrinology)

    1982-01-01

    Irradiation-induced effects on pituitary cell morphology and secretion of growth hormone (GH) and prolactin (PRL) have been analysed using an in vitro system. Specimens for organ culture were were obtained from three patients with pituitary tumours causing acromegaly but with different clinical activity of disease. Specimens were followed in vitro 1 h - 6 days after single-dose gamma irradiation (/sup 60/Co) with 70 100 and 150 Gy, respectively. These doses are used in clinical work for the stereotactic radiosuregery of pituitary adenomas. Considerable fluctuations in hormone secretion/release occurred during the first 24h after irradiation. All three tumours showed individual differences concern ing irradiation-induced morphological damage. Only a minor variation occurred between specimens from the same tumour. An individual sensitivity to irradiation of pituitary tumours in vitro is documented. The great number of surviving pituitary tumour cells one week after irradiation-many with an intact ultrastructure and containing hormone granules-indicated an initial high degree of radioresistance.

  13. Feline pituitary-dependent hyperadrenocorticism and insulin resistance due to a plurihormonal adenoma.

    Science.gov (United States)

    Cross, Emily; Moreland, Richard; Wallack, Seth

    2012-02-01

    A 12-year-old female spayed domestic short-haired cat presented for lethargy, poor hair coat, alopecia, difficulty walking, and mild polyuria/polydipsia. The cat's skin tore easily in the neck area during routine restraint for blood draw. Physical examination, blood analysis, and ultrasound imaging were all consistent with pituitary-dependent hyperadrenocorticism (PDH) with secondary insulin-resistant diabetes mellitus, which was nonketotic. Insulin therapy, fluids, and diet change were initiated for the diabetes mellitus and the owner reported improvement in clinical signs although the blood glucose measurements remained elevated. Surgical repair of the torn skin was successful. Although a guarded prognosis was given to the owner because of an advanced stage of hyperadrenocorticism, and the limited treatment options currently available for feline PDH, trilostane was agreed on as an initial therapeutic option. The day trilostane was to be initiated, the cat presented with dyspnea and the owner chose to euthanize. Because of the rarity of hyperadrenocorticism disease in the cat, permission was obtained by the owner for a necropsy to confirm suspected PDH as the underlying cause for insulin resistance and skin fragility syndrome.

  14. The Marine Metabolite SZ-685C Induces Apoptosis in Primary Human Nonfunctioning Pituitary Adenoma Cells by Inhibition of the Akt Pathway in Vitro

    Directory of Open Access Journals (Sweden)

    Xin Wang

    2015-03-01

    Full Text Available Nonfunctioning pituitary adenoma (NFPA is one of the most common types of pituitary adenoma. The marine anthraquinone derivative SZ-685C has been isolated from the secondary metabolites of the mangrove endophytic fungus Halorosellinia sp. (No. 1403 which is found in the South China Sea. Recent research has shown that SZ-685C possesses anticancer and tumor suppressive effects. The tetrazolium-based colorimetric assay (MTT assay to investigate the different effect of the marine compound SZ-685C on the proliferation of primary human NFPA cells, rat normal pituitary cells (RPCs and rat prolactinoma MMQ cell lines. Hoechst 33342 dye/propidium iodide (PI double staining and fluorescein isothiocyanate-conjugated Annexin V/PI (Annexin V-FITC/PI apoptosis assays detected an enhanced rate of apoptosis in cells treated with SZ-685C. Enhanced expression levels of caspase 3 and phosphate and tensin homolog (PTEN were determined by Western blotting. Notably, the protein expression levels of Akt were decreased when the primary human NFPA cells were treated with SZ-685C. Here, we show that SZ-685C induces apoptosis of human NFPA cells through inhibition of the Akt pathway in vitro. The understanding of apoptosis has provided the basis for novel targeted therapies that can induce death in cancer cells or sensitize them to established cytotoxic agents and radiation therapy.

  15. Endoscopic combined “transseptal/transnasal” approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases

    Directory of Open Access Journals (Sweden)

    Yasunori Fujimoto

    2015-07-01

    Full Text Available Objective The purpose of this study was to describe the endoscopic combined “transseptal/transnasal” approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially with respect to cerebrospinal fluid (CSF fistula.Method Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined “transseptal/transnasal” approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed.Results Intra- and postoperative CSF fistulae were observed in 36 (40% and 4 (4.4% patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%.Conclusion The endoscopic combined “transseptal/transnasal” approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.

  16. Single-Cell Phenotypic Characterization of Human Pituitary GHomas and Non-Functioning Adenomas Based on Hormone Content and Calcium Responses to Hypothalamic Releasing Hormones

    Science.gov (United States)

    Senovilla, Laura; Núñez, Lucía; de Campos, José María; de Luis, Daniel A.; Romero, Enrique; García-Sancho, Javier; Villalobos, Carlos

    2015-01-01

    Human pituitary tumors are generally benign adenomas causing considerable morbidity due to excess hormone secretion, hypopituitarism, and other tumor mass effects. Pituitary tumors are highly heterogeneous and difficult to type, often containing mixed cell phenotypes. We have used calcium imaging followed by multiple immunocytochemistry to type growth hormone secreting (GHomas) and non-functioning pituitary adenomas (NFPAs). Individual cells were typed for stored hormones and calcium responses to classic hypothalamic releasing hormones (HRHs). We found that GHomas contained growth hormone cells either lacking responses to HRHs or responding to all four HRHs. However, most GHoma cells were polyhormonal cells responsive to both thyrotropin-releasing hormone (TRH) and GH-releasing hormone. NFPAs were also highly heterogeneous. Some of them contained ACTH cells lacking responses to HRHs or polyhormonal gonadotropes responsive to LHRH and TRH. However, most NFPAs were made of cells storing no hormone and responded only to TRH. These results may provide new insights on the ontogeny of GHomas and NFPAs. PMID:26106585

  17. Hyperpolarization of the Membrane Potential Caused by Somatostatin in Dissociated Human Pituitary Adenoma Cells that Secrete Growth Hormone

    Science.gov (United States)

    Yamashita, Naohide; Shibuya, Naohiko; Ogata, Etsuro

    1986-08-01

    Membrane electrical properties and the response to somatostatin were examined in dissociated human pituitary adenoma cells that secrete growth hormone (GH). Under current clamp condition with a patch electrode, the resting potential was -52.4 ± 8.0 mV, and spontaneous action potentials were observed in 58% of the cells. Under voltage clamp condition an outward K+ current, a tetrodotoxin-sensitive Na+ current, and a Ca2+ current were observed. Cobalt ions suppressed the Ca2+ current. The threshold of Ca2+ current activation was about -60 mV. Somatostatin elicited a membrane hyperpolarization associated with increased membrane permeability in these cells. The reversal potential of somatostatin-induced hyperpolarization was -78.4 ± 4.3 mV in 6 mM K+ medium and -97.2 ± 6.4 mV in 3 mM K+ medium. These reversal potential values and a shift with the external K+ concentration indicated that membrane hyperpolarization was caused by increased permeability to K+. The hyperpolarized membrane potential induced by somatostatin was -63.6 ± 5.9 mV in the standard medium. This level was subthreshold for Ca2+ and Na+ currents and was sufficient to inhibit spontaneous action potentials. Hormone secretion was significantly suppressed by somatostatin and cobalt ions. Therefore, we suggest that Ca2+ entering the cell through voltage-dependent channels are playing an important role for GH secretion and that somatostatin suppresses GH secretion by blocking Ca2+ currents. Finally, we discuss other possibilities for the inhibitory effect of somatostatin on GH secretion.

  18. The Role of OsiriX Based Virtual Endoscopy in Planning Endoscopic Transsphenoidal Surgery for Pituitary Adenoma.

    Science.gov (United States)

    Rotariu, Daniel Ilie; Ziyad, Faiyad; Budu, Alexandru; Poeata, Ion

    2017-01-01

    Virtual endoscopy (VE) is the navigation of a 3D model reconstructed from radiological image data. The aim of this paper is to evaluate the role and accuracy of the virtual endoscopy realized using commercially available software, OsiriX, as a method of planning of surgical interventions. The computed tomographies of 22 patients with pituitary adenomas proposed for endoscopic approach were reconstructed using OsiriX. VE was performed prior to surgery to assess the surgical corridor and particular anatomy. We evaluated the following landmarks: inferior and middle turbinate, sphenoid ostia (SO), choanal arch (Ch), sphenoethmoidal recess (SER), sphenoid septa, sella turcica, carotid prominences and opticocarotid recesses (OCR). The intraoperative endoscopic images were reviewed and compared with the virtual images. The virtual images had a good resemblance with the actual surgical images. All the structures from the nasal cavity were identified and had a perfect matching except the SO which was identified in 8 cases in VE vs. 12 intraoperative. All the structures from the sphenoid sinus were identified with perfect matching except the ipsilateral carotid prominence (14 in VE vs. 10 intraoperative) and the contralateral carotid prominence (16 in VE vs. 18 intraoperative). The VE could not show the state of the sellar floor and did not offer any information about the sellar content. VE realized in OsiriX represents an affordable alternative to the specially designed systems, offering reliable data and good quality images that are useful for the preoperative planning, but some limitations are present such as inability to obtain additional information in cases where the sphenoid sinus is fully occupied by tumor or not aerated, inability to clearly differentiate between structures at the level of the sella, and impossibility to simulate working instruments.

  19. In vivo secretory potential and the effect of combination therapy with octreotide and cabergoline in patients with clinically non-functioning pituitary adenomas

    DEFF Research Database (Denmark)

    Andersen, M; Bjerre, P; Schrøder, H D;

    2001-01-01

    The secretory capacity, in vivo, of clinically non-functioning pituitary adenomas may possibly predict tumour volume reduction during intensive medical therapy. Ten patients (mean (range) 53 years (26-73)) with clinically non-functioning macroadenomas, > or = 10 mm were studied. The secretory...... capacity of the adenomas was examined using basal, NaCl and TRH-stimulated LH, FSH and alpha-subunit levels. The effect on tumour volume of 6 months' therapy with the combination of a somatostatin analogue, octreotide 200 microg x 3/day and a dopamine-D2-agonist, cabergoline 0.5 mg x 1/day was studied....... The basal LH, FSH and alpha-subunit levels were determined before and during 6 months' therapy with octreotide and cabergoline, and MR scans were used to evaluate tumour volume before and during this period of therapy. Octopus-perimetry was used to examine the visual fields. A reduction in tumour volume...

  20. Asymptomatic internal carotid artery occlusion after gamma knife radiosurgery for pituitary adenoma: Report of two cases and review of the literature.

    Science.gov (United States)

    Spatola, Giorgio; Frosio, Laura; Losa, Marco; Del Vecchio, Antonella; Piloni, Martina; Mortini, Pietro

    2016-01-01

    Gamma knife radiosurgery is an effective and safe treatment modality in the management of pituitary adenomas. Internal carotid occlusion is a rare but possible complication of Gamma Knife Radiosurgery for lesions within the cavernous sinus. To stress the importance of considering the Internal carotid artery as an organ at risk in cavernous sinus invading adenomas and reduce the dose delivered to this structure whenever possible. We report two cases of asymptomatic occlusion of the intracavernous segment of the internal carotid artery seven years after treatment in acromegalic patients. After trans-sphenoidal surgery, residual tumour was treated with gamma knife radiosurgery. The maximal doses to the affected artery were higher than 40 Gy and the 90% isodose was close to the arterial wall. Every effort should be done to minimize the radiation dose to the internal carotid artery. If not possible, "hot spots" exceeding the 90% isodose close to this vessel should be avoided.

  1. Candida albicans endophthalmitis in a patient with a non-functioning pituitary adenoma evolving into Cushing׳s disease: A case report

    Directory of Open Access Journals (Sweden)

    Eun Kyoung Lee

    2014-10-01

    Full Text Available A 53-year-old woman presented with complaints of blurred vision in the left eye. She had been treated for recurrent non-functioning pituitary adenoma (NFPA. A vitreous biopsy followed by histopathologic examination showed the presence of Candida albicans. Meanwhile, Cushing׳s disease was diagnosed and gamma knife surgery was performed. Vitrectomy and antifungal treatment improved ocular infection and inflammation. Herein, we describe the first case of C. albicans endophthalmitis in a patient with NFPA evolving into Cushing׳s disease.

  2. TU-CD-304-02: Planning and Delivery of Fully Dynamic Trajectory Modulated Arc Therapy On Pituitary Adenoma: Dosimetric Advantages Over Conventional Volumetric Modulated Arc Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Liang, J; Kim, S [Department of Radiation Oncology, Virginia Commonwealth University, Virginia (United States); Hristov, D [Department of Radiation Oncology, Stanford University, CA (United States); Otto, K [Department of Physics, University of British Columbia, British Columbia (Canada)

    2015-06-15

    Purpose: To assess the potential benefit of trajectory modulated arc therapy (TMAT) for treatments of small benign intracranial tumor, pituitary adenoma. Methods: A TMAT planning platform that incorporates complex source motion trajectory involving synchronized gantry rotation with translational and rotational couch movement was used for the study. The platform couples an interactive trajectory generation tool with a VMAT algorithm that performs multi-resolution, progressive sampling MLC optimization on a user-designed trajectory. A continuous couch rotation of 160° angular span with ±20° mini gantry arcs was used to emulate a non-coplanar horizontal arc-like trajectory. Compared to conventional non-coplanar gantry arcs (60°-100° gantry rotation with couch kicks), TMAT limited the unnecessary low to medium dose spread in the anterior and posterior directions, where primary OARs (e.g., brainstem, optic chiasm, optic nerves, and lens) are in close proximity to the targeted pituitary tumor volume. For 5 standard fractionation pituitary adenoma cases (50.4Gy/28fractions), TMAT and non-coplanar VMAT plans were generated and compared under equivalent objectives/constraints. TMAT delivery was implemented and demonstrated on Varian TrueBeam via XML scripts. Results: Both techniques showed good target coverage while OARs were able to meet the constraints on QUANTEC guidelines. Notably, TMAT decreased the dose deposition in the anterior-to-posterior direction surrounding PTV. TMAT significantly reduced the mean doses on brainstem, optic nerves, eyes and lens by 47.29%±13.17%, 28.51%±8.68%, 80.82%±8.71% and 65.38%±19.99% compared with VMAT, all p≤0.01. Percentage reductions of maximum point dose in eyes and lens were 75.68%±10.30% and 70.72%±18.62% respectively for TMAT versus VMAT, all p≤0.01. A representative isocentric TMAT pituitary plan was delivered via an XML script with 200 control points and 282 MUs. Conclusion: Deliverable TMAT plans were achieved in

  3. Pokemon基因在人垂体腺瘤组织中的表达及其意义%Expression and significance of Pokemon in human pituitary adenoma

    Institute of Scientific and Technical Information of China (English)

    刘玉飞; 张猛; 李维平; 黄国栋

    2012-01-01

    目的 探讨原癌基因Pokemon在人垂体腺瘤组织中的表达及其意义.方法 采用免疫组织化学法检测35例人垂体腺瘤组织和4例正常人垂体前叶新鲜组织中Pokemon蛋白的表达.结果 35例人垂体腺瘤组织中Pokemon的表达均明显高于4例正常垂体前叶组织(P<0.05),垂体瘤免疫组织化学分型与Pokemon的表达差异无统计学意义(P>0.05),垂体腺瘤Pokemon蛋白主要表达在细胞核中.结论 Pokemon的高表达在垂体腺瘤发病机制中可能起重要作用.%Objective To investigate the expression of oncogene Pokemon in human pituitary adenomas (PAs) tissues.Methods Immunohistochemistry was applied to detect the expression of Pokemon protein in 35 cases of PAs tissues and 4 cases of normal pituitary tissues.Results Pokemon was over expressed in 35 cases of Pas tissues as compared with 4 cases of normal pituitary tissues (P < 0.05),and it mainly located in the nuclei of PAs ceils.No significant difference (P > 0.05) was found in the Pokemon expression between the immunohistochemical classifications in PAs.Conclusion The over-expression of Pokemon is likely to play an important part in pathogenesis of pituitary adenoma.

  4. A point mutation of PRL gene in pituitary prolactin-secreting adenoma induced by 17-b-estradiol in SD rats

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Animal model bearing pituitary prolactin-secreting adenomas (prolactinoma) induced by 17-b -estradiol (E2) in both eutopic pituitary and ectopic pituitary grafted under the renal capsule was generated.Northern blotting assay indicated that PRL mRNA level in eutopic prolactinomas was higher than that in normal pituitaries and ectopic prolactinomas (P<0.05-0.01).By polymerase chain reaction (PCR)-single-strand conformation polymorphism (SSCP) analysis and DNA sequencing,a point mutation from C to A occurring at -36 nt in proximal promoter of rat PRL (rPRL) gene was found only in eutopic prolactinomas.No base change was detected in ectopic prolactinomas.Fusion gene transfection assay in vitro exhibited increased activity of the mutant promoter derived from eutopic prolactinoma (P<0.01).These data suggested that the base change in the proximal promoter of rPRL gene may be associated with hyperexpression of rPRL gene in eutopic prolactinomas.The pathogenesis of eutopic and ectopic prolactinomas induced by E2 in SD rats may be separate.

  5. Treatment protocols for growth hormone-secreting pituitary adenomas combined with craniofacial fibrous dysplasia: A case report of atypical McCune-Albright syndrome.

    Science.gov (United States)

    Xu, Jia; Li, Xi; Lv, Chang-Sheng; Chen, Ying; Wang, Meng; Liu, Jian-Feng; Gui, Lai

    2014-09-01

    McCune-Albright syndrome (MAS) is a rare, post-zygotic (non-germline) disorder, characterized by hypersecretory endocrinopathies, fibrous dysplasia of the bone and café-au-lait macules. The most common endocrine dysfunction is gonadal hyperfunction; thus, hypersecretion of growth hormones (GHs) as a manifestation of endocrine hyperfunction in MAS is rarely reported. MAS affects both genders, although the majority of cases have been reported in young females. Atypical presentations of MAS, with only one or two of the classic symptoms, have been previously described, but remain particularly challenging due to the lack of a diagnostic phenotype. In patients with atypical MAS, analysis of mutations in the gene of the α-subunit of the stimulatory G-protein is limited; thus, diagnosis is based on clinical judgment. In the present study, a male with polyostotic fibrous dysplasia and GH-secreting pituitary adenomas, diagnosed with atypical MAS, was reported. The pituitary adenoma was effectively treated with radiotherapy and the patient underwent surgery for the polyostotic fibrous dysplasia, with marked improvements observed in appearance.

  6. Pituitary apoplexy

    Directory of Open Access Journals (Sweden)

    Salam Ranabir

    2011-01-01

    Full Text Available Pituitary apoplexy is rare endocrine emergency which can occur due to infarction or haemorrhage of pituitary gland. This disorder most often involves a pituitary adenoma. Occasionally it may be the first manifestation of an underlying adenoma. There is conflicting data regarding which type of pituitary adenoma is prone for apoplexy. Some studies showed predominance of non-functional adenomas while some other studies showed a higher prevalence in functioning adenomas amongst which prolactinoma have the highest risk. Although pituitary apoplexy can occur without any precipitating factor in most cases, there are some well recognizable risk factors such as hypertension, medications, major surgeries, coagulopathies either primary or following medications or infection, head injury, radiation or dynamic testing of the pituitary. Patients usually present with headache, vomiting, altered sensorium, visual defect and/or endocrine dysfunction. Hemodynamic instability may be result from adrenocorticotrophic hormone deficiency. Imaging with either CT scan or MRI should be performed in suspected cases. Intravenous fluid and hydrocortisone should be administered after collection of sample for baseline hormonal evaluation. Earlier studies used to advocate urgent decompression of the lesion but more recent studies favor conservative approach for most cases with surgery reserved for those with deteriorating level of consciousness or increasing visual defect. The visual and endocrine outcomes are almost similar with either surgery or conservative management. Once the acute phase is over, patient should be re-evaluated for hormonal deficiencies.

  7. Differentiation of clinically non-functioning pituitary adenomas from meningiomas and craniopharyngiomas by positron emission tomography with [{sup 18}F]fluoro-ethyl-spiperone

    Energy Technology Data Exchange (ETDEWEB)

    Lucignani, G.; Moresco, R.M.; Del Sole, A.; Matarrese, M.; Bettinardi, V.; Fazio, F. [INB-CNR, Department of Nuclear Medicine, H.S. Raffaele, Milan (Italy); Losa, M.; Mortini, P.; Giovanelli, M. [Department of Neurosurgery, H.S. Raffaele, Milan (Italy)

    1997-09-01

    The differential diagnosis among various types of non-functioning sellar and parasellar tumours is sometimes difficult using currently available methods of morphological imaging. The aim of this study was to define whether assessment of the uptake of [{sup 18}F]fluoro-ethyl-spiperone (FESP) with positron emission tomography (PET) could be helpful for the differential diagnosis of pituitary adenomas and other parasellar lesions, and for establishing the appropriate therapeutic approach. The population examined comprised 16 patients with the diagnosis of primary tumour of the sellar/parasellar region who were waiting to undergo surgical treatment. The results demonstrated that PET with [{sup 18}F]FESP is a very specific method for differentiating adenomas from craniopharyngiomas and meningiomas. The visual interpretation of images allows such differentiation at approximately 70 min after tracer injection. Semiquantitative analysis of the dynamic PET data confirmed the results of visual interpretation, demonstrating that the uptake of [{sup 18}F]FESP was consistently (i.e. throughout the series) at least two- to threefold higher in non-functioning adenomas than in other parasellar tumours as early as 70 min after tracer injection, and that it increased still further thereafter. It is concluded that PET with [{sup 18}F]FESP might be of clinical value in those cases in which the differential diagnosis among various histological types of sellar tumour is uncertain with conventional methods. (orig.). With 3 figs., 1 tab.

  8. Is peri-operative steroid replacement therapy necessary for the pituitary adenomas treated with surgery? A systematic review and meta analysis.

    Directory of Open Access Journals (Sweden)

    Mamatemin Tohti

    Full Text Available Patients with pituitary adenomas usually receive "stress dose" steroids in the peri-operative peroids. Though randomized controlled trials(RCT have not been performed to assess the necessity of steroid coverage, there are several studies that explained the changes of adrenal function during peri-operative peroids. The aim of the present study is to investigate whether it is necessary to employ conventional peri-operative glucocorticoid replacement therapy to all the patients undergoing surgery.We searched studies addressing peri-operative steroids coverage for pituitary adenomas in the Web of Science, Medline and the Cochrane Library. Then we extracted studies about peri-operative morning serum cortisol(MSC levels, morbidity of early postoperative adrenal insufficiency, postoperative diabetes insipidus, relationships between MSC levels and adrenal integrity. We used RevMan Software to combine the results for meta-analysis. We used fixed-effects models for there was no significant heterogeneity existed.There are 18 studies from 11 countries published between 1987 and 2013 including 1224 patients. The postoperative serum cortisol levels were significantly increased compared with the preoperative one in hypothalamic-pituitary-adrenal axis(HPAA functions preserved patients(P<0.00001. The morbidity of early postoperative adrenal insufficiency ranged from 0.96% to 12.90%, with the overall morbidity of 5.55%(41/739. There was no significant differences of early postoperative diabetes insipidus between no supplementation patients and in supplementation patients(P=0.82. Conversely, there may be some disadvantages of high levels of cortisols such as high incidence of osteopenia and bone derangement and even the increased mortality rate. The patients with MSC levels of less than 60 nmol/l at 3 days after operation is considered as adrenal insufficient and more than 270 nmol/l as adrenal sufficient. To patients with MSC levels of 60-270 nmol/l, we need more

  9. 垂体腺瘤质地与手术入路的探讨%The evaluation for consistency of pituitary adenoma and surgical approach

    Institute of Scientific and Technical Information of China (English)

    王集生; 谢坚; 罗世祺

    2001-01-01

    Objective To discuss the relationship between the hardness of pituitary adenomas with surgical approach.Methods 100 cases with solid tumors were studied. We have reviewed their clinical features, level of hormone, the signal intensity of MR and operative results. Results Among the 88 cases of adenomas with sofe-texture, 36 cases of them were GH secreting adenomas, 21 cases were prolactinomas, 31 cases were nonfunctioning adenomas. 76 cases were with long-T2 MR signal, 12 cases with equal-T2 MR signal, The other 12 cases were with hard-texture, which prolactionmas in 4 cases and nonfunctioning adenomas in 8. Long-T2 MR signal were in 4 patients and equal-T2 signal in 8. Conclusions There are relationship among the signal of T2 weight, level of hormone and texture of adenomas, which are very important for choice of surgical approach.%目的 探讨大垂体腺瘤的手术入路。方法 分析了100例实性垂体腺瘤的临床表现、内分泌检查结果、MR检查T2信号特点及手术情况。结果 肿瘤质地软易切除者88例,其中生长激素腺瘤36例,泌乳激素腺瘤21例,无功能性腺瘤31例;MR检查T2像:高信号76例,等信号12例。肿瘤质地较韧者12例,其中泌乳激素腺瘤4例,无功能性腺瘤8例;MR检查T2像:高信号4例,等信号8例。结论 垂体腺瘤的质地与MR检查T2像信号强度、内分泌测定有关,可以指导大垂体腺瘤的手术入路选择。

  10. Atrial fibrillation associated with a thyroid stimulating hormone-secreting adenoma of the pituitary gland leading to a presentation of acute cardiac decompensation: A case report

    Directory of Open Access Journals (Sweden)

    George Jyothis T

    2008-02-01

    Full Text Available Abstract Introduction Hyperthyroidism is a well established cause of atrial fibrillation (AF. Thyroid Stimulating Hormone-secreting pituitary tumours are rare causes of pituitary hyperthyroidism. Whilst pituitary causes of hyperthyroidism are much less common than primary thyroid pathology, establishing a clear aetiology is critical in minimising complications and providing appropriate treatment. Measuring Thyroid Stimulating Hormone (TSH alone to screen for hyperthyroidism may be insufficient to appropriately evaluate the thyroid status in such cases. Case presentation A 63-year-old Caucasian man, previously fit and well, presented with a five-day history of shortness of breath associated with wheeze and dry cough. He denied symptoms of hyperthyroidism and his family, social and past history were unremarkable. Initial investigation was in keeping with a diagnosis of atrial fibrillation (AF with fast ventricular response leading to cardiac decompensation. TSH 6.2 (Normal Range = 0.40 – 4.00 mU/L, Free T3 of 12.5 (4.00 – 6.8 pmol/L and Free T4 51(10–30 pmol/L. Heterophilic antibodies were ruled out. Testosterone was elevated at 43.10 (Normal range: 10.00 – 31.00 nmol/L with an elevated FSH, 18.1 (1.0–7.0 U/L and elevated LH, 12.4 (1.0–8.0 U/L. Growth Hormone, IGF-1 and prolactin were normal. MRI showed a 2.4 cm pituitary macroadenoma. Visual field tests showed a right inferotemporal defect. While awaiting neurosurgical removal of the tumour, the patient was commenced on antithyroid medication (carbimazole and maintained on this until successful trans-sphenoidal excision of the macroadenoma had been performed. AF persisted post-operatively, but was electrically cardioverted subsequently and he remains in sinus rhythm at twelve months follow-up off all treatment. Conclusion This case reiterates the need to evaluate thyroid function in all patients presenting with atrial fibrillation. TSH-secreting pituitary adenomas must be considered

  11. 垂体窝上口形态学特点与垂体腺瘤生长关系的影像学研究%Imaging study of the relationship between morphological features of pituitary fossa superior orifice and growth pattern of pituitary adenomas

    Institute of Scientific and Technical Information of China (English)

    韦拳堂; 漆松涛; 彭玉平; 陆云涛; 龙浩; 王剑新

    2012-01-01

    Objective To explore the relationship between morphological features of pituitary fossa superior orifice and growth pattern of pituitary adenomas. Methods One hundred patients with pituitary adenomas were selected as pituitary adenoma. One hundred healthy people were set as normal control group. Head CT scan was used to observe the anatomical features of the pituitary fossa superior orifice in healthy people and the sella turcica in patients with pituitary adenoma. The effect of morphological features of pituitary fossa superior orifice on the growth pattern of pituitary adenoma was analyzed. Results The slant angle of pituitary fossa superior orifice was 0.79°±l 1.69° in healthy people and -1.73°±12.42° in pituitary adenoma group. The angle in normal control group can be classified into three types, namely anteverted type, horizontal type and retroverted type. The angle between the longest diameter of tumor and pituitary fossa superior orifice was 91.18°±10.24° in pituitary adenoma patients. According to morphology of the sella turcica, the tumor was of sac type in 41 patients, wok type in 24, cylinder type in 13 and cribriform type in 22. Conclusions Pituitary adenoma grows upward basically perpendicularly to pituitary fossa superior orifice. The slant angle of pituitary fossa superior orifice determines the growth direction of pituitary adenoma toward suprasella.%目的 探讨垂体窝上口形态学特点与垂体腺瘤生长方式的关系.方法 收集100例垂体腺瘤病人作为垂体腺瘤组,正常对照组为100例健康人.运用CT扫描观察正常人垂体窝上口与垂体腺瘤病人蝶鞍的解剖特点,并分析垂体窝上口形态学特点对垂体腺瘤生长方式的影响.结果 正常对照组垂体窝上口倾斜角为(0.79°±11.69°),垂体腺瘤组为(-1.73°±12.42°).该夹角在正常人可分为前倾型、水平型、后仰型.肿瘤最长径与垂体窝上口之间的夹角为(91.18°±10.24°).垂体腺瘤根据蝶鞍

  12. 以视功能障碍为主要表现的垂体腺瘤CT诊断%CT Diagnosis of Visual Dysfunction as the Main Performance of Pituitary Adenoma

    Institute of Scientific and Technical Information of China (English)

    刘正; 王晓

    2014-01-01

    目的:探讨以视功能障碍为主垂体腺瘤的CT诊断价值。方法:回顾分析26例经手术病理证实的视功能障碍为主垂体腺瘤的临床表现及CT征象。结果:26例均主要表现为视功能障碍症状,并有鞍区占位的特定CT征象,均诊断为垂体大腺瘤。结论:要提高对视功能障碍为主要表现垂体腺瘤的认识,鞍区CT检查对其具有明显的诊断优势。%Objective:To investigate the diagnostic value of CT in visual dysfunction of pituitary adenoma. Method:To retrospectively analyze the clinical manifestations and CT findings of 26 patients with pituitary adenomas by visual dysfunction as confirmed by operation and pathology. Result:26 cases were mainly manifested as visual dysfunction symptoms,and saddle area accounts for a specific CT features,and diagnosed as pituitary adenoma. Conclusion:To improve understanding of visual dysfunction as the main performance of pituitary adenoma,CT examination diagnosis sellar region has obvious advantages for its.

  13. Relationship Between Histopathology and Clinical Prognosis of Invasive Pituitary Adenoma%侵袭性垂体腺瘤的组织学与临床预后的关系

    Institute of Scientific and Technical Information of China (English)

    李勇; 舒凯; 董芳永; 万锋; 雷霆; 李龄

    2005-01-01

    目的 分析经蝶窦入路切除的侵袭性垂体腺瘤的组织学侵袭性与临床预后的关系.方法 我科自2000年1月~2003年5月行经蝶手术切除的具有完整影像学、病理学和随访资料的侵袭性垂体腺瘤82例,其中PRL腺瘤39例,GH腺瘤13例,ACTH腺瘤6例,无功能腺瘤24例,随访时间5~30个月.结果 侵袭性垂体腺瘤MRI影像学特点为鞍底受侵下陷,部分肿瘤突入蝶窦;颈内动脉包绕;海绵窦受累,鞍隔突破等,病理检查以鞍底硬膜浸润的发生率最高,并有20例(24.4%)发现有肿瘤内卒中或出血.PRL腺瘤的全切率明显低于无功能腺瘤(P<0.01),而无功能腺瘤、GH腺瘤与ACTH腺瘤之间相差不明显.PRL腺瘤的复发率较无功能腺瘤和GH腺瘤高(P<0.05).结论 侵袭性垂体腺瘤中,无功能腺瘤与GH腺瘤的治疗效果优于PRL腺瘤,垂体腺瘤的侵袭性生物学行为导致手术全切机率下降,是术后复发的主要原因.%To study the relationship between histopathology and clinical prognosis of invasive pituitary adenoma subjected to transsphenoidal surgery. Methods: The enrolled were 82 patients with invasive pituitary adenomas undergoing transsphenoidal surgery during Jan. 2000 May 2003 in our department with full MR imaging findings, pathology data and follow-up information. The follow-up duration was 5 30 months. Results: MR imaging findings of invasive pituitary adenoma included: depression of the sellar floor, involvement of sphenoid sinus and cavernous sinus, breakthrough of diaphragma sellae,encasement of internal carotid artery, etc. Pathological examination revealed that the invasion rate of dura in sella turcica was the highest among the structures around tumor. Pituitary adenoma apoplexy was found in 20 cases (24.4%). The total removal rate for PRL-secreting adenomas was significantly lower than that for non-secreting adenomas (P<0.01), but non-, GH-, ACTH-secreting adenomas had no significant differences. The

  14. Expressions of MMP-2-PEX and MMP-2 in invasive pituitary adenomas and its significance%MMP-2-PEX与MMP-2在侵袭性垂体腺瘤中的表达及意义

    Institute of Scientific and Technical Information of China (English)

    屈洪涛; 杨伊林; 王穗暖; 刘运生; 王强; 董博; 毛宇敏

    2013-01-01

    Objective To investigate the expressions of matrix metalloproteinase-2 hemopexin domain (MMP-2-PEX) and matrix metalloproteinase-2 (MMP-2) in invasive pituitary adenomas and non-invasive pituitary adenomas, and to evaluate the relationship between the expressions of MMP-2-PEX and MMP-2 and the invasion of pituitary adenomas. Methods The expressions of MMP-2-PEX and MMP-2 mRNA were examined by reverse transcription-polymerse chain reaction assay. The relation between MMP-2-PEX and MMP-2, and the correlation between expression of MMP-2-PEX, MMP-2 and invasiveness of pituitary adenomas were studied. Results The expression of MMP-2-PEX mRNA in invasive pituitary adenomas was significantly lower than that of non-invasive pituitary adenomas (P < 0.01). The expression of MMP-2 mRNA in invasive pituitary adenomas was significantly higher than that of non-invasive pituitary adenomas (P<0.01). mRNA level of MMP-2-PEX was negatively related with mRNA of MMP-2 , and there was no correlation between them in non-invasive pituitary adenomas. Conclusion Low level of MMP-2-PEX is closely related with high level of MMP-2, so MMP-2-PEX and MMP-2 can be used as an important index for the evaluation of invasiveness of pituitary adenoma.%目的 研究基质金属蛋白酶-2在C端的血红素样结构域(MMP-2-PEX)和基质金属蛋白酶-2(MMP-2)在侵袭性垂体腺瘤中的表达及其意义.方法 用逆转录酶-聚合酶链反应(RT-PCR)法检测116例垂体腺瘤标本的MMP-2-PEX及MMP-2的表达,分析其与侵袭性垂体腺瘤的关系及两者之间的相关性.结果 侵袭性垂体腺瘤组MMP-2-PEX mRNA表达较非侵袭性垂体腺瘤组显著降低(P<0.01).侵袭性垂体腺瘤组的MMP-2 mRNA表达明显高于非侵袭性垂体腺瘤组(P<0.01).侵袭性垂体腺瘤组中MMP-2-PEX mRNA表达与MMP-2 mRNA表达呈负相关(r=-0.66,P<0.05),而非侵袭性腺垂体腺瘤组中无相关性(r =-0.22,P>0.05).结论 MMP-2-PEX低表达及MMP-2高表达与垂体腺

  15. 侵袭性垂体腺瘤的MRI表现分析%The Invasive Signs on MRI of Invasive Pituitary Adenomas

    Institute of Scientific and Technical Information of China (English)

    蓝燚锋; 卢烈静; 梁碧玲; 马云彪; 范淑玉

    2015-01-01

    Objective To explore the invasive signs on MRI of invasive pituitary adenomas(IPA). Methods A total of 48 patients with giant pituitary adenoma diagnosed by MRI were analyzed, in which, 42 cases were confirmed by surgery. Results The appearance of the tumor was iso-intense on T1WI, iso-intense or high-intense on T2WI, and homogeneously or heterogeneously enhanced after Gd-DTPA injection. MRI findings of invasiveness included encasement of internal carotid artery, invasion of the sella turcica and adjacent bones, involvement of sphenoid sinus and cavernous sinus. 19 cases with grade-4 invasion and 8 cases with grade-3 invasion on MRI were confirmed involvement of cavernous sinus and encasement of internal carotid artery wholly or partly by surgery. Conclusion MRI results have good consistency with the operation. MRI is helpful in evaluating the invasion of pituitary adenomas before operation, which is of great clinical significance for the management of the disease.%目的:分析侵袭性垂体腺瘤的的MRI表现。方法回顾性分析48例MRI诊断为垂体大腺瘤患者的病例资料,其中34例经手术、病理证实。结果肿瘤以等T1、等或稍长T2信号为主,增强扫描后均匀或不均匀强化。肿瘤向周围组织侵犯表现为颈动脉包绕,海绵窦受累;鞍底下陷,部分肿瘤突入蝶窦,突破鞍隔等。MRI判断4级受侵19例,3级受侵8例,2级受侵7例,1级受侵9例,0级受侵5例;术中3-4级均证实海绵窦受侵犯,颈内动脉部分或完全受包绕。结论 MRI检查结果与手术具有较好的一致性,可在术前较客观评估垂体腺瘤是否具有侵袭性及其侵袭范围,对手术方式以及术后治疗方案的选择具有重要的临床意义。

  16. Somatotropinomas, but not nonfunctioning pituitary adenomas, maintain a functional apoptotic RET/Pit1/ARF/p53 pathway that is blocked by excess GDNF.

    Science.gov (United States)

    Diaz-Rodriguez, Esther; Garcia-Rendueles, Angela R; Ibáñez-Costa, Alejandro; Gutierrez-Pascual, Ester; Garcia-Lavandeira, Montserrat; Leal, Alfonso; Japon, Miguel A; Soto, Alfonso; Venegas, Eva; Tinahones, Francisco J; Garcia-Arnes, Juan A; Benito, Pedro; Angeles Galvez, Maria; Jimenez-Reina, Luis; Bernabeu, Ignacio; Dieguez, Carlos; Luque, Raul M; Castaño, Justo P; Alvarez, Clara V

    2014-11-01

    Acromegaly is caused by somatotroph cell adenomas (somatotropinomas [ACROs]), which secrete GH. Human and rodent somatotroph cells express the RET receptor. In rodents, when normal somatotrophs are deprived of the RET ligand, GDNF (Glial Cell Derived Neurotrophic Factor), RET is processed intracellularly to induce overexpression of Pit1 [Transcription factor (gene : POUF1) essential for transcription of Pituitary hormones GH, PRL and TSHb], which in turn leads to p19Arf/p53-dependent apoptosis. Our purpose was to ascertain whether human ACROs maintain the RET/Pit1/p14ARF/p53/apoptosis pathway, relative to nonfunctioning pituitary adenomas (NFPAs). Apoptosis in the absence and presence of GDNF was studied in primary cultures of 8 ACROs and 3 NFPAs. Parallel protein extracts were analyzed for expression of RET, Pit1, p19Arf, p53, and phospho-Akt. When GDNF deprived, ACRO cells, but not NFPAs, presented marked level of apoptosis that was prevented in the presence of GDNF. Apoptosis was accompanied by RET processing, Pit1 accumulation, and p14ARF and p53 induction. GDNF prevented all these effects via activation of phospho-AKT. Overexpression of human Pit1 (hPit1) directly induced p19Arf/p53 and apoptosis in a pituitary cell line. Using in silico studies, 2 CCAAT/enhancer binding protein alpha (cEBPα) consensus-binding sites were found to be 100% conserved in mouse, rat, and hPit1 promoters. Deletion of 1 cEBPα site prevented the RET-induced increase in hPit1 promoter expression. TaqMan qRT-PCR (real time RT-PCR) for RET, Pit1, Arf, TP53, GDNF, steroidogenic factor 1, and GH was performed in RNA from whole ACRO and NFPA tumors. ACRO but not NFPA adenomas express RET and Pit1. GDNF expression in the tumors was positively correlated with RET and negatively correlated with p53. In conclusion, ACROs maintain an active RET/Pit1/p14Arf/p53/apoptosis pathway that is inhibited by GDNF. Disruption of GDNF's survival function might constitute a new therapeutic route in

  17. Correlation between plasma neuropeptide Y and growth hormone in patients with pituitary adenoma%垂体腺瘤患者血浆神经肽Y与生长激素水平相关性研究

    Institute of Scientific and Technical Information of China (English)

    甄自刚; 陈胜利; 马景鑑

    2012-01-01

    目的 探讨垂体腺瘤患者血浆神经肽Y与生长激素之间的相关关系.方法 收集82例垂体腺瘤患者空腹静脉血3ml,进行血浆神经肽Y放射免疫测定分析,并与生长激素水平进行相关分析.初步探讨神经肽Y与生长激素之间的相关性.结果 促性腺激素细胞腺瘤患者中血浆神经肽Y与生长激素呈负相关.而在其他组别中神经肽Y与生长激素均无相关.结论神经肽Y参与了垂体腺瘤病理生理状态中下丘脑.垂体轴生长激素的调节,可能与垂体腺瘤的发生有关.%Objective To investigate the correlation between plasma neuropeptide Y (NPY) and growth hormone (GH) in patients with pituitary adenoma. Methods Fasting venous blood (3 ml per patient) was collected from 82 patients with pituitary adenoma. The level of plasma NPY was measured using radioimmunoassay, and the correlation with GH was analyzed. Results The level of plasma GH was negatively correlated with NPY in patients with go-nadotropin cell adenoma but not in those with pituitary adenoma of other cell-types. Conclusion NPY is involved in the regulation of growth hormone production from the hypothalamus-pituitary axis in pathological conditions, and is possibly associated with development of pituitary adenoma.

  18. 儿童和青少年垂体瘤的临床诊治分析%Clinical analysis of children and adolescents patients with pituitary adenomas

    Institute of Scientific and Technical Information of China (English)

    韩冲; 潘源; 陈高明; 丁学华; 刘志民

    2012-01-01

    目的 探讨儿童和青少年垂体瘤患者的临床资料和诊治特点.方法 回顾性分析1989年至2010年收治的74例儿童和青少年垂体腺瘤患者的病历资料.结果 74例患者中46例(62.2%)发病于青春后期,平均发病年龄17.7岁;男女比例1:1.85;肿瘤直径0.4~6.0cm;海绵窦侵袭性肿瘤24例(2.4%);泌乳素瘤、无功能腺瘤、促肾上腺皮质激素腺瘤及生长激素腺瘤分别为43例(58.1%)、16例(21.6%)、10例(13.5%)和5例(6.8%).24例海绵窦侵袭肿瘤患者中,男性14例,女性10例;43例泌乳素瘤患者男性9例,女性34例.74例患者最常见的临床表现为内分泌症状和视力障碍.所有患者均经手术治疗,术前仅9例患者曾接受多巴胺激动剂治疗,术后部分患者行多巴胺受体激动剂治疗和放疗,49例获随访,6例患者复发后再次手术治疗.32例视力障碍患者中有29例术后恢复正常或改善.结论 儿童和青少年垂体瘤患者好发于青春后期,各类型肿瘤中男女发病比例不同.在儿童和青少年垂体瘤患者中需普及多巴胺受体激动剂治疗,多巴胺受体激动剂、手术及必要时予以放疗可使患者达到良好的治疗效果.%Objective To describe clinical data and characteristics of diagnosis and treatment in children and adolescents patients with pituitary adenoma. Methods From 1989 to 2010, 74 children and adolescents patients with pituitary adenoma were analyzed retrospectively. Results In the 74 patients, 62. 2% of the tumors occurred in postpubertal age, and the average age of onset was 17. 7 years old. The ratio between male and female was 1 ;1. 85. The diameter of tumor was 0. 4-6. 0cm. Twenty-four cases invaded cavernous sinus, including 14 males and 10 lemale. The prolactinomas, nonfunctional adenomas, adrenocorticotropic hormone adenomas and growth hormone adenomas were 43 cases(58. 1% ) ,16 cases(21. 6% ) ,10 cases( 13. 5% ) and 5 cases(6. 8% ) , respectively. There were

  19. Study on chang of histopathology and molecular biology of NPY in human pituitary adenomas%神经肽Y在人垂体腺瘤中组织学和分子生物学变化的研究

    Institute of Scientific and Technical Information of China (English)

    马景鑑; 陈来照

    2009-01-01

    Objective To investigate the localization of neuropeptide Y(NPY) in the subcellular structure and expression of NPY in human pituitary adenomas, and their specificity and relationship. Method The tissues of pituitary adenomas were obtained from 57 patients with pituitary adenomas who underwent surgery in the department of neurosurgery in General hospital of Tianjin Medical University. The localization of NPY in pituitary adenoma cells was studied by immuno-electron microscopy. The expression of NPY in all patients with pituitary adenomas were studied by immunohischemical analysis and RT-PCR. Results (1)Immuno-electron microscopy demonstrated that the positive NPY was located mainly in the secretory granulas in cell matrix of pituitary adenomas. Gold particles were sparsely detected in the rough endoplasmic reticulum and cell matrix. (2) Immunohistochemical analysis showed that NPY was immunodetected in 59.6% (34/57) patients with pituitary adenomas. NPY expression was significantly different among different types of pituitary adenomass (P<0.05). NPY was immunodetected in 91.7% of gonadotrophic adenomas, 66.7% of GH and ACTH adenomas, 50% of null cell adenoma and plurihormonal adenoma, 25% of prolaetinomas. There was significant difference among them(χ~2=11.64, P=0.04). (3) RT-PCR showed that there was signification differentiation (F=4.21, P<0.01) among the expression of NPY in different types of pituitary adenoma. The NPY expression in gonadotrophic adenomas was the highest (7.00±8.32),with 9.3-fold(q=5.2616, P<0.01)compared with prolactinomas(0.75±0.11),5.8-fold (q=5.0143, P<0.01) with non-thnctional adenomas (1.79±2.13),2.7-fold (q=4.07, P<0.05) with GH adenomas (2.59±3.06). There was no significant differentiation among the rest groups. Conclusions (1)NPY really exists in human pituitary adenomas. (2)NPY expression is significantly different among different types of pituitary adenomas. The NPY expression level in gonadotrophic adenomas is the highest, the

  20. Caracterização clínica e imunoistoquímica dos adenomas clinicamente não-funcionantes de hipófise: clinical features and immunohistochemistry Non-functioning pituitary adenomas

    Directory of Open Access Journals (Sweden)

    Jane Eyre Alves Ferreira

    2005-12-01

    ônios hipofisários, para a proteína P 53, proteína C-erb-B2, Ki-67 e sua correlação com o crescimento tumoral. RESULTADOS: Não houve diferença estatisticamente significante entre os sexos masculino e feminino com relação à idade, tamanho tumoral e número de procedimentos cirúrgicos (p=0,279, p=0,813, p=0,139 respectivamente. Existe uma correlação estatisticamente significativa entre tamanho do tumor, número de procedimentos cirúrgicos realizados e deficiência hormonal (p=0,032, p=0,0223 respectivamente. Não houve correlação estatisticamente significativa entre imunoístoquímica positiva para proteína P53, para a proteína C-erb-B2, Ki-67 e o tamanho do tumor (r=0,182, p=0,396; r=-0,181, p=0,397; r=0,272, p=0,199, respectivamente .O tissue micro-array também não demonstrou uma correlação entre a imunoistoquímica positiva para Ki-67 e C-erb-B2 e o tamanho do tumor, porém mostrou uma correlação negativa estatisticamente significativa entre a positividade imunoistoquímica para p53 e o tamanho do tumor (r=-0,696;pClinically non-functioning pituitary adenomas do not produce clinical signs of hormonal hypersecretion. Therefore, signs and symptoms will depend on the mass effect of these adenomas over the central nervous system. Their etiopathogeny is complex and their development is probably influenced by several factors, such as hypothalamic hormones (GHRH, growth factors (FGF, proliferation factors (PCNA, and KI-67, protein P53 and the proto-oncogene c-erb-B2. OBJECTIVE: 1 Determining the clinical features of a population of 117 patients treated for clinically non-functioning pituitary adenoma (age, sex, tumor size, number of surgical procedures, development of hormonal deficiency and hyperprolactinemia. 2 Identifying, after the patients had been clinically characterized, those with clinically non-functioning adenomas with positive immunohistochemistry for hypophyseal hormones (PRL, LH, FSH, GH, TSH and ACTH. 3 Determining if the immunohistochemistry of

  1. Diagnosis and management of pituitary thyrotropin-secreting adenoma%垂体促甲状腺素腺瘤的诊断和处理

    Institute of Scientific and Technical Information of China (English)

    凌南; 李向东; 惠国桢; 王中; 虞正权; 周幽心

    2012-01-01

    目的 探讨垂体促甲状腺素(TSH)腺瘤的临床特点及治疗方法.方法 垂体TSH腺瘤患者4例,男1例,女3例,年龄25-47岁,中位病程7.5年,延误诊断4.2年.4例患者均有不同程度的甲状腺增大和甲亢症状,血浆FT3、FT4、T3、T4增高,3例患者TSH增高.1例对促甲状腺激素释放激素(TRH)激发试验有反应.头部鞍区MRI检查显示3例为大腺瘤,1例为微腺瘤.确诊后4例患者行经鼻-蝶窦人路垂体瘤切除术,其中1例术后辅以放疗.结果 术后病理均证实为垂体腺瘤.随访至今(术后约5-7年),鞍区MRI检查未见肿瘤复发,甲状腺激素水平基本控制在正常范围.结论 垂体TSH腺瘤发病率极低,甲亢患者血清TSH水平不被抑制时应警惕垂体TSH腺瘤的存在;鞍区影像学检查有助于垂体TSH腺瘤的早期诊断和治疗.%Objective To investigate the clinical features and treatment of pituitary thyrotropin-secreting(TSH) adenoma. Methods Data of four patients(1 male, 3 females) with TSH were analyzed retrospectively,who were 29 years old in avarage with a mean history of 7. 5 years. The mean duration of misdiagnosis was 4. 2 years. The patients had the diffuse goitre and hyperthyroidism with high levels of plasma free T3, free T4, total T3 and total T4. Plasma TSH was abnormally increased in 3 cases. Two patients were responsive to thyrotropin releasing hormone (TRH) test MRI showed 2 macro-adenomas and 2 micro-adenomas. All patients had transspheniodal surgery, of whom one had additional postoperative radiotherapy. Results The pituitary TSH adenomas in 4 cases were diagnosed pathologically. The patients have been followed up for 5 to 7 years with thyroid hormones in the normal ranges and without any tumor showed on MRI in all cases. Conclusion The morbidity of pituitary TSH adenoma is wery low. Attention shold be paid to the hyperthyroidism patients with higher plasma level of TSH,in whom MRI examination is helpful in early diagnosis and management.

  2. Fistula liquórica nasal espontânea, sela vazia e restos de adenoma hipofisário Spontaneous rhinorrhea, empty sella, and residual pituitary adenoma: a case report

    Directory of Open Access Journals (Sweden)

    Mario S. Cademartori

    1974-03-01

    Full Text Available É relatado o caso de uma paciente que, aos 20 anos de idade, após episódio de cefaléia fronto-occipital, entrou em amenorréia e, aos 39 anos, apresentou liquorréia nasal com um ano de duração. O estudo radiológico do crânio mostrou aumento das dimensões da sela turcica. O pneumencefalograma mostrou aeração irregular da mesma. Durante a intervenção cirúrgica para correção da fístula, foram encontrados restos de tumor hipofisário sobre o nervo óptico direito; não existia diafragma selar, estando a cavidade selar preenchida por leptomeninge, líquido cefalorraqueano e pequena quantidade de tecido hipofisário no assoalho. O caso fornece razoáveis elementos que comprovam a hipótese de que a atrofia espontânea de tumor hipofisário possa ser considerada como uma das causas que explicam o fato da sela túrcica carecer de conteúdo normal.The case of a 39-years-old patient with an one-year duration rhinorrhea is reported. An headache episode was related at hers 20 years of life, followed by amenorrhea. The sella diameters were increased at X-rays examination and parcial aeration inside the turcic sella was seen by pneumoencephalography. Residual portion of pituitary adenoma was found over the right optic nerve during the surgical procedure. The turcic sella was filled by leptomeningeal tissue, cerebrospinal fluid and rests of pituitary tissue. No sellar diaphragm was seen. This case fournishes creditable elements to the assumption that the so-called empty sella may be explained by pituitary tumor degeneration secondary to apoplexies.

  3. Folate receptor-mediated boron-10 containing carbon nanoparticles as potential delivery vehicles for boron neutron capture therapy of nonfunctional pituitary adenomas.

    Science.gov (United States)

    Dai, Congxin; Cai, Feng; Hwang, Kuo Chu; Zhou, Yongmao; Zhang, Zizhu; Liu, Xiaohai; Ma, Sihai; Yang, Yakun; Yao, Yong; Feng, Ming; Bao, Xinjie; Li, Guilin; Wei, Junji; Jiao, Yonghui; Wei, Zhenqing; Ma, Wenbin; Wang, Renzhi

    2013-02-01

    Invasive nonfunctional pituitary adenomas (NFPAs) are difficult to completely resect and often develop tumor recurrence after initial surgery. Currently, no medications are clinically effective in the control of NFPA. Although radiation therapy and radiosurgery are useful to prevent tumor regrowth, they are frequently withheld because of severe complications. Boron neutron capture therapy (BNCT) is a binary radiotherapy that selectively and maximally damages tumor cells without harming the surrounding normal tissue. Folate receptor (FR)-targeted boron-10 containing carbon nanoparticles is a novel boron delivery agent that can be selectively taken up by FR-expressing cells via FR-mediated endocytosis. In this study, FR-targeted boron-10 containing carbon nanoparticles were selectively taken up by NFPAs cells expressing FR but not other types of non-FR expressing pituitary adenomas. After incubation with boron-10 containing carbon nanoparticles and following irradiation with thermal neutrons, the cell viability of NFPAs was significantly decreased, while apoptotic cells were simultaneously increased. However, cells administered the same dose of FR-targeted boron-10 containing carbon nanoparticles without neutron irradiation or received the same neutron irradiation alone did not show significant decrease in cell viability or increase in apoptotic cells. The expression of Bcl-2 was down-regulated and the expression of Bax was up-regulated in NFPAs after treatment with FR-mediated BNCT. In conclusion, FR-targeted boron-10 containing carbon nanoparticles may be an ideal delivery system of boron to NFPAs cells for BNCT. Furthermore, our study also provides a novel insight into therapeutic strategies for invasive NFPA refractory to conventional therapy, while exploring these new applications of BNCT for tumors, especially benign tumors.

  4. [Successful treatment using detachable coils for traumatic carotid cavernous fistula as a complication of transsphenoidal surgery for a pituitary adenoma: a case report].

    Science.gov (United States)

    Kobayashi, N; Abe, T; Furuya, H; Dohi, K; Shimazu, M; Sasaki, K; Izumiyama, H; Matsumoto, K; Ohki, S; Nemoto, S

    2000-02-01

    We report a case of a patient with traumatic carotid cavernous fistula (CCF) caused by transnasal-transsphenoidal surgery, who was successfully treated using detachable coils. A 47-year-old man was admitted to our hospital because of severe headache. He was confirmed to have a nonfunctioning pituitary adenoma with presellar-type sphenoid sinus. Cerebral angiography initially disclosed no vascular lesions. A transnasal-transsphenoidal adenomectomy was performed. When the anterior wall of the sphenoid sinus was dissected with a chisel, the chisel deeply stuck into the posterolateral part of the sinus. Profuse arterial bleeding was observed through the sphenoid sinus. The bleeding was stopped easily by compression and packing with bone wax. The operation was continued, the sellar floor was opened widely and the tumor was removed subtotally. The medial wall of the cavernous sinus was intact. Histological examination revealed a pituitary adenoma. Immediately after surgery, the patient noticed a bruit. He developed chemosis and abducent palsy on the right side. Cerebral angiography displayed a high-flow CCF, which was attributed to the carotid artery injury caused by the transnasal-transsphenoidal surgery. The CCF disappeared after two-staged embolization using detachable coils, 1st transvenous and 2nd transarterial. Ten months later, cerebral angiography showed persistent occlusion of the fistula, and the patient experienced no tumor recurrence. It is suggested that drilling is a safer procedure than using a chisel for dissection of a sphenoid sinus with incomplete pneumatization. Endovascular treatment using detachable coils proved useful to manage the CCF, an unusual complication of transsphenoidal surgery.

  5. 梗死性垂体腺瘤卒中的临床分析%Clinical analysis of pituitary adenomas apoplexy for ischemic infarction

    Institute of Scientific and Technical Information of China (English)

    肖德勇; 黄银兴; 赵琳; 魏梁锋; 丁陈禹; 王守森

    2015-01-01

    目的:总结梗死性垂体腺瘤卒中的临床特点。方法回顾性分析9例缺血梗死性垂体腺瘤卒中的病例资料。8例有较典型的临床卒中症状。术前存在高生长激素血症6例,伴全垂体功能低下2例。CT或MRI增强扫描示肿瘤周边不均匀环形强化8例,鞍底下陷7例。术中见肿瘤血供差7例,明显干酪样或豆腐渣样组织5例,瘤内少量陈旧性出血2例。结果组织病理均见大片凝固性坏死,生长激素型腺瘤4例,生长激素+卵泡刺激素型腺瘤2例,催乳素型腺瘤1例,无功能型腺瘤2例。术后临床症状均不同程度改善,随访4个月以上,未见明显肿瘤残留或复发。结论梗死性垂体腺瘤卒中临床少见,常有较典型临床卒中症状,MRI表现具有特征性,生长激素型腺瘤具有好发倾向,经蝶入路手术治疗效果满意。%Objective To summary the clinical features of infarcted pituitary adenoma-associated apoplexy (IPAA). Methods Clinical data of 9 IPAA patients were analyzed retrospectively. The typical clinical stroke symptoms were found in 8 patients. Preoperative high serum growth hormone level existed in 6 patients and hypopituitarism in 2. The enhanced CT or MRI scan showed heterogenous ring enhancement in 8 patients and sellar floor depression in 7. During the surgery, poor tumor blood supply was found in 7 patients, caseous or bean-dregs like tissues in 5 and few dark blood clots in 2. Results Pathological examination showed massive coagulation necrosis in all the patients, and growth hormone adenoma in 4, growth hormone+follicle stimulating hormone adenoma in 2, prolactin adenoma in 1 and non-functioning adenomas in 2. Symptoms were improved significantly and no recurrence was seen during follow-up more than 4 months. Conclusions IPAA is rare, often of typical symptoms and characteristic MRI, in which growth hormone pituitary adenomas maybe common and satisfactory recovery results from transsphenoidal surgery.

  6. β-Arrestin 1 and 2 and G protein-coupled receptor kinase 2 expression in pituitary adenomas: role in the regulation of response to somatostatin analogue treatment in patients with acromegaly.

    Science.gov (United States)

    Gatto, Federico; Feelders, Richard; van der Pas, Rob; Kros, Johan M; Dogan, Fadime; van Koetsveld, Peter M; van der Lelij, Aart-Jan; Neggers, Sebastian J C M M; Minuto, Francesco; de Herder, Wouter; Lamberts, Steven W J; Ferone, Diego; Hofland, Leo J

    2013-12-01

    Recent in vitro studies highlighted G protein-coupled receptor kinase (GRK)2 and β-arrestins as important players in driving somatostatin receptor (SSTR) desensitization and trafficking. Our aim was to characterize GRK2 and β-arrestins expression in different pituitary adenomas and to investigate their potential role in the response to somatostatin analog (SSA) treatment in GH-secreting adenomas (GHomas). We evaluated mRNA expression of multiple SSTRs, GRK2, β-arrestin 1, and β-arrestin 2 in 41 pituitary adenomas (31 GHomas, 6 nonfunctioning [NFPAs], and 4 prolactinomas [PRLomas]). Within the GHomas group, mRNA data were correlated with the in vivo response to an acute octreotide test and with the GH-lowering effect of SSA in cultured primary cells. β-Arrestin 1 expression was low in all 3 adenoma histotypes. However, its expression was significantly lower in GHomas and PRLomas, compared with NFPAs (P affect GRK2 and β-arrestin expression in GHomas or in cultured rat pituitary tumor GH3 cells. Noteworthy, β-arrestin 1 was significantly lower (P < .05) in tumors responsive to octreotide treatment in vitro, whereas GRK2 and SSTR subtype 2 were significantly higher (P < .05). Likewise, β-arrestin 1 levels were inversely correlated with the in vivo response to acute octreotide test (P = .001), whereas GRK2 and SSTR subtype 2 expression were positively correlated (P < .05). In conclusion, for the first time, we characterized GRK2, β-arrestin 1, and β-arrestin 2 expression in a representative number of pituitary adenomas. β-Arrestin 1 and GRK2 seem to have a role in modulating GH secretion during SSA treatment.

  7. 2276例不同激素类型垂体腺瘤的临床及病理特点分析%Clinicopathologic features of 2276 cases of pituitary adenomas of different types

    Institute of Scientific and Technical Information of China (English)

    赵昭; 金树梅; 张学斌; 唐帆; 闫学江; 薛凯; 阎晓玲; 姚鑫

    2015-01-01

    Objective To analyze the clinical and pathological features of pituitary adenomas of different types.Methods The clinical data of 2276 patients with pituitary adenomas, surgically resected and conformed by pathology in our hospital from January 1997 to December 2013, were collected.In these patients, 181 were growth hormone (GH) adenomas, 391 were prolactin (PRL) adenomas, 75 were GH/PRL adenomas, 68 were adrenocorticotropic hormone (ACTH) adenomas, 32 were thyrotropic hormone (TSH) adenomas, 493 were follicle-stimulating hormone/luteinizing hormone (FSH/LH) adenomas, 866 were NULL cell adenomas, and 170 were plurihormonal adenomas;the clinicopathologic characteristics of these patients were retrospectively analyzed;the ki-67 index and incidence of stroke were compared between invasive pituitary adenomas and non-invasive pituitary adenomas.Results The percentage of patients with symptoms caused by mass effects (headaches, nausea/vomiting, vision loss, visual field defects and polydipsia polyuria) and hormone abnormality (acromegaly, amenorrhea, galactorrhea and Cushing syndrome) were 79.5% and 26.8%, respectively;endocrine symptoms were common in GH adenomas and PRL adenomas.PRL adenomas, ACTH adenomas and null cell adenomas had higher incidence of invasion among different types of pituitary adenomas.The ki-67 index was not statistically significant between invasive and non-invasive adenomas (2.4±2.2 vs.2.1 ±2.0, P>0.05).The incidence of stroke was not statistically significant between invasive and non-invasive adenomas (9.4% vs.9.3%, P>0.05).Conclusion Pituitary adenomas of different types have different clinical manifestations, and the clinical manifestations and pathological classification is not a one-to-one relationship;the proliferation and apoplexy features in invasive and non-invasive adenomas are not different.%目的 分析不同激素类型垂体腺瘤的临床及病理学特点. 方法 收集天津市环湖医院神经外科自1997年1

  8. Is Peri-Operative Steroid Replacement Therapy Necessary for the Pituitary Adenomas Treated with Surgery? A Systematic Review and Meta Analysis

    Science.gov (United States)

    Tohti, Mamatemin; Li, Junyang; Zhou, Yuan; Hu, Yuebing; Yu, Zhuang; Ma, Chiyuan

    2015-01-01

    Background Patients with pituitary adenomas usually receive “stress dose” steroids in the peri-operative peroids. Though randomized controlled trials(RCT) have not been performed to assess the necessity of steroid coverage, there are several studies that explained the changes of adrenal function during peri-operative peroids. The aim of the present study is to investigate whether it is necessary to employ conventional peri-operative glucocorticoid replacement therapy to all the patients undergoing surgery. Methods We searched studies addressing peri-operative steroids coverage for pituitary adenomas in the Web of Science, Medline and the Cochrane Library. Then we extracted studies about peri-operative morning serum cortisol(MSC) levels, morbidity of early postoperative adrenal insufficiency, postoperative diabetes insipidus, relationships between MSC levels and adrenal integrity. We used RevMan Software to combine the results for meta-analysis. We used fixed-effects models for there was no significant heterogeneity existed. Findings There are 18 studies from 11 countries published between 1987 and 2013 including 1224 patients. The postoperative serum cortisol levels were significantly increased compared with the preoperative one in hypothalamic-pituitary-adrenal axis(HPAA) functions preserved patients(P<0.00001). The morbidity of early postoperative adrenal insufficiency ranged from 0.96% to 12.90%, with the overall morbidity of 5.55%(41/739). There was no significant differences of early postoperative diabetes insipidus between no supplementation patients and in supplementation patients(P=0.82). Conversely, there may be some disadvantages of high levels of cortisols such as high incidence of osteopenia and bone derangement and even the increased mortality rate. The patients with MSC levels of less than 60 nmol/l at 3 days after operation is considered as adrenal insufficient and more than 270 nmol/l as adrenal sufficient. To patients with MSC levels of 60

  9. 垂体瘤凝固性坏死七例报告并文献复习%Pituitary adenoma coagulation necrosis: seven cases report and literatures review

    Institute of Scientific and Technical Information of China (English)

    任铭; 张宏伟; 张明山; 曲彦明; 夏雷; 王浩然; 朱明旺; 于春江

    2014-01-01

    目的 探讨垂体瘤凝固性坏死的临床表现、影像学特点、治疗及预后.方法 总结7例垂体瘤凝固性坏死的临床病例资料,并文献复习.结果 急性起病2例,亚急性起病5例.头痛6例、恶心呕吐3例、视力下降7例、视野缺损6例、眼肌麻痹3例、发热1例.全垂体功能低下4例;仅性腺轴功能低下1例;正常2例.MRI平扫以短T1为主的混杂信号6例,呈短T2低信号环5例;增强扫描肿瘤周边强化7例.术中见肿瘤呈黄白色豆渣样物质6例,呈沙砾样固体组织1例.术后2个月死亡1例,其余6例长期随访预后良好.结论 垂体瘤凝固性坏死是一种特殊类型的梗死性卒中,有特征性MRI表现;经蝶手术治疗为其首选治疗方式,效果理想.%Objective To summary the clinical manifestations,imaging findings,the treatment and prognosis of pituitary adenoma coagulative necrosis.Methods Seven cases were analyzed and the literatures were reviewed.Results In these seven patients,headache (6/7),nausea and vomiting (3/7),visual disturbance (7/7),visual field defect (6/7),ophthalmoplegia (3/7) and fever (1/7) were presented.Endocrine test showed hypopituitarism in four cases and hypogonadotropin in one.Magnetic resonance image (MRI) showed six had mixed intensity signal with hyperintense signal in the majority on T1-weighted image; five had peripheral ring hypointense signal on T2-weighted image.With gadolinium (Gd) enhancement,all seven masses showed peripheral rim enhancement.All the seven patients were finally diagnosed as pituitary adenoma coagulative necrosis pathologically after surgery via transsphenoidal approach.The mass showed yellowy white soybean dregs similar materials in six cases,and pale yellow solid substance in one case.One patient was died two months after surgery; the others showed no recurrence and hypopituitarism as follow-up.Conclusions Pituitary adenoma coagulative necrosis is one rare type of infarction pituitary apoplexy,with unique

  10. 磁共振动态增强扫描在垂体微腺瘤中的价值%The Value of Magnetic Resonance Dynamic Contrast Enhanced Scanning in Pituitary Adenomas

    Institute of Scientific and Technical Information of China (English)

    吴国昌; 李伟; 龙晚生; 罗学毛; 陈曼琼; 何义改

    2012-01-01

    Objective To investigate the diagnosis value of dynamic contrast enhanced MR scanning in pituitary adenoma. Methods 34 pituitary adenoma patients confirmed by clinical diagnosis, MR plain scanning, dynamic contrast enhanced scanning and delayed scaning were underwent on them, analyzing the signal characteristics of pituitary adenoma and the sensitivity in detecting pituitary adenoma of the three methods. Results MR plain scaning discover 19 sellar mass, and 15 pituitary have no significant change, the sensitivity of detecting pituitary adenoma was 44.11 %; dynamic contrast enhanced scanning discover 33 sellar mass, and 1 patient have no significant change, the sensitivity was 97.06%; delayed scanning discover 26 sellar mass, and 8 pituitary have no significant change, the sensitivity was 76.47%. In the detection rate of pituitary adenoma, dynamic enhanced MR scanning was significantly higher than the plain scanning, have statistically difference (P0.05). Conclusion Dynamic contrast enhanced scanning have high accuracy in the diagnosis of pituitary tumors, dynamic contrast enhanced scanning and delayed scanning can be used as the imaging methods in diagnostic of pituitary adenoma.%目的 探讨动态增强扫描在垂体微腺瘤中的诊断价值.方法 对34例经临床确诊的垂体微腺瘤患者,行平扫、动态增强扫描及延迟扫描,分析三者的信号特点及检出该病的灵敏度.结果 平扫发现19例鞍区占位,15例垂体无明显改变,灵敏度为44.11%;动态增强扫描发现33例鞍区占位,1例垂体无明显改变,灵敏度为97.06%;延迟扫描发现26例鞍区占位,8例垂体无明显改变,灵敏度为76.47%.在垂体微腺瘤检出率上,动态增强扫描明显高于平扫,具有统计学差异(P<0.05);延迟扫描明显高于平扫,具有统计学差异意义(P<0.05);动态增强扫描检出率虽高于延迟扫描,但无统计学差异(P>0.05).结论 动态增强对诊断垂体瘤具有较高准确性,动态增

  11. 单鼻孔经蝶入路手术切除垂体腺瘤%Pituitary adenoma resection by single-nostril transsphenoidal approach

    Institute of Scientific and Technical Information of China (English)

    许海洋; 李蕴潜; 赵刚

    2012-01-01

    Objective To summarize the experience of pituitary adenoma resection by single-nostril transsphenoidal approach and analyze the indications,intraoperative and postoperative common problems in order to improve the technique and quality of life.Methods Summarize the clinical data of 611 pituitary adenoma resections by single-nostril transsphenoidal approach from January 2005 to June 2010 retrospectively,reanalyze the choice of operative indications,analyze the bleeding during the operation and sums up the relevant pro cessing suggestions,and summarize the reasons and countermeasures of postoperative visual impairment.Results The tumors were totally removed in 538 cases,sub-resections in 59 cases,sub-totally removed in 14 cases,and no deaths.Eleven cases were poor gasification or concha sphenoid sinus in 11 totally removed patients.The bleeding came from diploe,emissarium,mucosa of sphenoid sinus,diploe,epidural space,dura matter of the sella turcica region,intercavernous sinuses,tumor or the tumor bed.The bleeding was controlled effectively with different approaches.There were 3 patients who underwent visual impairment,and the impairment was improved after treatment.Conclusion Following the correct operation principle,we can improve the rate of total resection; the single-nostril transsphenoidal approach is also suitable for the poor gasification; The prognosis can improve after deal with the intraoperative and postoperative common problems.%目的 总结单鼻孔经蝶入路手术切除垂体腺瘤的经验,针对该术式的适应证及术中、术后常见的问题进行分析,提高手术技巧,改善患者的生存质量. 方法 回顾总结2005年1月至2010年6月的611例经单鼻孔蝶窦入路切除的垂体腺瘤患者的临床资料,对手术的适应证重新进行评估;并对术中出血这一手术难点进行分析,总结出相应的处理建议;对术后视力障碍发生的原因及对策进行分析总结.结果 肿瘤全切除538

  12. DCE-MRI定量分析对垂体腺瘤诊断价值的分析%Diagnose pituitary adenoma using dynamic enhanced MRI: a quantitative approach

    Institute of Scientific and Technical Information of China (English)

    郑文强; 翟建; 陈远军

    2015-01-01

    Objective To evaluate the diagnostic value of quantitative Dynamic Contrast Enhanced MRI analysis on pituitary adenoma.Methods With the standard of pathology and follow-up results,67 cases of microadenoma,20 cases of macroadenoma and 15 cases of normal pituitary were selected and taken routine scanning,meanwhile the dynamic contrast-enhanced scanning was performed,then the characteristics of lesions on conventional images were analyzed,and the mean permeability parameters were measured,including transfer rate (Ktrans),back flux rate (Kep),fractional EES volume (Ve) using Tofts model,which were compared with each other among those three groups and between prolactinoma and somatotroph adenoma;finally,the areas under the ROC curve of permeability parameters were compared.Results 61 cases of 67 cases of pituitary adenoma could be diagnosed by conventional methods,therefore the diagnostic accuracy was 91.1%.The Ktrans,Kep and Ve values were(0.90 ±0.23)/min,(1.14 ±0.58)/min,1.02 ± 0.51 respectively in normal pituitary,and (0.46 ± 0.23)/min,(0.80 ± 0.27)/min,0.73 ± 0.32 in microadenoma and (0.41 ±0.25)/min,(0.71 ±0.48)/min,0.66 ±0.40 in macroadenoma.The Ktrans and Kep in normal adenoma were respectively higher than in microadenoma and macroadenoma,and the difference had statistical significance (P < 0.05),while the Ve value among these three groups had no statistical significance;the Ktrans in prolactinoma was higher than in somatotroph adenoma,and the difference had statistical significance (P < 0.05),while the difference of Kep and Ve between prolactinoma and somatotroph adenoma had no statistical significance.The area under the ROC curve in finding the microadenoma,Ktrans,Kep were 0.915 and 0.738,and the sensitivity of Ktrans and Kep were 92.3% and 53.8%,and the specificity of Ktrans and Kep were 85% and 100%.Conclusion Dynamic contrast-enhanced quantitative parameters,Ktrans and Kep are help to the diagnosis of pituitary adenoma,and K exhibits a

  13. Dynamic computed tomography of the pituitary gland using a single slice scanner in dogs with pituitary-dependent hypercortisolism

    NARCIS (Netherlands)

    Del Magno, Sara; Grinwis, Guy C M; Voorhout, George; Meij, Björn P.

    2016-01-01

    Selective removal of the pituitary adenoma has not been advocated in dogs with pituitary-dependent hypercortisolism because the pituitary adenoma is usually not visualized on routine computed tomography (CT).Dynamic pituitary CT scanning is aimed at the detection of the pituitary flush and, indirect

  14. Inhibitory effect of resveratrol on the proliferation of GH3 pituitary-adenoma cells and voltage-dependent potassium current

    Institute of Scientific and Technical Information of China (English)

    Ming Chu; Lanlan Wei; Chao Wang; Yu Cheng; Kongbin Yang; Baofeng Yang

    2006-01-01

    BACKGROUND:Recent researches indicate that activation of potassium channel is likely to cause many kinds of cells to proliferate and differentiate;using chemical to block the potassium channel can restrain the proliferation of small lung-cancer cells.breast cancer.prostate cancer and human lymphocyte,etc.Previous researches proved that resveratrol(RE),a selective estrogen receptor modulator(SERM).could inhibit growth of GH3 calls,induce apoptosis,and resist tumor through interfering K+ channel.OBJECTIVE:To investigate the effects of RE on Voltage-dependent K+ current [Ik(v)] and cell proliferation in GH3 pituitary-tumor cells.DESIGN:Observational contrast study.SETTING:Department of Neurosurgery.the First Clinical Hospital of Harbin Medical University;Department of Microbiology,Harbin Medical University;Department of Pharmacology,Harbin Medical University.MATERIALS: GH3 pituitary-tumor cell line of rats was purchased from the American Type Culture Collection (ATCC).RE and[3-(4,5-dimethylthiazo1-2-y1)-2.5-diphenyl-tetrazolium bromide](MTT)were obtained from Sigma Chemical CO,St Louis,USA;Ham's F-10 medium from Gibco BRL;Equine serum and fetal bovine serum from Hyclone Laboratories,Logan,UT;FACSCalibur flow cytometer from BD Company,USA.RE was dissolved in ethanol and stored at-20 ℃.It was diluted to different concentrations (10.50,100 μmol/L)with medium and extra cellular solution when needed.rhe final concentration of ethanol was Jess than 0.01%.METHODS:The experiment was carried out in the Department of Microbiology and Pharmacology of Harbin Medical University from March 2005 to January 2006.①Cell preparation:Proliferating indexes affected by 10.50 and 100 μmol/L RE were measured with MTT,respectively.0.0001 volume fraction of ethan ol was added into control group.Inhibitory rate of cellular growth was calculated as the following formula:Inhibitory rate (%)=(1-A value in experimental group/A value in control group)x100%.The experiments mentioned above were

  15. Transsphenoidal pseudocapsule based extracapsular resection of functioning pituitary adenomas%经蝶窦入路假包膜外切除功能性垂体腺瘤

    Institute of Scientific and Technical Information of China (English)

    李俊君; 曹奕强; 王伟民

    2016-01-01

    目的:探讨经蝶窦入路假包膜外切除功能性垂体腺瘤疗效。方法回顾性分析28例采用经蝶窦入路假包膜外切除功能性垂体腺瘤的病例,术后随访6~24个月。结果28例垂体腺瘤病人均在显微镜下全切肿瘤,术后病人临床症状改善,内分泌学检查激素水平恢复正常。术中发生脑脊液漏3例,术中修补后痊愈。术后发生一过性尿崩5例,使用醋酸去氨加压素治疗后得到控制,无垂体功能低下及死亡病例。结论经鼻蝶假包膜外切除功能性垂体腺瘤可提高治愈率,减少并发症发生,值得临床推广与运用。%Objective To evaluate the therapeutic effectiveness of transsphenoidal pseudocapsule-based extracapsular resection (TPER) of functioning pituitary adenomas (FPAs). Methods The clinical data of 28 FPA patients undergoing TPER surgery were analyzed retrospectively. The patients were followed up for 6 to 24 months. Results All the patients underwent total removal of the tumor under the microscope. After the operation, the clinical symptoms of patients were improved, the hormone levels returned to normal. Intraoperative cerebrospinal fluid leakage occurred in 3 patients, no leakage was found after repair. Postoperative transient diabetes insipidus occurred in 5 patients and was controlled with Minirin. There was no hypopituitarism and death. Conclusions TPER of functional pituitary adenomas can improve the cure rate and reduce complications, thus being worthy of clinical use.

  16. Histological and Immunohistochemical Revision of Hepatocellular Adenomas: A Learning Experience

    Directory of Open Access Journals (Sweden)

    S. Fonseca

    2013-01-01

    Full Text Available Light has been shed on the genotype/phenotype correlation in hepatocellular adenoma (HCA recognizing HNF1α-inactivated HCA (H-HCA, inflammatory HCA (IHCA, and β-catenin-activated HCA (b-HCA. We reviewed retrospectively our surgical HCA series to learn how to recognize the different subtypes histopathologically and how to interpret adequately their immunohistochemical staining. From January 1992 to January 2012, 37 patients underwent surgical resection for HCA in our institution. Nine had H-HCA (25% characterized by steatosis and loss of L-FABP expression; 20 had IHCA (55.5% showing CRP and/or SAA expression, sinusoidal dilatation, and variable inflammation; and 1 patient had both H-HCA and IHCA. In 5 patients (14%, b-HCA with GS and β-catenin nuclear positivity was diagnosed, two already with hepatocellular carcinoma. Two cases (5.5% remained unclassified. One of the b-HCA showed also the H-HCA histological and immunohistochemical characteristics suggesting a subgroup of β-catenin-activated/HNF1α-inactivated HCA, another b-HCA exhibited the IHCA histological and immunohistochemical characteristics suggesting a subgroup of β-catenin-activated/inflammatory HCA. Interestingly, three patients had underlying vascular abnormalities. Using the recently published criteria enabled us to classify histopathologically our retrospective HCA surgical series with accurate recognition of b-HCA for which we confirm the higher risk of malignant transformation. We also underlined the association between HCA and vascular abnormalities.

  17. Selective inferior petrosal sinus sampling without venous outflow diversion in the detection of a pituitary adenoma in Cushing's syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Andereggen, Lukas [Bern University Hospital, University Institute of Diagnostic and Interventional Neuroradiology, Bern (Switzerland); Bern University Hospital, Department of Neurosurgery, Bern (Switzerland); Schroth, Gerhard; Gralla, Jan; Ozdoba, Christoph [Bern University Hospital, University Institute of Diagnostic and Interventional Neuroradiology, Bern (Switzerland); Seiler, Rolf; Mariani, Luigi; Beck, Juergen; Widmer, Hans-Rudolf; Andres, Robert H. [Bern University Hospital, Department of Neurosurgery, Bern (Switzerland); Christ, Emanuel [Bern University Hospital, Division of Endocrinology, Diabetology and Clinical Nutrition, Bern (Switzerland)

    2012-05-15

    Conventional MRI may still be an inaccurate method for the non-invasive detection of a microadenoma in adrenocorticotropin (ACTH)-dependent Cushing's syndrome (CS). Bilateral inferior petrosal sinus sampling (BIPSS) with ovine corticotropin-releasing hormone (oCRH) stimulation is an invasive, but accurate, intervention in the diagnostic armamentarium surrounding CS. Until now, there is a continuous controversial debate regarding lateralization data in detecting a microadenoma. Using BIPSS, we evaluated whether a highly selective placement of microcatheters without diversion of venous outflow might improve detection of pituitary microadenoma. We performed BIPSS in 23 patients that met clinical and biochemical criteria of CS and with equivocal MRI findings. For BIPSS, the femoral veins were catheterized bilaterally with a 6-F catheter and the inferior petrosal sinus bilaterally with a 2.7-F microcatheter. A third catheter was placed in the right femoral vein. Blood samples were collected from each catheter to determine ACTH blood concentration before and after oCRH stimulation. In 21 patients, a central-to-peripheral ACTH gradient was found and the affected side determined. In 18 of 20 patients where transsphenoidal partial hypophysectomy was performed based on BIPSS findings, microadenoma was histologically confirmed. BIPSS had a sensitivity of 94% and a specificity of 67% after oCRH stimulation in detecting a microadenoma. Correct localization of the adenoma was achieved in all Cushing's disease patients. BIPSS remains the gold standard in the detection of a microadenoma in CS. Our findings show that the selective placement of microcatheters without venous outflow diversion might further enhance better recognition to localize the pituitary tumor. (orig.)

  18. HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH NONFUNCTIONING PITUITARY ADENOMAS UNDERGOING POSTOPERATIVE RADIATION THERAPY: A CASE-CONTROL STUDY.

    Science.gov (United States)

    González, Baldomero; Vargas, Guadalupe; Espinosa, Etual; Mendoza-Zubieta, Victoria; Ferreira-Hermosillo, Aldo; Zárate, Aldo; Rodríguez, Adolfo; Mercado, Moisés

    2016-05-01

    Nonfunctioning pituitary adenomas (NFPAs) can be associated with significant morbidity including a compromised quality of life (QoL). Radiotherapy (RT) is listed as one of the contributing factors to QoL impairment in these patients, however the evidence supporting this association is scarce and conflicting. Here we evaluate health-related QoL (HRQoL) impairment in patients with NFPA and to what extent this is due to RT. HRQoL was evaluated with the short form-36 questionnaire (SF-36), which explores 8 domains pertaining physical, emotional, and mental well being. We assessed 50 patients with NFPA subjected to RT after pituitary surgery, and their results were compared to those from 127 subjects who had undergone surgery but not RT. Both groups were matched for age, sex, and metabolic and cardiovascular comorbidities. The SF-36 was applied a median of 72 months after RT in the group of cases and 78 months after the last surgical procedure in the control group. Both groups scored equally low in the 8 areas explored by the survey. In a multiple linear regression model, age was significantly associated with worse physical health scores, whereas female sex was associated with worse general health perception and lower emotional role and physical role scores. The presence of a visual field defect was significantly associated with a worse social role functioning score. QoL in patients with NFPAs is significantly compromised in most scales evaluated by the SF-36 survey. However, RT itself does not affect QoL.

  19. 46例垂体瘤的临床特征及影像特点分析%Clinical Features and Imaging Characteristics of 46 Cases with Pituitary Adenomas

    Institute of Scientific and Technical Information of China (English)

    岳欣; 全会标

    2016-01-01

    Objective To retrospectively summarize the clinical features and imaging characteristics of 46 cases with pituitary adenomas.Methods Forty-six cases with pituitary adenomas treated in our hospital between February 2013 and February 2016 were retrospectively analyzed. The age of onset, gender, clinical manifestations, type, size and shape of pituitary adenomas were summarized. The CT and MRI imaging manifestations of pituitary adenomas were analyzed, and the characteristics of CT plain scan, enhanced scan, MRI scan and enhanced scan were summarized.Results Most of the patients with pituitary adenoma were female, and the age of onset was significantly smaller than that of the male patients. The main clinical manifestations included dizziness, vomiting, blurred or declined vision, galactorrhea, amenorrhea and menstrual disorders. In various types of pituitary adenomas, prolactinoma, mixed tumor and ACTH adenomas were common. The detection of micro-adenoma is difficult, and most of them were equal density or low density lesions. Enhanced early pituitary gland showed a limited low density area, with clear boundary; CT plain scanning of large adenomas showed supra sella cistern hemorrhage, with complete capsule and clear boundary, showing homogeneous density or slightly higher density region. The TIWI of micro-adenomas and large adenomas showed low signal or slightly low signal, and T2WI showed high or equal signal; Enhanced scan showed limited low density region, with clear boundary.Conclusion Pituitary adenomas have certain clinical features and they easily occur in women of reproductive age. Most of them are macroadenomas. Patients have dizziness, vomiting, blurred or declined vision, galactorrhea, amenorrhea, menstrual disorders and other symptoms. CT and MRI imaging manifestations of pituitary adenomas have certain characteristics, which can well display necrosis, cystic change and hemorrhage. Both of the two methods are feasible for clinical examination of adenomas

  20. 内镜经鼻蝶窦手术治疗巨大垂体腺瘤(附69例报道)%Endoscopic endonasal transsphenoidal surgery for giant pituitary adenomas: a report of 69 cases

    Institute of Scientific and Technical Information of China (English)

    樊俊; 彭玉平; 漆松涛

    2015-01-01

    Objective To present our experience with the surgical management of giant pituitary adenomas through endoscopic endonasal transsphenoidal approach.Methods A retrospective data analysis of all patients who underwent endoscopic endonasal transsphenoidal surgery in Nanfang Hospital between January 2007 and June 2013 was performed.Patients who presented with pituitary adenomas larger than 4 cm were included in the study.Analysis of factors related to the choice of the operative approach,extent of resection,follow-up outcome,and complications were evaluated.Results Sixty-nine patients (18%) with giant adenomas matched our inclusion criteria.This included 51 (74%) patients with nonfunctional tumors,11 (16%) prolactinomas,and 7 (10%) growth hormone-secreting adenomas.Gross total removal of the tumor was achieved in 26 cases (38%),subtotal removal in 23 (33%),and 20 (29%) had partial resection.Postoperative diabetes insipidus occurred in 9 cases (13%),new anterior pituitary insufficiency in 10 (15%),CSF leaks in 2 (3%),and meningitis in 2(3%).There was no dead case.The patients with Knosp score 3-4 adenomas had a higher total resection rate than those with Knosp score 0-2 (P < 0.001).Preoperative headache,visual dysfunction,oculomotor disorders and hypopituitarism were recovered in 20 (83%),59 (86%),9 (60%),and 12 (36%) cases,respectively.Nine patients with nonfunctional tumors underwent a second transsphenoidal surgery,10 underwent radiotherapy,and 14 had a follow-up care.Drug therapy was performed in 11 patients with functional tumors,and radiotherapy in 3.Conclusions Endoscopic endonasal surgery might provide safe and effective treatment for patients with giant adenomas.The selection of surgical approach should be established according to the tumor extension and personal experience.In cases in which total resection might be associated with high risk,we advocated the use of partial resection followed by adjuvant drug therapy or

  1. Self-perception of cognitive function among patients with active acromegaly, controlled acromegaly, and non-functional pituitary adenoma: a pilot study.

    Science.gov (United States)

    Yedinak, Chris G; Fleseriu, Maria

    2014-08-01

    Pituitary adenomas (PAs) represent 15 % of all brain tumors. One-sixth of these are reported to cause acromegaly via excess growth hormone secretion. These tumors have been associated with multiple comorbidities, including neuropsychiatric and cognitive dysfunction. We aimed to assess patient perception of cognitive deficits and the relationship of cognitive changes to active acromegaly (AA) versus controlled acromegaly (CA) versus non-functional PAs (NFPA). A modified FACT-Cog survey was used, which focused on the prevalence and severity of perceived dysfunction in five areas of cognitive function: ability to learn, concentration/distractibility, mental agility, memory and recall, and verbal recall. Patient perception of current health and health change over the previous 12 months was also assessed. The overall perceived prevalence and severity of cognitive dysfunction were the highest among NFPA groups, particularly in the areas of mental agility, verbal recall, and memory/recall. Patients with AA reported greater prevalence and severity of dysfunction with respect to concentration/distractibility and ability to learn. Patients with AA reported the best overall current health, though patients with CA reported the greatest improvement in health over the previous year. These findings may indicate that PAs can affect cognitive function regardless of whether excess growth hormone is present. Acromegaly and NFPA patients perceive specific areas of cognitive dysfunction that may require further evaluation and treatment. Further research may be useful regarding patient quality of life, patient functionality during normal daily activities, and perceived dysfunction despite biological disease control.

  2. 无功能性垂体腺瘤围手术期内分泌水平的变化及诊断进展%Nonfunctioning pituitary adenomas perioperative endocrine levels and diagnostic progress

    Institute of Scientific and Technical Information of China (English)

    李彪; 田君; 王守森

    2014-01-01

    无功能性垂体腺瘤起源于垂体前叶上皮细胞,约占垂体腺瘤的1/3,大多数患者临床表现为头痛、视物模糊。但是部分患者术前及术后出现垂体功能减退。肿瘤对门静脉及垂体柄的压迫导致垂体前叶缺血坏死是引起垂体功能低下的主要机制,术中操作、肿瘤大小及残留都可导致新发垂体功能低下。术前主要以生长激素缺乏为主,而术后出现各个激素轴的改变。垂体功能减退容易被忽视,仅靠激素基础值的检测诊断远远不够,必要时需行刺激试验确诊。一旦明确垂体功能减退,充足的激素替代治疗能够提高患者的生活质量。%Nonfunctioning pituitary adenomas originate in the epithelial cells of the anterior pituitary, which accounts for about 1/3 of pituitary adenomas .The most common clinical symptoms in patients with nonfunctioning pituitary adenomas are headache and visual changes .Some patients present hypopituitarism pre-or postoperation .Portal vein and pituitary stalk are compressed by adenomas and cause ischemic necrosis of the anterior pituitary , which is the main mechanism of hypopituitarism .Growth hormone deficiency is the mainly manifestation in the preoperation , the various hormone axis change in the postoperation .Hypopituitarism is often overlook easily , hormone-based detection and diagnosis alone is not enough, the stimulation test is needed when necessary .Once hypopituitarism is confirmed, adequate hormone replacement therapy can improve the quality of life of patients .

  3. The clinacal significance of detecting endocrine hormones in pituitary adenoma patients withadenomectomy%PRL型和GH型垂体瘤手术前后内分泌激素水平监测的临床意义

    Institute of Scientific and Technical Information of China (English)

    孙刚

    2012-01-01

    Objective To investigate the clinical significance of endocrine hormone levels monitored before and after PRL and GH type of pituitary tumor surgery. Methods prolactin (PRL) adenoma, 36 cases of growth hormone (GH) adenoma,29 cases before and after surgery serum PRL, GH level of detection. Results Total resection of PRL adenomas and GH adenoma patients 7 and 14 days after hormone levels were lower than the preoperative and surgery is not the total resection group, the difference was statistically significant( P < 0. 05 ). Conclusion Surgical treatment can significantly improve the state of high hormone levels in patients with pituitary tumors before surgery, postoperative PRL and GH levels can be used as an important indicator of the degree of removal of the judge of PRL-and GH pituitary tumor surgery.%目的 探讨PRL型和GH型垂体瘤手术前后内分泌激素水平监测的临床意义.方法 泌乳素(PRL)腺瘤36例和生长激素(GH)腺瘤29例,对手术前后血清PRL、GH水平进行检测.结果 PRL腺瘤及GH腺瘤手术全切组患者术后1、7、14d时激素水平,均低于术前和手术未全切组,差异有统计学意义(P<0.05).结论 手术治疗可以明显改善垂体瘤患者术前高激素水平状态,术后PRL和GH水平可做为判断PRL型和GH型垂体瘤手术切除程度的重要指标.

  4. Combined beta FSH and beta LH response to TRH in patients with clinically non-functioning pituitary adenomas.

    Science.gov (United States)

    Somjen, D; Tordjman, K; Kohen, F; Baz, M; Razon, N; Ouaknine, G; Stern, N

    1997-05-01

    'Paradoxical' responses of LH, FSH, alpha-subunits and beta LH to TRH have previously been reported in individuals with clinically non-functioning pituitary tumours (NFT). The present study was designed to assess the in vivo and in vitro responses of beta FSH to TRH in NFT. We further examined the possibility that a TRH challenge with combined measurement of beta FSH and beta LH will identify a common anomalous secretory pattern in patients with NFT. Forty patients with NFT underwent a standard TRH test (400 micrograms intravenously). Blood samples for the determination of beta FSH, beta LH, FSH and LH were collected prior to TRH as well as 15, 30, 45, 60 and 90 minutes following injection. Additionally, cultured adenomatous cells from eight to these patients were exposed to TRH in the absence and presence of octreotide and gonadotropin subunits were determined. TRH elicited a marked rise in circulating beta FSH in 29 of 40 individuals and in beta LH in 28 of 36 patients with NFT. In a subgroup of eight individuals whose tumours were harvested during surgery and cultured for 7-21 days, TRH increased beta FSH or beta LH and alpha-subunit release in cultured adenomatous cells in all cases, including tumours from subjects not responding to TRH in vivo. In this subgroup of patients octreotide inhibited basal beta FSH secretion but not basal beta LH secretion both in vivo and in primary cultures of NFT cells. Both the in vivo and in vitro beta FSH, beta LH and alpha-subunit responses to TRH were entirely inhibited by octreotide. In all, 38 of the 40 subjects could be identified by either elevated basal beta FSH or beta LH levels and/or an abnormal rise in either beta FSH or beta LH in response to TRH. The measurement of basal and TRH-stimulated beta-FSH and beta-LH levels identifies an abnormal hormonal secretory pattern in the vast majority (> 90%) of patients with clinically nonfunctioning pituitary tumours.

  5. Neuro-endoscopic endonasal transsphenoidal surgery for the large pituitary adenoma:78 cases report%内镜下经鼻蝶入路切除垂体大腺瘤:附78例报告

    Institute of Scientific and Technical Information of China (English)

    王斌; 徐培坤; 程宏伟; 冯春国; 张科

    2015-01-01

    目的 探讨单纯使用神经内镜照明下经鼻蝶入路切除垂体大腺瘤的方法及应用价值.方法 2011年7月-2014年5月,对78例垂体大腺瘤在单纯使用神经内镜照明下经右侧单鼻孔-蝶窦入路进行手术切除.术中主要使用磨钻磨除同侧蝶窦前壁及鞍底骨质,分别使用0°和30°内镜进行瘤腔内瘤体切除. 结果 78例患者中全切除垂体腺瘤62例(79.49%),次全切除12例(15.38%),大部分切除3例(3.85%),部分切除1例(1.28%).其中71例术后获得了2个月~2年的随访,瘤体未见复发;49例头痛症状消失;47例视力均有不同程度改善;12例月经恢复;21例肢端肥大症患者面容及手脚均有不同程度地缩小.激素水平复查PRL恢复正常32例,GH恢复正常21例,ACTH恢复正常2例. 结论 经鼻内镜垂体瘤切除术是一个简便、安全、微创的外科技术.随着内镜器械的不断更新,其操作灵活性和舒适度不断改善,内镜下经鼻蝶切除垂体腺瘤必将得到更广泛的开展.%Objective To summarize the experience of the simple neuroendoscopic endonasal transsphenoidal surgery for the large pituitary adenoma and discuss it's application value.Methods Seventy-eight cases of the large pituitary adenoma treated by simple neuroendoscopic endonasal transsphenoidal surgery from July,2011 to May,2014 were analyzed retrospectively.Tumors were resected using 0 and 30 degree endoscope after opening the same side of the anterior wall of the sphenoidal sinus and sellar bone using the abrasive drilling during operation.Results The tumor removal was total in 62 (79.49%),subtotal in 12 (15.38%),major in 3(3.85%) and part in 1 (1.28%).Seventy-one cases were followed up for 2 months to 2 years after operation and no recurrence was founded,the symptoms of headache disappeared in 49 cases;The vision of patients was improved in 47 cases,menstruation resumed in 12 cases;The acromegaly of patients reduced in 21 cases.Hormone level

  6. The Disorders of Growth Hormone Secretion in Women with Polycystic Ovary Syndrome Compared to Patients with the Non-Functional Pituitary Adenomas

    Directory of Open Access Journals (Sweden)

    Yu.M. Urmanova

    2016-06-01

    Full Text Available Objective of the study — to investigate the disorders of growth hormone (GH secretion in women with polycystic ovary syndrome (PCOS compared to patients with non-functional pituitary adenomas (NFPA. Under our supervision during period from September 2015 to March 2016, there were 15 female outpatients of childbearing age with PCOS and 15 — with NFPA. Average age of patients was 25.5 and 28.9 years, respectively. The duration of disease ranged from 7 months to 9 years. It was found that in both groups, there were neuroendocrine disorders typical for each pathology. So, in the first group of patients with PCOS, the following violations were most often: obesity, striae, acanthosis, аcne, hyperandrogenemia, hyperpolyme­norrhea, and in the second one — secondary amenorrhea, hyperprolactinemia, panhypopituitarism. In both groups, there was anovulation, as well as decline of GH and insulin-like growth factor‑1 (IGF‑1 secretion. In addition, patients with NFPA had significantly decreased basal levels of tropic hormones — GH, luteinizing hormone (LH and follicle-stimulating hormone (FSH on the background of hyperprolactinemia and normal values of IGF‑1, while in patients with PCOS, the levels of GH, LH, FSH were reduced on the background of hyperandrogenemia and IGF‑1 decline. Thus, it was found that in the group of patients with PCOS, there was the most significant reduction of basal IGF‑1 levels, whereas GH deficiency was less frequent. Patients with NFPA had panhypopituitarism, namely combined deficiency of GH, LH, FSH, thyroid stimulating hormone, while IGF‑1 deficiency was less frequent. Disorders of GH and IGF‑1 secretion identified in our study confirm the literature data that patients with PCOS have a reduction in the levels of GH and IGF‑1 on the background of hyperinsulinemia and hyperandrogenaemia.

  7. Clinical feature of pituitary adenomas in the aged patients(a report of 46 cases)%老年垂体腺瘤患者46例临床分析

    Institute of Scientific and Technical Information of China (English)

    魏宇佳; 安宁; 刘仕勇; 宋业纯; 杨辉

    2011-01-01

    Objective To enhance the levels of the clinical diagnosis and treatment of pituitary adenomas in the aged patients.Methods The clinical data of 46 aged patients with pituitary adenomas, who underwent surgery from January, 2001 to January, 2009,were analyzed retrospectively, including the disease course, clinical manifestation, immunohistochemical examination, complications before and after the operation and the data gained by following up. All the data were compared to those of 91 patients with pituitary adenomas, aged 45~59 years, serving as control group. Results The disease course was significantly longer and the occurrence rates of headache or dizziness, defect of visual field, macroadenoma, preoperative complication and nonfunctioning adenoma were significantly higher in the aged group than those in the control group (P<0.05). Most patients suffered from hypopituitarism and needed to be treated by the hormone and some patients even suffered from serious osteoporosis after the operation in the aged patients with pituitary adenomas. Conclusions Great attention should be pay to the aged patient with pituitary adenomas which should be diagnosed and treated as early as possible. The close following up and timely treatment of the postoperative complication is helpful to improving postoperative life quality in the aged patients with pituitary patients undergoing surgery.%目的 探讨老年垂体腺瘤患者的临床特征及手术疗效,为老年垂体腺瘤患者的临床诊治提供参考.方法 回顾性分析2001年1月至2009年1月收治的46例老年垂体腺瘤患者(老年组)的临床资料,包括其临床表现、术后病理结果 及术后并发症等,并与同期住院的91例非老年患者(对照组)相比较.结果 与对照组相比,老年组患者病程明显较长,以头痛头晕为主诉、就诊时视野缺损、巨大腺瘤、术前合并其它疾病及无功能腺瘤者所占比例明显增高(P<0.05).术后数月至数年多数

  8. MRI characteristics of pituitary adenomas and relationships among the adenomas volume, serum GH levels and pathological immune responses in patients with acromegaly%肢端肥大症型垂体腺瘤MRI特点及其与血清GH水平、肿瘤GH表达水平的关系分析

    Institute of Scientific and Technical Information of China (English)

    孔令胜; 姚维成; 栗世方; 贺昭忠; 成磊

    2014-01-01

    目的:探讨肢端肥大症型垂体腺瘤MRI特点及其与血清生长激素(GH)水平、肿瘤GH表达水平之间的关系。方法回顾性分析2008年1月~2013年6月采用经鼻蝶入路显微手术切除的84例肢端肥大症型垂体腺瘤患者的临床资料。结果MRI显示肿瘤可突破鞍膈向鞍上生长、突破鞍底向蝶窦内生长,鞍下侵犯指数[(2.35±0.69)cm]明显高于鞍上侵犯指数[(0.66±0.25) cm;P0.05)。结论肢端肥大症型垂体腺瘤有明显的向蝶窦内优先侵犯生长的趋势;其术前血清GH水平、肿瘤GH表达水平及瘤体大小之间无明显相关性。%Objective To explore the MRI characteristics of the pituitary adenomas and relationships among the adenomas volume, basic serum growth hormone (GH) level, pathological immune responses in the patients with acromegaly. Methods The clinical data of 84 acromegaly patients with pituitary adenomas, who underwent microsurgery via single-nostril transspheniodal approach from January, 2008 to June, 2013, were analyzed retrospectively. Results MRI showed that some tumors broke the sellar diaphragm into suprasellar regions or the sellar floor into the sphenoid sinuses. Infrasellar invasion index [(2.35±0.69) cm] was significantly higher than that [(0.66 ± 0.25) cm] of suprasellar invasion index (P0.05). Conclusions The pituitary adenomas volumes are insignificantly related to the preoperative basic serum GH level, and GH pathological immune response strength in the patients with cromegaly, in whom the pituitary adenomas trends to growth into the sphenoid sinuses.

  9. Indium-111 pentetreotide single-photon emission tomography in patients with TSH-secreting pituitary adenomas: correlation with the effect of a single administration of octreotide on serum TSH levels

    Energy Technology Data Exchange (ETDEWEB)

    Losa, M. [Department of Neurosurgery, IRCCS San Raffaele, University of Milan (Italy); Magnani, P. [INB-CNR Department of Nuclear Medicine, IRCCS San Raffaele, University of Milan (Italy); Mortini, P. [Department of Neurosurgery, IRCCS San Raffaele, University of Milan (Italy); Persani, L. [Centro Auxologico Italiano IRCCS, University of Milan (Italy); Acerno, S. [Department of Neurosurgery, IRCCS San Raffaele, University of Milan (Italy); Giugni, E. [Department of Neurosurgery, IRCCS San Raffaele, University of Milan (Italy); Songini, C. [INB-CNR Department of Nuclear Medicine, IRCCS San Raffaele, University of Milan (Italy); Fazio, F. [INB-CNR Department of Nuclear Medicine, IRCCS San Raffaele, University of Milan (Italy); Beck-Peccoz, P. [Institute of Endocrine Sciences, Istituto Clinico Humanitas, University of Milan (Italy); Giovanelli, M. [Department of Neurosurgery, IRCCS San Raffaele, University of Milan (Italy)

    1997-07-01

    Few data are available on the visualization of somatostatin receptors in vivo in patients with thyrotropin (TSH)-secreting adenoma. We studied five patients with TSH-secreting adenomas using single-photon emission tomography (SPET) after administration of indium-111 pentetreotide. The intensity of {sup 111}In-pentetreotide uptake by the tumours was correlated with the degree of TSH suppression after a single administration of 100 {mu}g octreotide s.c. Five patients (three women and two men) aged 27-46 years were investigated. Except for one patient with acromegaly, all had pure TSH-secreting tumours. One patient was previously untreated, while two had received octreotide, one antithyroid drugs, and one radioiodine. In all patients SPET demonstrated increased uptake of {sup 111}In-pentetreotide by the pituitary adenoma. The target to non-target ratio (T/nT) of {sup 111}In-pentetreotide uptake was higher than 10 in three patients. Administration of 100 {mu}g octreotide s.c. caused a significant reduction in TSH levels from 4.8{+-}1.4 mU/l to a nadir of 3.1{+-}1.1 mU/l after 6 h (P<0.001 by ANOVA). Suppression of TSH secretion ranged from 30% to 60% of the baseline value. The T/nT ratio showed a trend toward a direct relationship with the degree of TSH inhibition after acute octreotide administration (r=0.67; P=NS). Our study showed that {sup 111}In-pentetreotide scan visualized somatostatin receptors in all five of the patients with TSH-secreting pituitary adenomas, confirming the frequent presence of somatostatin receptors in these rare tumours, even though the correlation with the TSH inhibition after a single administration of octreotide did not reach significance. (orig.). With 1 fig., 1 tab.

  10. 经眉弓锁孔入路与单鼻孔蝶窦入路显微手术治疗垂体腺瘤的比较%Microneurosurgery for pituitary adenoma by supraorbital keyhole or endonasal transsphenoidal approaches

    Institute of Scientific and Technical Information of China (English)

    李学元; 李新钢; 张学广; 张连群; 马翔宇; 赵鹏

    2009-01-01

    Objective To compare the clinical effects of microneurosurgery by supraorbital key-hole or endonasal transsphenoidal approaches in the treatment of pituitary adenoma and investigate their complications. Methods We retrospectively analyzed the data of 87 patients with pituitary adenoma of which the anteroposterior diameter was less than 3 cm. These patients, admitted to our hospital from May, 2006 to June, 2008, were operated in an endoscope-assisted microsurgical manner via a supraorbital key-hole approach (n=42) or an endonasal transsphenoidal approach (n=45). The efficacy of these two approaches was compared and their complications were observed. Results The excision rate of the pituitary adenoma developing on or around the sella turcica operated through the supraorbital key-hole approach was significantly higher than that through the endonasal transsphenoidal approach(P0.05). The incidence rate of epistaxis and unilateral dysosphresia in the supraorbital key-hole approach was significantly lower as compared with that in the endonasal transsphenoidal approach (P0.05);眉弓锁孔入路组患者术后鼻衄和一侧嗅觉减退发生率(0,0)明显低于单鼻孔蝶窦入路组(11%,20%),差异有统计学意义(P<0.05).结论 眉弓锁孔入路手术无嗅觉减退、鼻衄、蝶窦炎等并发症的发生,适于向鞍上、鞍旁生长的垂体腺瘤,具有较大的临床推广价值.

  11. Radiation necrosis of the optic chiasm, optic tract, hypothalamus, and upper pons after radiotherapy for pituitary adenoma, detected by gadolinium-enhanced, T1-weighted magnetic resonance imaging: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Tachibana, O.; Yamaguchi, N.; Yamashima, T.; Yamashita, J. (Univ. of Kanazawa School of Medicine (Japan))

    1990-10-01

    A 26-year-old woman was treated for a prolactin secreting pituitary adenoma by surgery and radiotherapy (5860 rads). Fourteen months later, she developed right hemiparesis and dysarthria. A T1-weighted magnetic resonance imaging scan using gadolinium contrast showed a small, enhanced lesion in the upper pons. Seven months later, she had a sudden onset of loss of vision, and radiation optic neuropathy was diagnosed. A T1-weighted magnetic resonance imaging scan showed widespread gadolinium-enhanced lesions in the optic chiasm, optic tract, and hypothalamus. Magnetic resonance imaging is indispensable for the early diagnosis of radiation necrosis, which is not visualized by radiography or computed tomography.

  12. Long-term (up to 18 years) effects on GH/IGF-1 hypersecretion and tumour size of primary somatostatin analogue (SSTa) therapy in patients with GH-secreting pituitary adenoma responsive to SSTa

    OpenAIRE

    Maiza, Jean Christophe; Vezzosi, Delphine; Matta, Maria; Donadille, Florence; Loubes-Lacroix, Florence; Cournot, Maxime; Bennet, Antoine; Caron, Philippe

    2007-01-01

    Context The role of somatostatin analogues (SSTa) in the treatment of acromegaly. Objective To evaluate the antihormonal and antitumour efficacy of long-term (up to 18 years) primary treatment with SSTa in patients with GH-secreting pituitary adenoma responsive to SSTa. Design An open, prospective, single-centre, clinical study. Patients Thirty-six acromegalic patients, aged 17–75 years (postoral glucose tolerance test GH > 1 µg/l, increased IGF-1 for age and sex), were monitored in a single ...

  13. Familial pituitary tumor syndromes.

    Science.gov (United States)

    Elston, Marianne S; McDonald, Kerrie L; Clifton-Bligh, Roderick J; Robinson, Bruce G

    2009-08-01

    The vast majority of pituitary tumors are benign and occur sporadically; however, they can still result in significant morbidity and even premature mortality through mass effects and hormone dysfunction. The etiology of sporadic tumors is still poorly understood; by contrast, advances have been made in our understanding of familial pituitary adenoma syndromes in the past decade. Currently, four genes are known to be associated with familial pituitary tumor syndromes: MEN1, CDKN1B, PRKAR1A and AIP. The first three genes are associated with a variety of extrapituitary pathologies, for example, primary hyperparathyroidism with multiple endocrine neoplasia type 1, which might aid identification of these syndromes. By contrast, AIP mutations seem to occur in the setting of isolated familial pituitary adenomas, particularly of the growth-hormone-secreting subtype. Awareness and identification of familial pituitary tumor syndromes is important because of potential associated pathologies and important implications for family members. Here, we review the current knowledge of familial pituitary tumor syndromes.

  14. 海绵窦内侧壁的显微解剖与扩大经蝶窦入路治疗侵袭海绵窦的垂体腺瘤%TThe Therapy of Cavernous Sinus Parietal Microdissection and Expand Sphenoid Sinus Approach in Invasion Cavernous Sinus Pituitary Adenoma

    Institute of Scientific and Technical Information of China (English)

    王志恩

    2016-01-01

    目的:研究海绵窦内侧壁的显微解剖与扩大经蝶窦入路治疗侵袭海绵窦的垂体腺瘤方法。方法随机选取2013年1月~2015年12月我院收治的22例垂体腺瘤患者临床资料,应用海绵窦内侧壁的显微解剖与扩大经蝶窦入路治疗侵袭海绵窦的手术方法。结果22例垂体腺瘤患者均顺利完成手术,19例垂体腺瘤全部切除,3例垂体腺瘤次全切除,未发生感染、昏迷和死亡病例。结论海绵窦内侧壁的显微解剖与扩大经蝶窦入路治疗侵袭海绵窦的垂体腺瘤手术效果理想。%Objective To study the therapy of cavernous sinus parietal microdissection and expand sphenoid sinus approach in invasion cavernous sinus pituitary adenoma.Methods Randomly selected 22 patients with pituitary adenoma clinical data from January 2013 to December 2015 in our hospital, which were application therapy of cavernous sinus parietal microdissection and expand sphenoid sinus approach.Results 22 patients with pituitary adenoma patients were successfully operated, 19 patients total removal of pituitary adenoma, 3 patients subtotal resection of pituitary adenoma, infection did not occur, coma and death.Conclusion Expansion of the cavernous sinus microdissection transsphenoidal approach over the side wall of the treatment of pituitary adenomas invading the cavernous effect.

  15. Analysis of the Postoperative Hypopituitarism in Pituitary Adenomas after Endoscopic Trans-Sphenoidal Microsurgery%内镜经鼻蝶术后垂体腺瘤患者腺垂体功能低下情况分析

    Institute of Scientific and Technical Information of China (English)

    倪世慧; 毕长龙; 杨亦春; 赵立伟; 贾玉锋; 王继庆; 孙飞

    2016-01-01

    [目的]检测垂体腺瘤患者内镜经鼻蝶术后相关激素水平变化,分析影响垂体功能低下的因素,指导其激素替代治疗.[方法]总结本院神经外科2008年至2013年内镜下经鼻蝶手术82例垂体腺瘤患者的临床资料及治疗方法,测定患者术前及术后d3甲状腺轴、肾上腺轴及性腺轴相关激素水平并进行比较.[结果]患者术后d3甲状腺轴及肾上腺轴激素水平较术前有所降低,发生腺垂体功能低下者共34例,占41.5%(34/82).高龄、术前存在垂体功能低下、无功能型、大型肿瘤患者术后发生垂体功能低下比例较高,其中微腺瘤发生率为16.7%(2/12),大腺瘤45.7%(32/70),45例无功能腺瘤发生腺垂体功能减低者16例,占35.5%.而术后腺垂体功能低下发生与患者性别无关.[结论]垂体腺瘤术后垂体相关各项激素水平较术前会有不同程度的下降;术前高龄、垂体功能低下、无功能性垂体腺瘤及肿瘤体积较大的患者,术后发生腺垂体功能低下可能性较高,合理的激素替代疗法有利于患者康复.%[Objective]To investigate the change in the hormonal level of the pituitary adenomas resected by the endoscopic trans-sphenoidal microsurgery,to evaluate the postoperative damaging factors of pituitary function,and to guide hormonal replacement therapy.[Methods]We retrospectively analyzed the clinical data and therapeutic methods of 82 cases of obtained pituitary adenomas.The determinations of the hormonal level preoperative and 3d postoperative were detected.These results suggested hypopituitarism and were statistically analyzed.[Results]The pituitary hormone levels,including thyroid hormone,corticosteroid,and prolactin, were lower 3 days postoperatively in all patients (P <0.05).Hypopituitarism was found in 34 cases and ac-counted for 41.4% of the total 82 patients,including 2 cases of microadenomas (12 cases,2.4%),22 cases of macroadenomas and giant adenomas (70 cases,16.7%),and 16

  16. Growth hormone-secreting pituitary adenoma with concomitant colorectal cancer: a report of 8 cases%垂体生长激素腺瘤合并结直肠癌:附8例报告

    Institute of Scientific and Technical Information of China (English)

    伍韶斌; 陈志康; 陈晋湘; 葛杰; 袁伟杰; 裴海平; 陈子华

    2011-01-01

    Objective To study the clinical characteristics of growth hormone (GH) -secreting pituitary adenoma with concomitant colorectal cancer. Methods The clinical and pathological data of 8 patients with GH-secreting pituitary adenoma and concomitant colorectal cancer admitted from 2006 to 2011 were retrospectively analyzed. Results There were 6 male and 2 female patients, and the median age was 59 (48-69) years. The history of acromegaly caused by pituitary tumor of the patients ranged from 10 to 30 years. Two patients had undergone treatment for pituitary adenoma. The serum levels of hormones were detected and MRI/CT examinations were performed before surgery. All patients were diagnosed as having colorectal cancer by colonoscopic biopsy and all underwent radical operation for colorectal cancer. The clinical stages of the tumor were Dukes B and C. Adjuvant chemotherapy was given in all patients after surgery. The postoperative complications included pulmonary infection , hypertension , hyperglycemia , hypokalemia, etc. , which were all resolved by symptomatic treatments. No anastomotic fistula or abdominal infection occurred. One case was self - discharged from hospital against advice (and then was lost to follow-up). The other 7 cases were followed up for 2 to 44 months and all were alive. Conclusions For patients with GH-secreting pituitary adenoma and concomitant colorectal cancer, the comprehensive treatments for colorectal cancer shoud be adopted first, and later the pituitary adenoma is treated according to the patient' s situation.%目的 探讨垂体生长激素腺瘤合并结直肠癌的临床特征.方法 回顾分析2006-2011年收治的8例垂体生长激素腺瘤合并结直肠癌的临床和病理资料.结果 男6例,女2例;中位年龄59岁(48 ~69岁).有垂体瘤肢端肥大病史10 ~30年,2例已行垂体瘤治疗.术前检测激素水平和MRI及CT影像学检查.经纤维结肠镜活检确定为结直肠癌.所有患者均按结直肠癌

  17. Retinal nerve fiber layer loss documented by Stratus OCT TM in patients with pituitary adenoma: case report Perda da camada de fibras nervosas retiniana documentada por meio do Stratus OCT TM em pacientes com adenoma hipofisário: relato de caso

    Directory of Open Access Journals (Sweden)

    Bruno Campelo Leal

    2006-04-01

    Full Text Available PURPOSE: To report abnormalities of retinal nerve fiber layer (RNFL thickness using optical coherence tomography (Stratus OCT TM in patients with pituitary adenoma. METHODS: Two patients with long-standing bitemporal visual field defects and optic nerve band atrophy were submitted to optical coherence tomography examination (Stratus OCT TM. RESULTS: Both patients with band atrophy revealed diffuse loss of the retinal nerve fiber layer on Stratus OCT TM, with severe reduction in the nasal and temporal areas of the optic disc. Retinal nerve fiber layer loss correlated well with visual field loss and with previous histological studies of band atrophy of the optic nerve. CONCLUSIONS: Stratus optical coherence tomography can provide useful information in the diagnosis of band atrophy from chiasmal lesions such as pituitary adenomas.OBJETIVO: Relatar alterações na camada de fibras nervosas retiniana (CFNR com o uso da tomografia de coerência óptica (Stratus OCT TM em pacientes com adenoma hipofisário. MÉTODOS: Dois pacientes com defeito perimétrico bitemporal de longa duração e atrofia em banda do nervo óptico foram examinados com tomografia de coerência óptica (Stratus OCT TM. RESULTADOS: Ambos pacientes demonstraram perda difusa da camada de fibras nervosas retiniana com redução acentuada nas regiões nasal e temporal do disco óptico. A perda da camada de fibras nervosas retiniana se correlacionou com o defeito de campo visual e com os estudos histológicos de atrofia em banda do nervo óptico. CONCLUSÕES: A tomografia de coerência óptica (Stratus OCT TM pode apresentar grande utilidade no diagnóstico da atrofia em banda decorrente de lesões quiasmáticas tais como os adenomas pituitários.

  18. 垂体生长激素腺瘤的临床和病理特征%Clinical and pathological characteristics of patients with growth hormone-secreting pituitary adenomas

    Institute of Scientific and Technical Information of China (English)

    陈晓; 何新尧; 陈宇凡; 赵卫国; 孙青芳; 卞留贯; 王卫庆; 宁光

    2013-01-01

    目的 探讨垂体生长激素(GH)腺瘤患者的临床及病理学特征.方法 回顾性分析92例垂体GH腺瘤患者的临床资料,均采用经鼻蝶手术治疗.结果 本组患者均有典型肢端肥大症状,但只有20例出现其他内分泌症状;共有微腺瘤20例,大腺瘤72例;侵袭性腺瘤19例,非侵袭性73例;术后免疫组织病理学结果示,GH(+)15例,GH(+)和泌乳素(+)38例,GH(+)和促肾上腺皮质激素(+)2例,GH(+)和促卵泡激素(+)1例,GH(+)和促黄体激素(+)l例;包括GH在内的三种及以上激素(+)35例.术后1周总缓解率为55.4%(51/92).单纯GH(+)腺瘤缓解率为66.7%(10/15),伴其它激素阳性腺瘤缓解率为53.2%(41/77),两者无统计学差异(P>0.05).73例患者术后随访3~52个月,平均30.3个月,肢端肥大症状、月经不调、溢乳、性欲减退和甲状腺功能异常缓解率分另为86.3%(63/73)、71.4%(5/7)、66.7%(4/6)、33.3%(2/6)和42.9%(3/7).结论 多数垂体GH腺瘤组织病理学表现为多激素阳性腺瘤,但是仅有少数患者表现出除肢端肥大症外的其它内分泌症状.%Objective To analyze the clinical and pathological characteristics of growth hormone (GH)-secreting pituitary adenomas.Methods The clinical and pathological data of 92 patients with GH-secreting pituitary adenomas,who underwent microsurgery from January,2000 to July,2012,were analyzed retrospectively.Results Of 92 GH-secreting pituitary adenomas,the pathological findings showed that 20 were microadenoma (≤ 10 mm in size) and 72 macroadenoma (>10 mm in size); 19 were invasive adenomas and 73 non-invasive; 15 were GH-positive adenomas and 77 GH-positive and other hormones positive (38 were GH-and prolactin-positive).All patients presented with acromegaly,but only 20 patients (21.7%) presented with other endocrinolgical symptoms besides acromegaly.The overall rate of postoperative symptom relief was 55.4% (51/92) one week after operation,and there were no

  19. Transsphenoid surgery of pituitary adenoma of growth hormone%经蝶窦入路手术治疗垂体生长激素腺瘤

    Institute of Scientific and Technical Information of China (English)

    高广忠; 卞留贯

    2011-01-01

    Objective To explore the effect of tumor size, preoperative GH and the intraoperative growth hormone ( GH) measurement on the operative outcome in pituitary adenoma of GH. Methods The clinical data of 47 patients with acromegaly wereanalyzed retrospectively . The oral glucose tolerance test was used in pre-operative diagnosis and post-operative evaluation. All the patients were operated through transsphenoid and the intraoperative GH was measured in 19 patients. Results After the operation, the symptoms of acromegaly were significantly relieved in 30 patients. According to the criteria of remission, there were 29 (61. 7% ) . However, the remission rate of microadenoma (77. 7%) was significantly higher than that in macroadenoma (51. 7%). Conclusion The early diagnosis of acromegaly is the crucial of the improvement of surgical outcome. For the doubt cases,OGTT is helpful for the early diagnosis. The transsphenoid approach is the first choice of the treatment of acromegaly. The intraoperative GH measurement is valuable for the early evaluation of surgical outcome. If the intraoperative GH can be rapidly and timely measured, it will be effective to increase the remission rate.%目的 探讨垂体生长激素(GH)腺瘤患者的肿瘤大小、术前GH水平、术中GH的动态变化对手术效果的影响.方法 回顾分析47例垂体GH腺瘤,18例术前行口服糖耐量试验(OGTT);均采用经蝶窦入路手术,19例术中检测GH水平,21例术后1个月行OGTT试验.结果 术后随访期内临床症状明显缓解的30例,随访期内GH<2.0.g/ml的有29例,总的缓解率61.7%,其中微腺瘤77.7%、大腺瘤的缓解率是51.7%.结论 垂体GH腺瘤患者的早期诊断是提高手术效果的关键,OGTT抑制试验有助于早期诊断;经鼻蝶入路手术是治疗首选,术中GH的动态观察有助于早期判断手术效果,若能及时快速测定GH,将有助于提高缓解率.

  20. Analysis of volumetric response of pituitary adenomas receiving adjuvant CyberKnife stereotactic radiosurgery with the application of an exponential fitting model

    Science.gov (United States)

    Yu, Yi-Lin; Yang, Yun-Ju; Lin, Chin; Hsieh, Chih-Chuan; Li, Chiao-Zhu; Feng, Shao-Wei; Tang, Chi-Tun; Chung, Tzu-Tsao; Ma, Hsin-I; Chen, Yuan-Hao; Ju, Da-Tong; Hueng, Dueng-Yuan

    2017-01-01

    Abstract Tumor control rates of pituitary adenomas (PAs) receiving adjuvant CyberKnife stereotactic radiosurgery (CK SRS) are high. However, there is currently no uniform way to estimate the time course of the disease. The aim of this study was to analyze the volumetric responses of PAs after CK SRS and investigate the application of an exponential decay model in calculating an accurate time course and estimation of the eventual outcome. A retrospective review of 34 patients with PAs who received adjuvant CK SRS between 2006 and 2013 was performed. Tumor volume was calculated using the planimetric method. The percent change in tumor volume and tumor volume rate of change were compared at median 4-, 10-, 20-, and 36-month intervals. Tumor responses were classified as: progression for >15% volume increase, regression for ≤15% decrease, and stabilization for ±15% of the baseline volume at the time of last follow-up. For each patient, the volumetric change versus time was fitted with an exponential model. The overall tumor control rate was 94.1% in the 36-month (range 18–87 months) follow-up period (mean volume change of −43.3%). Volume regression (mean decrease of −50.5%) was demonstrated in 27 (79%) patients, tumor stabilization (mean change of −3.7%) in 5 (15%) patients, and tumor progression (mean increase of 28.1%) in 2 (6%) patients (P = 0.001). Tumors that eventually regressed or stabilized had a temporary volume increase of 1.07% and 41.5% at 4 months after CK SRS, respectively (P = 0.017). The tumor volume estimated using the exponential fitting equation demonstrated high positive correlation with the actual volume calculated by magnetic resonance imaging (MRI) as tested by Pearson correlation coefficient (0.9). Transient progression of PAs post-CK SRS was seen in 62.5% of the patients receiving CK SRS, and it was not predictive of eventual volume regression or progression. A three-point exponential model is of potential predictive value

  1. Parathyroid adenoma

    Science.gov (United States)

    Hyperparathyroidism - parathryoid adenoma; Overactive parathyroid gland - parathyroid adenoma ... The parathyroid glands in the neck help control calcium use and removal by the body. They do this by ...

  2. Structure of the TPR domain of AIP: lack of client protein interaction with the C-terminal α-7 helix of the TPR domain of AIP is sufficient for pituitary adenoma predisposition.

    Science.gov (United States)

    Morgan, Rhodri M L; Hernández-Ramírez, Laura C; Trivellin, Giampaolo; Zhou, Lihong; Roe, S Mark; Korbonits, Márta; Prodromou, Chrisostomos

    2012-01-01

    Mutations of the aryl hydrocarbon receptor interacting protein (AIP) have been associated with familial isolated pituitary adenomas predisposing to young-onset acromegaly and gigantism. The precise tumorigenic mechanism is not well understood as AIP interacts with a large number of independent proteins as well as three chaperone systems, HSP90, HSP70 and TOMM20. We have determined the structure of the TPR domain of AIP at high resolution, which has allowed a detailed analysis of how disease-associated mutations impact on the structural integrity of the TPR domain. A subset of C-terminal α-7 helix (Cα-7h) mutations, R304* (nonsense mutation), R304Q, Q307* and R325Q, a known site for AhR and PDE4A5 client-protein interaction, occur beyond those that interact with the conserved MEEVD and EDDVE sequences of HSP90 and TOMM20. These C-terminal AIP mutations appear to only disrupt client-protein binding to the Cα-7h, while chaperone binding remains unaffected, suggesting that failure of client-protein interaction with the Cα-7h is sufficient to predispose to pituitary adenoma. We have also identified a molecular switch in the AIP TPR-domain that allows recognition of both the conserved HSP90 motif, MEEVD, and the equivalent sequence (EDDVE) of TOMM20.

  3. Structure of the TPR domain of AIP: lack of client protein interaction with the C-terminal α-7 helix of the TPR domain of AIP is sufficient for pituitary adenoma predisposition.

    Directory of Open Access Journals (Sweden)

    Rhodri M L Morgan

    Full Text Available Mutations of the aryl hydrocarbon receptor interacting protein (AIP have been associated with familial isolated pituitary adenomas predisposing to young-onset acromegaly and gigantism. The precise tumorigenic mechanism is not well understood as AIP interacts with a large number of independent proteins as well as three chaperone systems, HSP90, HSP70 and TOMM20. We have determined the structure of the TPR domain of AIP at high resolution, which has allowed a detailed analysis of how disease-associated mutations impact on the structural integrity of the TPR domain. A subset of C-terminal α-7 helix (Cα-7h mutations, R304* (nonsense mutation, R304Q, Q307* and R325Q, a known site for AhR and PDE4A5 client-protein interaction, occur beyond those that interact with the conserved MEEVD and EDDVE sequences of HSP90 and TOMM20. These C-terminal AIP mutations appear to only disrupt client-protein binding to the Cα-7h, while chaperone binding remains unaffected, suggesting that failure of client-protein interaction with the Cα-7h is sufficient to predispose to pituitary adenoma. We have also identified a molecular switch in the AIP TPR-domain that allows recognition of both the conserved HSP90 motif, MEEVD, and the equivalent sequence (EDDVE of TOMM20.

  4. Hypersecretion of the alpha-subunit in clinically non-functioning pituitary adenomas: Diagnostic accuracy is improved by adding alpha-subunit/gonadotropin ratio to levels of alpha-subunit

    DEFF Research Database (Denmark)

    Andersen, Marianne; Ganc-Petersen, Joanna; Jørgensen, Jens Otto Lunde;

    2010-01-01

    BACKGROUND: In vitro, the majority of clinically non-functioning pituitary adenomas (NFPAs) produce gonadotropins or their alpha-subunit; however, in vivo, measurements of alpha-subunit levels may not accurately detect the hypersecretion of the alpha-subunit. AIM: We wanted to estimate the refere......BACKGROUND: In vitro, the majority of clinically non-functioning pituitary adenomas (NFPAs) produce gonadotropins or their alpha-subunit; however, in vivo, measurements of alpha-subunit levels may not accurately detect the hypersecretion of the alpha-subunit. AIM: We wanted to estimate...... the reference intervals and decision limits for gonadotropin alpha-subunit, LH and FSH levels, and aratio (alpha-subunit/LH+FSH), especially taking into consideration patient gender and menstrual status. Furthermore, we wanted to examine if the diagnostic utility of alpha-subunit hypersecretion was improved...... patients with NFPAs. Gonadotropin alpha-subunit, LH and FSH levels were measured and alpha-ratios were calculated. RESULTS: In healthy adults, the cut-offs for alpha-subunit levels were significantly different between men and pre- and postmenopausal women: the cut-offs were 1.10, 0.48 and 3.76 IU...

  5. Risk-adapted single or fractionated stereotactic high-precision radiotherapy in a pooled series of nonfunctioning pituitary adenomas. High local control and low toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Bostroem, Jan Patrick [MediClin Robert Janker Clinic and MediClin MVZ Bonn, Department of Radiosurgery and Stereotactic Radiotherapy, Bonn (Germany); University Hospital of Bonn, Department of Neurosurgery, Bonn (Germany); Meyer, Almuth [HELIOS Klinikum Erfurt, Department of Endocrinology, Erfurt (Germany); Pintea, Bogdan [University Hospital of Bonn, Department of Neurosurgery, Bonn (Germany); Gerlach, Ruediger [HELIOS Klinikum Erfurt, Department of Neurosurgery, Erfurt (Germany); Surber, Gunnar; Hamm, Klaus [HELIOS Klinikum Erfurt, Department of Radiosurgery, Erfurt (Germany); Lammering, Guido [MediClin Robert Janker Clinic and MediClin MVZ Bonn, Department of Radiosurgery and Stereotactic Radiotherapy, Bonn (Germany); Heinrich-Heine-University of Duesseldorf, Department of Radiotherapy and Radiation Oncology, Duesseldorf (Germany)

    2014-12-15

    The purpose of this work was to evaluate a prospectively initiated two-center protocol of risk-adapted single-fraction (SRS) or fractionated radiotherapy (SRT) in patients with nonsecretory pituitary adenomas (NSA). A total of 73 NSA patients (39 men/34 women) with a median age of 62 years were prospectively included in a treatment protocol of SRS [planning target volume (PTV) < 4 ccm, > 2 mm to optic pathways = low risk] or SRT (PTV ≥ 4 ccm, ≤ 2 mm to optic pathways = high risk) in two Novalis registered centers. Mean tumor volume was 7.02 ccm (range 0.58-57.29 ccm). Based on the protocol guidelines, 5 patients were treated with SRS and 68 patients with SRT. Median follow-up (FU) reached 5 years with 5-year overall survival (OS) of 90.4 % (CI 80.2-95 %) and 5-year local control and progression-free survival rates of 100 % (CI 93.3-100 %) and 90.4 % (CI 80.2-95 %), respectively. A post-SRS/SRT new visual disorder occurred in 2 patients (2.7 %), a new oculomotor nerve palsy in one pre-irradiated patient, in 3 patients (4.1 %) a pre-existing visual disorder improved. New complete hypopituitarism occurred in 4 patients (13.8 %) and in 3 patients (25 %) with pre-existing partial hypopituitarism. Pituitary function in 26 % of patients retained normal. Patients with tumor shrinkage (65.75 %) had a significantly longer FU (p = 0.0093). Multivariate analysis confirmed correlation of new hypopituitarism with duration of FU (p = 0.008) and correlation of new hypopituitarism and tumor volume (p = 0.023). No significant influence factors for occurrence of visual disorders were found. Our SRS/SRT protocol proved to be safe and successful in terms of tumor control and protection of the visual system, especially for large tumors located close to optic pathways. (orig.) [German] Evaluation eines prospektiv angelegten Behandlungsprotokolls einer risikoadaptierten Radiochirurgie (SRS) oder stereotaktischen Radiotherapie (SRT) von Patienten mit hormoninaktiven Hypophysenadenomen

  6. High dose radiotherapy for pituitary tumours

    Energy Technology Data Exchange (ETDEWEB)

    Mead, K.W. (Queensland Radium Inst., Herston (Australia))

    1981-11-01

    The results of treatment of 120 pituitary tumours are presented. Based on this experience operable chromophobe adenomas are now treated with 5,000 rads in 4 weeks and inoperable ones receive an additional central dose to 7,500 rads. Pituitary Cushing's tumours are given 10,000 rads in 5 weeks using small fields and acromegalics 5,000 rads to the whole sella and 7,500 to its lower half. The absence of complications at these dose levels is attributed to the use of small fields and the precise application of treatment.

  7. Surgical treatment of pituitary adenomas via endoscopic transsphenoidal approach: a clinical analysis of 39 cases%经鼻蝶入路内镜下切除垂体腺瘤39例临床分析

    Institute of Scientific and Technical Information of China (English)

    龙孝斌; 程超; 汪求精

    2010-01-01

    目的 探讨经鼻蝶入路内镜下切除垂体腺瘤的手术技巧和适应证. 方法 南方医科大学珠江医院耳鼻咽喉头颈外科白2000年1月至2008年1月采用经鼻蝶入路内镜下肿瘤切除术治疗垂体腺瘤患者39例,其中非功能性腺瘤2例,功能性腺瘤37例,回顾性分析患者的临床资料、手术效果及相关并发症. 结果 37例功能性腺瘤全部切除(94.9%),2例非功能性腺瘤(Ⅴ期)因瘤组织侵犯鞍旁,术野操作受限术中未能全部切除(5.1%),患者于术后一个月行局部放射治疗,术后3年仍带瘤生存;术后48h内出现一过性多尿或尿崩者11例,脑脊液鼻漏者2例,均经治疗后痊愈;随访发现1例非功能性腺瘤患者存在单颞侧视野缺损,头痛症状完全消失或减轻16例(88.9%),泌乳症状减轻或消失11例(91.7%),视力恢复17例(100%),性功能好转7例(77.8%).37例功能性腺瘤患者激素水平均较术前明显好转或恢复正常. 结论 经鼻蝶人路内镜下切除垂体腺瘤具有简便、安全、微创的优点,只要正确地掌握好此类手术的适应证,在完整切除瘤体的前提下,能有效避免并发症,获得满意的治疗效果.%Objective To evaluate the indications and the surgical technique of endoscopic transsphenoidal approach in the surgical treatment of pituitary adenomas. Methods We retrospectively analyzed the surgical effectiveness and complications of transsphenoidal approach under endoscope in treating 39 patients suffering from pituitary adenomas, including 37 with functional adenomas and 2 with non-functional adenomas. Results In all the patients with functional adenomas,tumors were totally resected. The 2 patients with non-functional adenoma invaded the seller obtained partial resection, and thus, postoperative radiotherapy was performed and preoperative symptoms were improved. All patients had no serious complications. All cases were followed up for 6-36 months: 1 had temporally visual loss; 11

  8. 内镜辅助下经鼻蝶入路垂体瘤切除术临床应用分析%Clinical Application Analysis of Endonasal Trans-sphenoidal Pituitary Adenoma Resection

    Institute of Scientific and Technical Information of China (English)

    赵雪

    2014-01-01

    Objective:To explore the clinical effect of endonasal trans-sphenoidal pituitary adenoma resection.Method:The data of 30 patients with pituitary adenomas in our hospital from May 2009 to August 2011 were analyzed retrospectively,in neuroendoscopy mononostril enter,without excision of the bony septum,directly from the front wall of the sphenoid sinus openings open sphenoid,was further sellar pituitary adenomas,and analyzing the relationship between tumor size and clinical effects.Result:The patients were followed up 3 months to 1 year,26 cases of headache symptoms within 3 months after opration disappeared,6 cases disappeared after 6 months.15 cases of vision loss,12 cases were normal,3 cases were improved.12 cases of lactation amenorrhea were within 3 months after operation returned to normal.1 case of acromegaly had abated.All patients after 3 months to 1 year follow-up,showed no cerebrospinal fluid rhinorrhea,optic nerve damage,meningitis,pituitary dysfunction and other complications.Conclusion:Endonasal trans-sphenoidal pituitary adenoma resection has less trauma,simple operation,operative field clear,quick recovery,is an effective minimally invasive pituitary tumor resection surgical methods.%目的:探讨内镜辅助下经鼻蝶入路垂体瘤切除术的临床治疗效果。方法:回顾性分析2009年5月-2011年8月笔者所在医院收治的30例垂体腺瘤患者的资料,在神经内窥镜下经单鼻孔进入,不切除骨性鼻中隔,直接自蝶窦开口打开蝶窦前壁,进一步经鞍底切除垂体腺瘤,并分析瘤体大小与临床效果的关系。结果:本组患者术后均随访3个月~1年,26例头痛症状于术后3个月内逐渐消失,6例在术后6个月消失;15例视力减退患者中,12例视力恢复正常,3例视力好转;12例闭经泌乳者,均于术后3个月内恢复正常;1例肢端肥大者有所减轻。所有患者在术后3个月~1年随访中,均未见脑脊液鼻漏、视神经损伤

  9. Clinical trial of sexual dysfunctions in male patients with pituitary adenomas%垂体腺瘤男性患者性功能障碍的临床观察

    Institute of Scientific and Technical Information of China (English)

    周任远; 王国民; 张跃辉; 施国伟; 何家扬; 蒋为众; 李士其

    2012-01-01

    Objective To explore the clinical features and related factors of sexual dysfunctions in male patients with pituitary adenomas.Methods The questionnaires of sexual functions were collected from 86 male patients with pituitary adenomas. We examined the clinical features of sexual dysfunctions and analyzed the correlations between sexual behaviors and age,tumor type,invasiveness,tumor size,serum levels of prolactin (PRL) and testosterone.Results The incidence of sexual dysfunctions was 80.2% (69/86).Sexual dysfunctions were found in 84.6% (66/78) of the patients with functioning pituitary adenomas and 37.5% (3/8) of those with non-functioning pituitary adenoma respectively.In the PRL group,the incidence of erectile dysfunctions was 92.1% (35/38) and it was higher than those in the FSH (folliclestimulating hormone) and GH (growth hormone) groups (P < 0.05).In the FSH group,the incidence of reduced sexual desire was 78.3% (18/23).In the GH group,the incidence of erectile dysfunctions was 70.6% ( 12/17 ) and the incidence of reduced sexual desire or ejaculation dysfunction was lower than that of the PRL/FSH group (P < 0.05).Conclusion The incidence of sexual dysfunctions is quite high in males with pituitary adenomas,especially for those with functioning pituitary adenomas.The clinical features of sexual dysfunctions vary in different types of functioning pituitary adenoma. The incidence of erectile dysfunctions is the highest in the PRL group.Pathological type of pituitary tumors is a major risk factor of sexual dysfunctions.%目的 了解垂体腺瘤男性患者性功能障碍(SD)的发病特征和影响因素.方法 回顾性调查和分析86例男性垂体腺瘤患者术前性功能情况,总结不同类型垂体腺瘤男性患者SD的发病特征,分析SD与年龄、肿瘤类型、侵袭性、大小、血泌乳素水平和睾酮水平的相关性.结果 垂体腺瘤男性患者SD的发生率为80.2%( 69/86).其中,功能性垂

  10. 215例垂体腺瘤术后患者腺垂体功能评估及替代状况分析%Outcome of postoperative hypopituitarism and hormone replacement situation in 215 patients with pituitary adenoma

    Institute of Scientific and Technical Information of China (English)

    曾梅芳; 赵曜; 王镛斐; 李益明; 蒋翠萍; 叶红英; 张烁; 何敏; 杨叶虹; 鹿斌; 胡仁明; 李士其

    2012-01-01

    Objective To investigate the outcome of postoperative hypopituitarism and hormone replacement in patients with pituitary adenoma,and to analyze the potential factors related to postoperative hypopituitarism.Methods A total of 215 postoperative patients with pituitary adenoma were analyzed.Pituitary functions( including gonadal,thyroid,and adrenal axes ) were asessed by strict criteria.Data of surgery history and hormone replacement situation were collected for statistical analysis.Results The prevalence of hypopituitarism was 54.0%,including 36.7% hypogonadism,32.6% hypothyroidism,and 28.4% hypoadrenalism.Replacements of gonadal steroid,glucocorticoid,and thyroxine were carried out in 25.6%,84.3%,and 80.6% of the cases,respectively.Univariate analysis showed that male sex and large tumor were related to hypopituitarism. Conclusion After pituitary adenomectomy,approximately half of the patients present anterior pituitary dysfunction,while quite a number of them have not been treated appropriately.%目的 了解垂体腺瘤术后患者腺垂体功能减退及其替代治疗情况,寻找与其功能减退可能相关的因素.方法 对215例就诊于华山医院内分泌科的垂体腺瘤术后患者进行垂体性腺轴、甲状腺轴、肾上腺皮质轴功能评估,收集手术病史、替代状况等资料进行统计分析.结果 存在腺垂体功能减退的患者占54.0%,其中性腺、甲状腺、肾上腺皮质功能减退的比例分别为36.7%、32.6%、28.4%,相应激素替代为25.6%、84.3%、80.6%.单因素分析显示男性和肿瘤较大与腺垂体功能减退相关.结论 内分泌科就诊的垂体腺瘤术后患者半数存在腺垂体功能减退,而且有相当一部分功能减退的患者未能得到恰当的替代治疗.

  11. 垂体腺瘤患者经蝶术后急性视功能障碍的原因和防治%Causes and treatment of acute visual dysfunction after transsphenoidal surgery of pituitary adenoma

    Institute of Scientific and Technical Information of China (English)

    刘念; 连伟; 王任直; 幸兵; 姚勇

    2015-01-01

    Objective Visual dysfunction is a sever complication of transsphenoidal surgery of pituitary adenoma.In this study,we explored the mechanisms and strategies of prevention and treatment of early acute visual deterioration after transsphenoidal surgery for removal of pituitary adenoma.Methods Clinical data of 12 patients with transsphenoidal pituitary adenoma resection of early postoperative acute visual deterioration were analyzed retrospectively.All the cases were come from Peking Union Medical College Hospital during Jan 1991 to May 2014.Results Among 12 cases,8 were with intrasellar haematoma,2 with suprasellar haematoma,2 with vascular spasm.After all these treatments,good recovery achieved in 10 cases,not so well in 1 with rupture of intracranial aneurysm,and 1 case death with suprasellar haematoma and intracranial infection.Conclusions Blood circulation variation of the optic nerve and optic chiasma could be caused by long-term compressing with thepituitary adenoma,on this basis,combined with the intrasellar haematoma,direct injury during the operation,and acuteischemia of the optic chiasma andtamping too tight in the sella turcica,etc,resulting in acute visual function disorder after pituitary adenomas transsphenoidal surgery,find the reason and early treatment can be effective to save the patient's visual acuity.%目的 探讨经蝶垂体腺瘤术后早期继发急性视功能障碍的原因及其防治措施.方法 回顾性分析北京协和医院1991年1月至2014年5月经蝶垂体腺瘤切除术后早期发生急性视功能障碍的12例患者的临床资料.结果 12例中8例鞍内出血,2例鞍上出血,2例血管痉挛.治疗后视功能恢复良好10例,1例合并颅内动脉瘤破裂恢复欠佳,1例鞍上出血死亡.结论 视神经和视交叉长期受到垂体腺瘤压迫而导致血运变差,在此基础上,合并了继发鞍内血肿、手术直接损伤、急性视神经缺血、鞍内填塞过紧等因素,从而导致垂体腺瘤经蝶

  12. 导航辅助内镜下经鼻蝶手术治疗复杂垂体腺瘤%Neuronavigation-Guided Pure Endoscopic Endonasal Transsphenoidal Surgery for Complex Pituitary Adenomas

    Institute of Scientific and Technical Information of China (English)

    薛亚军; 赵耀东; 崔大明; 沈照立; 楼美清

    2015-01-01

    目的:分析导航辅助内镜下经鼻蝶手术治疗复杂垂体腺瘤的疗效。方法:回顾分析2010年4月—2012年9月采用内镜下经鼻蝶手术治疗的60例复杂垂体腺瘤患者的疗效。患者具有下列一项或多项特征:肿瘤直径>4 cm(34例),Knosp分级3~4级(41例),复发或残留腺瘤(17例)。所有患者采用内镜下经鼻蝶垂体腺瘤切除术,术中使用神经导航辅助。术后行视力、神经影像及内分泌学检查。结果:60例患者中,无功能腺瘤33例,功能性腺瘤27例;肿瘤行大体全切42例,大部切除11例,部分切除7例。术后视力改善32例,内分泌治愈8例。直径>4 cm腺瘤大体全切18例,Knosp分级3~4级腺瘤大体全切23例,复发或残留腺瘤大体全切12例。术后发生电解质紊乱4例,脑脊液鼻漏3例,尿量增多1例,术区出血导致视力下降、垂体前叶功能低下、嗜睡1例,再手术5例。结论:导航辅助内镜下经鼻蝶手术治疗复杂垂体腺瘤安全、有效,对Knosp分级4级的侵袭性腺瘤、复杂功能性腺瘤的疗效仍有待进一步提高。%Objective:To analyze the efficacy of neuronavigation‐guided pure endoscopic endonasal transsphenoidal approach for the surgical removal of complex pituitary adenomas .Methods :The clinical data of 60 patients who received pure endoscopic endonasal transsphenoidal surgery for complex pituitary adenomas from Apr 2010 to Sep 2012 was retrospectively analyzed . These patients had one or more characteristics which including tumors more than 4 cm in size(34 patients) ,Knosp grade 3‐4(41 patients) ,recurrent or residual tumor(17 patients) .All patients received pure endoscopic endonasal transsphenoidal surgery and neuronavigation was used . Neuro‐ophthalmological , neuroimaging and endocrinological examination were performed postoperatively .Results:There were 33 nonfunctional adenomas and 27 functional adenomas .Overall

  13. 387例育龄期垂体腺瘤女性临床特征及术后随访研究%Clinical features and postoperative follow-up of 387 female patients with pituitary adenomas during reproductive age

    Institute of Scientific and Technical Information of China (English)

    黄新梅; 刘军; 吴跃跃; 盛励; 徐炯; 陈灶萍; 丁和远; 查兵兵; 王芳

    2014-01-01

    Objective To investigate the clinical features,pathology,imaging,treatment,and prognosis in women with pituitary adenomas during reproductive age.Methods Total 387 cases of 15-50 years old females with pituitary adenomas were analyzed and followed up.Results During reproductive age,92.5% patients with pituitary adenomas complained of symptoms of menstrual disorders,menopause,galactorrhea and so on.The younger the patients,the higher preoperative growth hormone or prolactin levels,the more the patients were diagnosed by endocrine manifestation.69.5% patients suffered from macroadenomas and 60.21% patients were above 30 years old.Tumor size was positively related with patient's age.The common type was prolactinoma (34.1%).58.7% patients were suffering from invasive pituitary adenomas.Invasiveness of tumor were related with preoperative prolactin levels,tumor size,presence of endocrine manifestations,and pituitary apoplexy.95.4% patients underwent operation by transsphenoidal approach.The most common complications and clinical symptoms were polyuria (71.5%),hypernatremia (20.9%),hyponatremia (17.3%),and fever (5.0%) during the week after surgery.Craniotomy which caused the incidence of postoperative serum sodium level< 130 mmol/L or greater than 150 mmol/L was 19.7 times of that in transsphenoidal surgery.The older the age,the higher the incidence of postoperative polyuria was.Insufficiencies of luteinizing hormone,follicle-stimulating hormone,adrenocorticotropin,and thyroidstimulating hormone were found in 7.5%,7.5%,5.3%,and 4.4% of patients respectively after 3 months of surgery.Postoperative hypopituitarism was not related with hypopituitarism and tumor size before surgery (P > 0.05).The most common symptoms were hyposmia (22.47%),followed by fatigue (19.82%),and sexual dysfunction (16.74%) during the follow-up period.Replacement therapy consisted of daily 10-20 mg of hydrocortisone and 50-75 μg of levothyroxine after surgery

  14. 经鼻蝶窦入路切除海绵窦侵袭性垂体腺瘤的临床研究%Resection of pituitary adenomas invading cavernous sinus through transsphenoidal approach

    Institute of Scientific and Technical Information of China (English)

    黄忻涛; 郝解贺; 马宁; 万大海; 刘跃亭; 薛乃照; 孙之洞

    2014-01-01

    Objective To explore the characteristics,surgical indications,methods and outcomes of the resection of invasive pituitary adenomas through transsphenoidal approach.Methods The clinical data of patients with pituitary adenomas invading cavernous sinus underwent surgery through transsphenoidal approach wcrc analyzed retrospectively.The extent of tumor removal,the change of hormone levels and the postoperative complications were analyzed.Results In 23 cascs,total tumor removal was achieved in 7 cases,subtotal in 12,and partial in 4.There were 12 cases of non-functioning adenomas,10 prolactinomas and 1 growth hormone adenoma.The postoperative PRL levels were decreased to normal in 4 cases,≥80% in 4,< 80% in 2.The postoperative GH level was decreased to > 50% in 1 case.The postoperative complications included 3 cases of hypopituitarism,l cerebrospinal fluid fistulae,1 deterioration of vision,2 transient cranial nerve palsy,5 transient diabetes insipidus and 4 electrolyte unbalance.18 cases had been followed-up from 3 months to 2 years,5 cases of recurrence.Conclusions The pituitary adenomas invading cavernous sinus could be revealed and removed satisfactorily with fewer surgical complications through the transsphenoidal approach.%目的 探讨侵袭海绵窦垂体腺瘤的特点、经鼻蝶窦入路适应证及手术治疗体会.方法 回顾性分析采用经鼻蝶窦入路切除侵袭海绵窦垂体腺瘤的临床资料,分析肿瘤切除程度、激素水平的变化以及出现的并发症.结果 23例患者中,肿瘤全切除7例,次全切除12例,部分切除4例.病理检查无功能腺瘤12例,催乳素腺瘤10例,生长激素腺瘤1例.术后催乳素4例降至正常范围,4例下降≥80%,2例下降<80%;1例生长激素下降>50%.手术并发症包括垂体功能低下3例,脑脊液鼻漏1例,视力恶化1例,短暂脑神经麻痹2例,一过性尿崩5例,电解质紊乱4例.18例得到了随访,时间3个月~2年,5例复发.结论 采

  15. 垂体腺瘤的侵袭与CD147、Galectin-3及微血管密度表达的关系%The relationship between expression of CD147, Galectin-3 and MVD and invasiveness of pituitary adenomas

    Institute of Scientific and Technical Information of China (English)

    张祎年; 何宁; 王发明; 陈亚青; 周俊林; 白亮彩; 毛俊杰

    2008-01-01

    Objective To investigate the expression of CD147, Galeetin-3 and microvessel density(MVD) in invasive and non-invasive pituitary adenomas, and to evaluate the relationship between MRI invasive features and expression of CD147, Galectin-3 and MVD in pituitary adenomas. Methods MRI was performed preoperatively in 34 patients with histologically verified pituitary adenomas. The expression of CD147, Galectin-3 and MVD were determined by using immunohistochemical SP method in all patients. The correlation between MRI features and expression of CD147, Galectin-3 and MVD were studied between invasive and non-invasive pituitary adenomas. Results Among MRI invasive features, adenoma crossing the lateral line of internal carotid artery ( ICA ), the encasement of ICA by tumors over 50%, sphenoidal sinus invasion, irregular tumor shape and bilateral ICA asymmetry were correlated with increased expression of CD147 and Galectin-3 ( P0.05 ). Conclusion The increased expression of CD147 and Galectin-3 may be related to MRI invasive features, CD147 and Galectin-3 are two molecular markers for assessing the invasion of pituitary adenomas. MRI is very useful in determining the invasive scope and extent of pituitary adenomas.%目的 检测CD147、Galeetin-3及微血管密度(MVD)在侵袭性和非侵袭性垂体腺瘤中的表达,以探讨其与垂体腺瘤MRI侵袭特征的关系.方法 对34例垂体腺瘤患者术前行MRI检查,术后收集标本应用免疫组化sP法检测垂体腺瘤标本中CD147、Galeetin-3及MVD的表达,分析MRI侵袭性表现与CD147、Galecfin-3及MVD表达之间的关系.结果 在垂体腺瘤相关MRI侵袭征象中,肿瘤超过外切线、海绵窦段颈内动脉被肿瘤包绕>50%、蝶窦侵犯、肿瘤形态不规则及双侧颈内动脉的不对称性均与CD147及Galectin-3的表达有关(P0.05).结论 CD147及Galectin-3的高表达与垂体腺瘤MRI侵袭特征密切相关,CD147和Galectin-3可以作为垂体腺瘤侵袭性的分子标记物.

  16. 垂体瘤合并视功能损害患者生存质量现状的调查%Inveseigation of quality of life of patients with pituitary adenomas with visual impairment

    Institute of Scientific and Technical Information of China (English)

    杨荔; 王金茹; 张素丽

    2014-01-01

    目的:调查有视功能损害的垂体瘤患者的生存质量现状并进行分析,为提高和改善患者的生活质量提供依据。方法选择有视功能损害的垂体瘤患者50例,所有患者行视力、矫正视力、Octopus视野计检查。采用视功能损害眼病患者生存质量量表在术前对患者进行问卷调查,分析调查结果。结果50例有视功能损害的垂体瘤患者生存质量总分为(114.54±30.11)分,其中症状与视功能得分为(46.70±14.50)分,身体机能得分为(24.00±5.41)分,社会得分为(23.28±5.76)分,精神心理得分为(20.54±6.92)分。视力轻度下降组、视力中度下降组和视力重度下降组生存质量总得分分别为(138.38±10.92),(125.68±12.52),(75.00±18.75)分,三组比较差异有统计学意义(F=86.04,P<0.01)。结论随着视力损害程度加重,垂体瘤患者生存质量下降明显,护理人员应当从建立良好护患关系、心理疏导等方面来提高和改善患者的生活质量。%Objective To analyze the quality of life of patients with pituitary adenomas with visual impairment .Methods Fifty patients with pituitary adenomas with visual impairment at different levels from January 2014 to March 2014 were selected .They were tested with vision correction and Octopus campimetry , and their quality of life was measured .Results The total score of quality of life of patients with pituitary adenomas with visual impairment was ( 114 .54 ±30 .11 ) .The score of symptom with visual function , the physical function, social function and mental health were (46.70 ±14.50),(24.00 ±5.41),(23.28 ±5.76) and (20.54 ±6.92).The score of quality of life of patients with the mild vision impairment , moderate vision impairment, and severe vision impairment were (138.38 ±10.92), (125.68 ±12.52) and (75.00 ±18.75). There was significant difference among the three

  17. 垂体微腺瘤的临床内分泌与病理免疫组化类型相关性研究%Micro pituitary adenomas clinical endocrine correlation with pathologic types of immunohistochemical study

    Institute of Scientific and Technical Information of China (English)

    禹亚丽

    2014-01-01

    目的:对垂体微腺瘤的临床症状体征、内分泌与病理免疫组化类型相关性进行探讨。方法选取2010年1月至2012年12月在本院确诊的垂体微腺瘤患者84例,对其进行内分泌、影像学和病理检查,分析检查结果之间的关系。结果患者出现内分泌症状76例(90.47%),免疫组化阳性组内分泌症状发生率[92.59%(75/81)]较免疫组化阴性组[33.33%(1/3)]高,差异具有显著性(χ2=5.92,P<0.05),表明内分泌症状与免疫组化结果相符。血清泌乳素(PRL)阳性组血清PRL增高及闭经、溢乳或月经失调发生率高于PRL阴性组;生长激素(GH)阳性组血清GH增高及巨人症或肢端肥大发生率高于GH阴性组。结论垂体微腺瘤患者的临床表现、内分泌结果与病理免疫组化类型相关,可用来提高垂体微腺瘤的诊断率与治疗率。%Objective To explore the relationship between the clinical symptoms and endocrine of micro pituitary adenomas and pathological immunohistochemical type. Method We had Choosed 84 patients with micro pituitary adenomas from January 2010 to December 2012 in our hospital, then checked the endocrine, imaging and pathological of them, and analysis the relationship between the test results. Result There were 76 cases (90.47%) had endocrine symptoms in all patients, the immunohistochemical positive endocrine symptoms rate was 92.59%(75/81) , this rate was higher than the immunohistochemical negative group which rate was 33.33%(1/3), the difference was statistically signiifcant (χ2=5.92, P<0.05), this indicated that the endocrine symptoms consistent with immunohistochemical results. The increased serum PRL and amenorrhea, spilled milk or incidence of menstrual disorder rate of serum prolactin (PRL) positive group were higher than that of PRL negative groups; increased serum GH and gigantism or acromegaly fertilizer rates of growth hormone (GH) positive group were higher than GH

  18. 伴有垂体生长激素腺瘤的McCune-Albright综合征一例并文献复习%MAS associated with pituitary GH adenoma:therapeutic process,necropsy and papers review

    Institute of Scientific and Technical Information of China (English)

    柳夫义; 钟定荣; 朱慧娟; 金自孟; 王任直; 李文婷; 窦万臣; 姚勇; 李桂林; 杨义; 马文斌; 李永宁; 幸兵

    2009-01-01

    Objective To observe the disease development and treatment process of McCune-Albright syndrome(MAS)associated with pituitary growth hormone(GH)adenoma by a continuous prospective following of a patient.To analyze the clinical and pathological recordings from the following and necropsy and obtain conclusions about the appropriate treatment for this disease.Method A prospective following of a patient of MAS associated with pituitary GH adenoma was performed continuously by recording the disease development and the treatment process until his death,after which a necropsy was performed.Combined with the recordings,necropsy revealing and literature study,the case was analyzed and discussed.Results MAS is a disease with progressive development,which can be accelerated by the associated pituitary GH adenoma and thus impair the life quality and shorten the life span of the patients.Although radiation could efficaciously controll GH hypersecretion of pituitary,it also may cause malignant transformation of the dysplastic bone tissue.The direct cause of death of this case,demonstrated by necropsy and pathology,was that the malignant transformed dysplastic bone tissue caused compression of the brain tissue,which eventually caused brain hernia and death.Conclusions CH adenoma,present in patient with MAS,is difficult to treat because the skull base bone dysplasia often prevents traditionary surgical removal of the tumor,while navigation-assisted transsphenoidal operation may be considered.Radiation therapy(RT)is in controversy because of the risk of sarcomatous transformation of the dysplastic bone tissue.%目的 通过1例伴有垂体生长激素(GH)腺瘤的MeCune-Albright综合征(MAS)患者长期追踪随访,观察此病的发展过程及治疗情况,结合文献总结分析该患者详细的临床和病理资料,为此病诊治提供帮助.方法 长期追踪随访1例MAS患者的病情变化及临床治疗过程直至患者死亡,收集整理患者的临床资料,数次

  19. Expression of p53, Ki-67 and c-erb B2 in growth hormone-and/or prolactin-secreting pituitary adenomas Expressão de p53, Ki-67 e c-erb B2 em adenomas hipofisários secretores de prolactina e/ou hormônio de crescimento

    Directory of Open Access Journals (Sweden)

    Carlos Henrique A. Botelho

    2006-03-01

    Full Text Available The subcellular events implicated on the formation and behavior of pituitary adenomas are not fully understood. In this study we investigated the presence of p53, Ki-67 and c-erb B2 in 38 pituitary adenomas with immunohistochemical positivity for GH and prolactin (n=26; 68.4%, for prolactin (n=9; 23.7% and for GH (n=3. 7.8%. The analyses revealed the following results: 24 (63.2% tumors expressed variable positivity for c-erb B2, 11 (28.9% expressed p53 positivity and 11 (28.9% tumors were variably positive for Ki-67. Our results demonstrated a high percentage of GH/prolactin-, prolactin- and GH-secreting tumors with immunohistochemical positivity for c-erb B2. Once this membrane receptor is related to growth factors EGF and TGFalpha and both have a definite effect on tumor growth, our data suggest a possible role for c-erb B2 on the evolution of these tumors.Os eventos subcelulares implicados na formação e comportamento dos adenomas hipofisários não são completamente compreendidos. Neste estudo nós investigamos a presença de p53, Ki-67 e c-erb B2 em 38 adenomas hipofisários com positividade imuno-histoquímica para GH e prolactina (n=26, 68,4%, para prolactina (n=9, 23,7% e para GH (n=3, 7,8%. A análise revelou os seguintes resultados: 24 tumores (63,2% expressaram positividade variável para c-erb B2, 11 (28,9% expressaram positividade para p53 e 11 tumores (28,9% foram variavelmente positivos para Ki-67. Nossos resultados demonstraram elevada percentagem de tumores secretores de GH/prolactina, prolactina e GH com positividade imuno-histoquímica para c-erb B2. Desde que este receptor de membrana está relacionado aos fatores de crescimento EGF e TGFalfa e ambos têm efeito definido no crescimento tumoral, nossos dados sugerem possível função para o c-erb B2 na evolução destes tumores.

  20. Temozolomide-Induced Shrinkage of Invasive Pituitary Adenoma in Patient with Nelson’s Syndrome: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Maria Kurowska

    2015-01-01

    Full Text Available Introduction. Invasive tumours in Nelson’s syndrome need aggressive therapy. Recent reports have documented the efficacy of temozolomide (TMZ in the treatment of adenomas resistant to conventional management. Objective. The review of the literature concerning TMZ treatment of atypical corticotroph adenomas and a case study of 56-year-old woman who developed Nelson’s syndrome. Treatment Proceeding. The patient with Cushing’s disease underwent transsphenoidal adenomectomy followed by a 27-month-long period of remission. Due to a regrowth of the tumor, she underwent two reoperations followed by stereotactic radiotherapy. Because of treatment failures, bilateral adrenalectomy was performed. Then she developed Nelson’s syndrome. A fourth transsphenoidal adenomectomy was performed, but there was a rapid recurrence. Five months later, she underwent a right frontotemporal craniotomy. Due to a rapid regrowth of the tumour, the patient did not receive gamma-knife therapy and was treated with cabergoline and somatostatin analogue for some time. Only TMZ therapy resulted in marked clinical, biochemical, and radiological improvement. To date, this is the first case of invasive corticotroph adenoma in Nelson’s syndrome treated with temozolomide in Poland. Conclusion. In our opinion, temozolomide can be an effective treatment option of invasive adenomas in Nelson’s syndrome.

  1. 垂体生长激素瘤患者血清生长激素水平的改变及其与糖代谢异常的关系%Changes of serum growth hormone (GH) levels and its relationship with abnormal glucose metabolism in patients with growth hormone-secreting pituitary adenoma

    Institute of Scientific and Technical Information of China (English)

    张炜; 张征; 徐尔理

    2014-01-01

    目的 评价垂体生长激素瘤(GH-secreting pituitary adenoma)患者血清生长激素(GH)水平的改变及其与糖代谢异常的关系. 方法 检测GH-secreting pituitary adenoma (GH-secreting pituitary adenoma组)患者BP、血GH、IGF-1及泌乳素,并行75 g OGTT,计算ISI、稳态模型胰岛素抵抗指数(HOMA-IR)、葡萄糖及胰岛素曲线下面积(AUCg,AUCi),将所得结果与垂体无功能瘤(NPA)组及糖代谢正常(NGT组)者进行比较. 结果 GH-secreting pituitary adenoma组血GH、IGF-1、IGF-1%及泌乳素高于其他两组(P<0.01).GH-secreting pituitary adenoma组IGR及糖尿病患病率高于NPA组及NGT组.GH-secreting pituitary adenoma组FPG、2 hPG高于NGT组,ISI则低于NGT组(P<0.05或P<0.01);FIns、AUCg、AUCi及HOMA-IR高于其他两组(P<0.05或P<0.01).根据75 g OGTT结果将GH-secreting pituitary adenoma组分为两亚组,高血糖亚组血GH高于血糖正常亚组.相关性分析结果显示,GH-secreting pituitary adenoma组血GH与FPG、2 hPG及AUCg呈正相关;IGF-1%与2hPG及AUCg呈正相关. 结论 GH-secreting pituitary adenoma患者高血糖患病率升高,且其原因与GH高分泌相关.

  2. Pituitary gigantism: Causes and clinical characteristics.

    Science.gov (United States)

    Rostomyan, Liliya; Daly, Adrian F; Beckers, Albert

    2015-12-01

    Acromegaly and pituitary gigantism are very rare conditions resulting from excessive secretion of growth hormone (GH), usually by a pituitary adenoma. Pituitary gigantism occurs when GH excess overlaps with the period of rapid linear growth during childhood and adolescence. Until recently, its etiology and clinical characteristics have been poorly understood. Genetic and genomic causes have been identified in recent years that explain about half of cases of pituitary gigantism. We describe these recent discoveries and focus on some important settings in which gigantism can occur, including familial isolated pituitary adenomas (FIPA) and the newly described X-linked acrogigantism (X-LAG) syndrome.

  3. First-pass perfusion computed tomography: Initial experience in differentiating adrenal adenoma from metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Qiao Zhongwei [Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong, University School of Medicine, Shanghai 200025 (China); Department of Radiology, Children' s Hospital of Fudan University, Shanghai 201102 (China); Xia Chunmei [Department of Physiology and Pathophysiology, Shanghai Medical, College, Fudan University, Shanghai 200032 (China); Zhu Yanbo; Shi Weiping [Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong, University School of Medicine, Shanghai 200025 (China); Miao Fei [Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong, University School of Medicine, Shanghai 200025 (China)], E-mail: fmiao818@gmail.com

    2010-03-15

    Objective: To differentiate adrenal adenoma from metastasis in patients using perfusion computed tomography (PCT) imaging. Methods: Thirty-two patients with adrenal masses underwent first-pass PCT imaging. Of these patients, twenty-one were diagnosed with adrenal adenoma, and the others with metastases. Perfusion maps of blood volume (BV), blood flow (BF), mean transit time (MTT) and permeability surface-area production (PS) were generated with an Advantage Windows workstation using the CT perfusion 3.0 software (General Electric Medical Systems, Milwaukee, WI). Histopathologic sections immunostained for CD34 were quantitatively evaluated for microvessel density (MVD). Results: The perfusion parameters such as BV, BF and PS were statistically significant different between the two groups, with adenomas showing higher mean BV (12.18 versus 3.86), BF (97.51 versus 45.99) and PS (21.73 versus 10.93) compared with metastases (p < 0.05). For BV, a cutoff point of 7.30 was found to have a sensitivity of 95.2% and a specificity of 100% to differentiate between adenoma and metastasis. The sensitivity and specificity were 81.0 and 80.0%, respectively, for BF with a cutoff point of 71.96; and 85.7 and 86.7%, respectively, for PS with a cutoff point of 12.70 to differentiate adenoma and metastasis. A comparison of MVD counts from adenomas with those from metastases showed a significant difference (p < 0.05). However, no significant differences were observed in the four perfusion parameters and MVD between lipid rich and lipid poor adenomas. Conclusion: PCT may be useful for evaluating the neovascularization of adrenal masses and differentiating adenoma from metastasis on the basis of PCT parameters. Adenomas show higher BV, BF and PS compared with metastases. According our data, the optimal threshold BV is 7.30, resulting in a sensitivity of 95.