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https://www.readbyqxmd.com/read/28332874/long-term-outcome-of-the-different-treatment-alternatives-for-recurrent-and-persistent-cushing-s-disease
#1
Ana Laura Espinosa-de-Los-Monteros, Ernesto Sosa-Eroza, Etual Espinosa, Victoria Mendoza, Rocio Arreola, Moises Mercado
BACKGROUND: Treatment alternatives for persistent and recurrent Cushing's disease (CD) include pituitary surgical reintervention, radiotherapy, pharmacotherapy and bilateral adrenalectomy (BA). The decision of which of these alternatives is better suited for the individual patient rests on clinical judgment and the availability of resources. OBJECTIVE: To evaluate the long-term efficacy of the different secondary interventions for persistent and recurrent Cushing's disease...
March 23, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28326242/nasal-lobular-capillary-hemangioma-as-a-complication-after-an-endoscopic-transsphenoidal-gonadotrophin-producing-pituitary-adenoma-resection
#2
Dalila Forte, Amets Sagarribay Irañeta, Anabela Nabais, António Figueiredo, Manuela Mafra, Victor Gonçalves
Background Lobular capillary hemangioma is a rare benign tumor, most frequently located in the head or neck region, the nasal cavity being uncommonly affected. Its etiopathogenesis is not fully established, although traumatic and hormonal factors have been implied. Case Description A 50-year-old female patient underwent an uneventful endoscopic transsphenoidal removal of a pituitary cystic macroadenoma at our institution. Nasal packing was used in postoperative hemostasis. Histopathology was compatible with a gonadotrophin-producing adenoma...
January 2017: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/28323961/normalized-early-post-operative-cortisol-and-acth-values-predict-nonremission-after-surgery-for-cushing-s-disease
#3
David Asuzu, Grégoire P Chatain, Christina Hayes, Sarah Benzo, Raven McGlotten, Meg Keil, Andrea Beri, Susmeeta T Sharma, Lynnette Nieman, Maya Lodish, Constantine Stratakis, Russell R Lonser, Edward H Oldfield, Prashant Chittiboina
Context: Perioperative increases in adrenocorticotropic hormone (ACTH) and cortisol mimic corticotropin releasing hormone (CRH) stimulation testing. This phenomenon may help identify patients with residual adenoma after transsphenoidal surgery (TSS) for Cushing's disease (CD). Objective: To predict non-remission after TSS for CD. Design: Retrospective case control study of patients treated at a single center from December 2003 till July 2016...
March 15, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28323955/rapid-onset-of-diabetic-ketoacidosis-following-sglt2-inhibition-in-a-patient-with-unrecognized-acromegaly
#4
Marino Quarella, Daniel Walser, Michael Brändle, Jean-Yves Fournier, Stefan Bilz
Context: Diabetic ketoacidosis has been described as a rare complication of acromegaly and may be observed in 1% of affected patients. The well described direct lipolytic effect of growth hormone results in increased availability of free fatty acids (FFA) for hepatic ketogenesis and is an important pathogenic event. More recently, ketoacidosis has been identified as an important complication of sodium-glucose-transport-protein 2 inhibitors (SGLT2i). Increased pancreatic glucagon secretion, impaired renal ketone body clearance and an increase in FFA concentrations secondary to decreased insulin concentrations are likely precipitating factors...
February 21, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28322180/operative-landscape-at-canadian-neurosurgery-residency-programs
#5
Michael K Tso, Ayoub Dakson, Syed Uzair Ahmed, Mark Bigder, Cameron Elliott, Daipayan Guha, Christian Iorio-Morin, Michelle Kameda-Smith, Pascal Lavergne, Serge Makarenko, Michael S Taccone, Bill Wang, Alexander Winkler-Schwartz, Tejas Sankar, Sean D Christie
Background Currently, the literature lacks reliable data regarding operative case volumes at Canadian neurosurgery residency programs. Our objective was to provide a snapshot of the operative landscape in Canadian neurosurgical training using the trainee-led Canadian Neurosurgery Research Collaborative. METHODS: Anonymized administrative operative data were gathered from each neurosurgery residency program from January 1, 2014, to December 31, 2014. Procedures were broadly classified into cranial, spine, peripheral nerve, and miscellaneous procedures...
March 21, 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/28321378/hemi-transseptal-approach-for-pituitary-surgery-a-follow-up-study
#6
Naif Fnais, Salvatore Di Maio, Susan Edionwe, Anthony Zeitouni, Denis Sirhan, Constanza J Valdes, Marc A Tewfik
Objectives The hemi-transseptal (Hemi-T) approach was developed to overcome the potential drawbacks of the nasoseptal flap (NSF) in endoscopic endonasal transsphenoidal skull base surgery. In this study, we describe further refinements on the Hemi-T approach, and report long-term outcomes as compared with traditional methods of skull base reconstruction. Design A retrospective case-control study. Setting Montreal Neurological Institute and Jewish General Hospital, Montreal, Canada. Participants Patients who underwent endoscopic endonasal transsphenoidal approach to skull base pathology...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321372/treatment-outcomes-of-rathke-s-cleft-cysts-managed-with-marsupialization
#7
Edward C Kuan, Frederick Yoo, Jennifer Chyu, Marvin Bergsneider, Marilene B Wang
Objectives Rathke's cleft cysts (RCC) are benign cystic lesions of the sella resulting from incomplete obliteration of Rathke's cleft. Symptomatic lesions often require surgical decompression, which is often amenable to a transnasal, transsphenoidal (TNTS) approach. We report our experience with marsupialization of RCC and describe a novel technique to promote re-epithelization of the cyst cavity. Design Retrospective review. Setting Tertiary academic medical center. Participants Patients who underwent TNTS for RCC between 2007 and 2015...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321371/anatomic-variations-in-pituitary-endocrinopathies-implications-for-the-surgical-corridor
#8
Edward C Kuan, Frederick Yoo, Won Kim, Karam W Badran, Thomas E Heineman, Ali R Sepahdari, Marvin Bergsneider, Marilene B Wang
Objectives/Hypotheses Functioning pituitary adenomas may produce endocrinopathies such as acromegaly and Cushing syndrome. Both conditions lead to characteristic anatomic variations as a result of hormonally induced abnormal soft tissue deposition. We evaluate the anatomic differences between acromegalics and Cushing disease patients and compare these dimensions to controls. Design Radiographic review of preoperative magnetic resonance images (MRI) of the pituitary gland. Setting Tertiary academic medical center...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28301972/efficacy-of-transsphenoidal-surgery-in-achieving-biochemical-cure-of-growth-hormone-secreting-pituitary-adenomas-among-patients-with-cavernous-sinus-invasion-a-systematic-review-and-meta-analysis
#9
Vanessa Briceno, Hasan A Zaidi, Joanne A Doucette, Kaho B Onomichi, Amer Alreshidi, Rania A Mekary, Timothy R Smith
OBJECTIVES: Growth hormone-secreting pituitary adenomas in adults can result in severe craniofacial disfigurement and potentially fatal medical complications. Surgical resection leading to remission of the disease is dependent on complete surgical resection of the tumor. Lesions that invade the cavernous sinus may not be safely accessible via an endonasal transsphenoidal surgery (TSS), and the rates of biochemical remission of patients with residual disease vary widely in the literature...
March 16, 2017: Neurological Research
https://www.readbyqxmd.com/read/28300715/operative-learning-curve-after-transition-to-endoscopic-transsphenoidal-pituitary-surgery
#10
Tasneem Shikary, Norberto Andaluz, Jareen Meinzen-Derr, Collin Edwards, Philip Theodosopoulos, Lee A Zimmer
OBJECTIVES: No clear consensus yet defines the endpoints for operative learning curves in the transition to minimally invasive endoscopic techniques. This retrospective review of our first 202 patients who underwent endoscopic pituitary resection examines the statistical learning curve related to operative times--a measure of our surgical team's efficiency and complication rates, a reflection of surgical skill and maturity. METHODS: Retrospective chart review included patient demographics, tumor type, operative times, complication rates, and follow-up...
March 11, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28298041/randomized-double-blinded-placebo-controlled-trial-comparing-two-multimodal-opioid-minimizing-pain-management-regimens-following-transsphenoidal-surgery
#11
Deborah M Shepherd, Heidi Jahnke, William L White, Andrew S Little
OBJECTIVE Pain control is an important clinical consideration and quality-of-care metric. No studies have examined postoperative pain control following transsphenoidal surgery for pituitary lesions. The study goals were to 1) report postoperative pain scores following transsphenoidal surgery, 2) determine if multimodal opioid-minimizing pain regimens yielded satisfactory postoperative pain control, and 3) determine if intravenous (IV) ibuprofen improved postoperative pain scores and reduced opioid use compared with placebo...
March 3, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28291643/successful-treatment-of-pituitary-carcinoma-with-concurrent-radiation-temozolomide-and-bevacizumab-after-resection
#12
Waseem Touma, Spencer Hoostal, Richard A Peterson, Andres Wiernik, Karen S SantaCruz, Emil Lou
The optimal treatment of pituitary carcinomas (PC) is unknown. Treatment includes surgical resection, radiation, and more recently, temozolomide (TMZ). Pituitary adenomas have relatively high expression of vascular endothelial growth factor; therefore, bevacizumab, an antiangiogenic agent, has been used in a small number of aggressive or malignant pituitary tumors after recurrence. However, it has not been administered concurrently with other chemotherapeutic agents or combined with radiation therapy in PC...
March 11, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28290971/delayed-diagnosis-of-tsh-secreting-adenoma-attributed-to-worsening-post-traumatic-stress-disorder-symptoms-in-a-military-veteran-because-of-provider-anchoring-bias
#13
Shyam K Daya, Andrew O Paulus, Ernest E Braxton, Penny J Vroman, Derek A Mathis, Ryan Lin, Mark W True
INTRODUCTION: Anchoring bias occurs when clinicians hold on to previously known information about a patient, with failure to consider the full realm of possibilities to explain new findings. We present a case of delayed diagnosis of thyroid-stimulating-hormone-secreting pituitary adenoma (TSHoma), a rare disorder, in a military veteran whose symptoms were misconstrued as being caused from worsening of his prior diagnosis of post-traumatic stress disorder (PTSD). Anchoring bias in this case led to 2-year delay in the correct diagnosis...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28289766/-complications-and-monitoring-standards-after-elective-craniotomy-in-germany
#14
C Henker, C Schmelter, J Piek
BACKGROUND: The increasing endeavors to make inpatient treatment processes more effective leads to a reduction of the length of stay in hospital and minimization of postoperative monitoring. Therefore, the aim of our study was to determine potential postoperative complications for neurosurgical patients undergoing elective surgery with respect to assessment of the relevance for intensive medical care. Furthermore, our approach was compared with the standard of postoperative care of such patients in Germany...
March 13, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28286276/the-value-of-intraoperative-mri-in-endoscopic-and-microsurgical-transsphenoidal-pituitary-adenoma-resection
#15
Andrej Paľa, Andreas Knoll, Christine Brand, Gwendolin Etzrodt-Walter, Jan Coburger, Christian Rainer Wirtz, Michal Hlaváč
INTRODUCTION: The routine use of iMRI helps to achieve gross total resection in transsphenoidal pituitary surgery. We have compared the added value of iMRI for extent of resection in endoscopic versus microsurgical transsphenoidal adenomectomy. METHODS: A total of 96 patients with pituitary adenoma were included. 28 consecutive patients underwent endoscopic transsphenoidal tumor resection. For comparison, we used a historic cohort of 68 consecutive patients treated microsurgically...
March 9, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28286028/spindle-cell-oncocytoma-report-of-two-cases-with-massive-bleeding-and-review-of-the-literature
#16
REVIEW
Domenico Billeci, Elisabetta Marton, Enrico Giordan, Valentina Carraro, Monica Ronzon, Sabrina Rossi
Spindle cell oncocytoma (SCO) is a rare pituitary tumor, classified as a WHO grade I neoplasm. Due to its rarity, SCO is often preoperatively misdiagnosed as a pituitary macroadenoma. In the present study we report two recent cases of SCO, a 61-year-old male and a 65-year-old female presenting at Treviso General Hospital between March 2014 and April 2015. Tumor resection was achieved by endoscopic transsphenoidal approach but massive hemorrhagic events hampered surgery, endangering the patient's life in both cases...
March 9, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28284581/cognitive-function-surrounding-resection-of-nonfunctioning-pituitary-adenomas-with-suprasellar-extension-a-prospective-matched-control-study
#17
Philipp Hendrix, Christoph J Griessenauer, Elisa Hans, Andreas Simgen, Joachim Oertel, Julia Karbach
OBJECTIVE: Patients suffering from pituitary adenomas may experience cognitive dysfunctions due to hormonal imbalance or suprasellar tumor extension displacing neural structures. Progressively enlarging or symptomatic nonfunctioning pituitary adenomas with suprasellar extension are frequently resected. The literature on neurocognitive performance surrounding resection of these lesions is sparse. METHODS: A prospective matched-control study was conducted to investigate the impact of nonfunctioning pituitary adenomas with suprasellar extension on preoperative and postoperative cognitive performance...
March 8, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28284576/hemostasis-in-endoscopic-endonasal-skull-base-surgery-using-the-aquamantys-bipolar-sealer-technical-note
#18
Richard Bram, Susan Fiore, Daryl McHugh, Ghassan J Samara, Raphael P Davis
BACKGROUND: A major challenge during endoscopic transsphenoidal surgery is adequate intraoperative hemostasis. The Aquamantys® is a relatively new bipolar sealing device which uses radiofrequency energy and saline. This promotes hemostasis while decreasing charring and thermal spread. In this paper, we describe our experience with the Aquamantys® Mini EVS 3.4 Epidural Vein Sealer Bipolar Electrocautery System (Medtronic Advanced Energy, Portsmouth, NH, USA) during endoscopic surgery for tumors of the skull base with particular attention to ergonomic benefits and technical nuances...
March 8, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28284449/cerebral-vasospasm-after-transsphenoidal-surgery-for-pituitary-adenoma-case-report-and-review-of-the-literature
#19
N Bougaci, P Paquis
INTRODUCTION: Cerebral vasospasm (CVS) is a rare complication of transsphenoidal surgery for pituitary adenomas. CASE REPORT: The authors describe a symptomatic cerebral ischemia due to an internal carotid, left middle cerebral artery and anterior cerebral artery vasospasm in a patient undergoing transsphenoidal surgery for a pituitary macro adenoma. The patient was successfully treated by an endovascular balloon angioplasty. CONCLUSION: This issue should be taken into account, even when rare, in every patient who has surgery for a pituitary tumor, particularly when it concerns a large macro adenoma with suprasellar extension...
March 8, 2017: Neuro-Chirurgie
https://www.readbyqxmd.com/read/28284009/pituitary-carcinoma-in-a-patient-with-an-sdhb-mutation
#20
Nicola Tufton, Federico Roncaroli, Irene Hadjidemetriou, Mary N Dang, Judit Dénes, Leonardo Guasti, Maria Thom, Michael Powell, Stephanie E Baldeweg, Naomi Fersht, Márta Korbonits
We present the first case of pituitary carcinoma occurring in a patient with a succinate dehydrogenase subunit B (SDHB) mutation and history of paraganglioma. She was initially treated for a glomus tumour with external beam radiotherapy. Twenty-five years later, she was diagnosed with a non-functioning pituitary adenoma, having developed bitemporal hemianopia. Recurrence of the pituitary lesion (Ki-67 10% and p53 overexpressed) occurred 5 years after her transsphenoidal surgery, for which she underwent two further operations followed by radiotherapy...
March 10, 2017: Endocrine Pathology
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