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https://www.readbyqxmd.com/read/28523537/prolactinoma-management-predictors-of-remission-and-recurrence-after-dopamine-agonists-withdrawal
#1
Margarida Teixeira, Pedro Souteiro, Davide Carvalho
OBJECTIVE: Prolactinomas are the most common functional pituitary tumour. Dopamine agonists (DA) are its principal treatment. The criteria that should guide therapy withdrawal and the factors that influence disease remission or relapse are not yet fully established. Our purpose is to evaluate the proportion of patients who attempted DA withdrawal, and to identify the factors that influence clinicians to try it. In addition, we aim to study the factors that are involved in prolactinoma remission/relapse after therapy withdrawal...
May 18, 2017: Pituitary
https://www.readbyqxmd.com/read/28516968/preliminary-experience-with-4k-ultra-high-definition-endoscope-analysis-of-pros-and-cons-in-skull-base-surgery
#2
M Rigante, G La Rocca, L Lauretti, G Q D'Alessandris, A Mangiola, C Anile, A Olivi, G Paludetti
During the last two decades endoscopic skull base surgery observed a continuous technical and technological development 3D endoscopy and ultra High Definition (HD) endoscopy have provided great advances in terms of visualisation and spatial resolution. Ultra-high definition (UHD) 4K systems, recently introduced in the clinical practice, will shape next steps forward especially in skull base surgery field. Patients were operated on through transnasal transsphenoidal endoscopic approaches performed using Olympus NBI 4K UHD endoscope with a 4 mm 0° Ultra Telescope, 300 W xenon lamp (CLV-S400) predisposed for narrow band imaging (NBI) technology connected through a camera head to a high-quality control unit (OTV-S400 - VISERA 4K UHD) (Olympus Corporation, Tokyo, Japan)...
June 2017: Acta Otorhinolaryngologica Italica
https://www.readbyqxmd.com/read/28500926/different-patterns-of-gelatinolytic-activity-in-pituitary-macro-and-microadenomas
#3
Daniel Babula, Joanna Kocot, Anna Horecka, Marcin Baran, Jacek Kurzepa
OBJECTIVE: Gelatinases, Matrix MetalloProteinase(MMP)-2 and MMP-9, belong to zinc-dependent endopeptidases involved in several physiological and pathological processes including inflammation and tumor development. Because the information about the involvement of gelatinases in pituitary adenoma (PA) development are scant, our objective was the analysis of MMP-2 and MMP-9 activity in serum and tumor tissue of PA patients. PATIENTS AND METHODS: Twenty one patients with PA (macroadenoma n=18, microadenoma n=3), qualified to the endoscopic resection of tumors were enrolled...
May 4, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28465267/outcome-of-endoscopic-transsphenoidal-surgery-for-acromegaly
#4
Jung Hee Kim, Kyu Yeon Hur, Jung Hyun Lee, Ji Hyun Lee, Young-Bem Se, Hey In Kim, Seung Hoon Lee, Do-Hyun Nam, Seong Yeon Kim, Kwang-Won Kim, Doo-Sik Kong, Yong Hwy Kim
OBJECTIVE: Endoscopic transsphenoidal surgery has recently been introduced in pituitary surgery. We investigated outcomes and complications of endoscopic surgery in two referral centers in Korea. METHODS: We enrolled 134 patients with acromegaly (microadenomas, n=15; macroadenomas, n=119) who underwent endoscopic transsphenoidal surgery at Seoul National University Hospital (n=74) and Samsung Medical center (n=60) between Jan 2009 and Mar 2016. Remission was defined as having a normal IGF-1 and a suppressed GH less than 1 ng/mL during an oral glucose tolerance test...
April 29, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28461279/metabolic-in-vivo-visualization-of-pituitary-adenomas-a-systematic-review-of-imaging-modalities
#5
REVIEW
Amy Yao, Priti Balchandani, Raj K Shrivastava
INTRODUCTION: Pituitary adenomas are the most common intrasellar mass. Functional pituitary adenomas (PAs) constitute the majority of pituitary tumors and can produce symptoms related to hormonal overproduction. Timely and accurate detection is therefore of vital importance to prevent potentially irreversible sequelae. Magnetic resonance imaging (MRI) is the gold standard for detecting PAs, but is limited by poor sensitivity for microadenomas and an inability to differentiate scar tissue from tumor residual or predict treatment response...
April 28, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28452619/comparison-of-mri-techniques-for-detecting-microadenomas-in-cushing-s-disease
#6
Yuval Grober, Hagit Grober, Max Wintermark, John A Jane, Edward H Oldfield
OBJECTIVE Many centers use conventional and dynamic contrast-enhanced MRI (DMRI) sequences in patients with Cushing's disease. The authors assessed the utility of the 3D volumetric interpolated breath-hold examination, a spoiled-gradient echo 3D T1 sequence (SGE) characterized by superior soft tissue contrast and improved resolution, compared with DMRI and conventional MRI (CMRI) for detecting microadenomas in patients with Cushing's disease. METHODS This study was a blinded assessment of pituitary MRI in patients with proven Cushing's disease...
April 28, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28447589/neuroretinal-evaluation-using-optical-coherence-tomography-in-patients-affected-by-pituitary-tumors
#7
Yasar Altun, Ayse Sevgi Karadag, Seyho Cem Yucetas, Sadullah Saglam, A Z A Tak, Ilhan Cag, Yusuf Ehi
AIM: To investigate the thickness of the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), inner plexiform layer (IPL), and choroid thickness (CT) in patients with pituitary tumours, microadenoma and macroadenoma, using spectral optical coherence tomography (OCT). METHODS: Thirty six patients who had micro and macroadenoma, and 34 healthy participants (control group) were included in the study. Spectral OCT was used to measure the RNFL, GCL, IPL, and CT values for all patients...
2017: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/28435794/cushing-disease-in-a-patient-with-multiple-endocrine-neoplasia-type-2b
#8
Kannan Kasturi, Lucas Fernandes, Martha Quezado, Mary Eid, Leigh Marcus, Prashant Chittiboina, Mark Rappaport, Constantine A Stratakis, Brigitte Widemann, Maya Lodish
CONTEXT: Multiple endocrine neoplasia type 2B (MEN2B) is a rare autosomal-dominant cancer syndrome characterized in part by metastatic medullary thyroid cancer (MTC) and pheochromocytoma. Cushing disease is a rare cause of endogenous hypercortisolism in children. CASE DESCRIPTION: We describe a 21-year-old African-American male who was diagnosed at age 10 with an ACTH-secreting pituitary microadenoma. At age 16 he developed medullary thyroid cancer and was found to have multiple endocrine neoplasia type 2B with the characteristic M918T mutation of the RET proto-oncogene...
June 2017: J Clin Transl Endocrinol Case Rep
https://www.readbyqxmd.com/read/28382019/transcriptome-analysis-showed-a-differential-signature-between-invasive-and-non-invasive-corticotrophinomas
#9
Leonardo Jose Tadeu de Araújo, Antonio Marcondes Lerario, Margaret de Castro, Clarissa Silva Martins, Marcello Delano Bronstein, Marcio Carlos Machado, Ericka Barbosa Trarbach, Maria Candida Barisson Villares Fragoso
ACTH-dependent hypercortisolism caused by a pituitary adenoma [Cushing's disease (CD)] is the most common cause of endogenous Cushing's syndrome. CD is often associated with several morbidities, including hypertension, diabetes, osteoporosis/bone fractures, secondary infections, and increased cardiovascular mortality. While the majority (≈80%) of the corticotrophinomas visible on pituitary magnetic resonance imaging are microadenomas (MICs, <10 mm of diameter), some tumors are macroadenomas (MACs, ≥10 mm) with increased growth potential and invasiveness, exceptionally exhibiting malignant demeanor...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/28368500/long-term-endocrine-outcomes-following-endoscopic-endonasal-transsphenoidal-surgery-for-acromegaly-and-associated-prognostic-factors
#10
Harish Babu, Alicia Ortega, Miriam Nuno, Aaron Dehghan, Aaron Schweitzer, H Vivien Bonert, John D Carmichael, Odelia Cooper, Shlomo Melmed, Adam N Mamelak
BACKGROUND: Long-term remission rates from endoscopic transsphenoidal surgery for acromegaly and their relationship to prognostic indicators of disease aggressiveness are not well documented. OBJECTIVE: To investigate long-term remission rates in patients with acromegaly after endoscopic transsphenoidal surgery, and correlate this with molecular and radiographic markers of disease aggressiveness. METHODS: We identified all patients undergoing endoscopic transsphenoidal surgery for acromegaly from 2005 to 2013 at Cedars-Sinai Pituitary Center...
March 29, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28356253/adrenocortical-carcinoma-masquerading-as-cushing-s-disease
#11
Kush Dev Jarial, Rama Walia, Santosh Kumar, Anil Bhansali
Cushing's syndrome (CS) can be classified as adrenocorticotropic hormone (ACTH)-dependent or ACTH-independent depending on the ACTH levels. However, 30% of the patients with CS have ACTH levels in the 'grey zone' (5-20 pg/mL), thereby posing a challenge in establishing the aetiological diagnosis. In a patient with full-blown features of Cushing's syndrome with equivocal ACTH levels, and a pituitary microadenoma on contrast-enhanced MRI sella, can falsely lead to a diagnosis of Cushing's disease. Pituitary microadenoma, if <6 mm in size, may be an incidental finding (incidentaloma) in this scenario and can be present in ∼3-27% of the healthy population...
March 29, 2017: BMJ Case Reports
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
#12
REVIEW
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...
May 2017: Neurological Research
https://www.readbyqxmd.com/read/28281008/efficacy-of-endoscopic-endonasal-transsphenoidal-surgery-for-cushing-s-disease-in-230-patients-with-positive-and-negative-mri
#13
Hélène Cebula, Bertrand Baussart, Chiara Villa, Guillaume Assié, Anne Boulin, Luc Foubert, Sorin Aldea, Saad Bennis, Michèle Bernier, François Proust, Stephan Gaillard
OBJECT: The primary objective was to assess the remission rate, and the secondary objectives were to evaluate the early complications and recurrence rate and to define the predictive factors for the remission and recurrence rates. PATIENTS AND METHODS: This prospective single-center study included 230 consecutive patients, operated on by a single surgeon for Cushing's disease via a transsphenoidal endoscopic endonasal approach, over a 6-year period (2008-2013). The patients included in this series were all adults (>18 years of age), who presented with clinical and biological characteristics of Cushing's disease confirmed based on dedicated MRI pituitary imaging...
March 9, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28279153/the-association-between-biochemical-control-and-cardiovascular-risk-factors-in-acromegaly
#14
John D Carmichael, Michael S Broder, Dasha Cherepanov, Eunice Chang, Adam Mamelak, Qayyim Said, Maureen P Neary, Vivien Bonert
BACKGROUND: The study aim was to estimate the proportion of acromegaly patients with various comorbidities and to determine if biochemical control was associated with reduced proportion of cardiovascular risk factors. METHODS: Data were from a single-center acromegaly registry. Study patients were followed for ≥12 months after initial treatment. Study period was from first to last insulin-like growth factor-I and growth hormone tests. RESULTS: Of 121 patients, 55% were female...
March 9, 2017: BMC Endocrine Disorders
https://www.readbyqxmd.com/read/28277481/prolactin-secreting-pituitary-microadenoma-results-of-transsphenoidal-surgery-after-medical-therapy-with-dopamine-agonist
#15
Mario Francesco Fraioli, Giuseppe Umana, Andrea Pagano, Bernardo Fraioli, Pierpaolo Lunardi
Medical therapy with dopamine agonist is very effective in controlling prolactin serum levels and it usually represents the first therapeutic choice for prolactin secreting pituitary adenomas. However, many patients present increase of prolactinemia after withdrawal of medical therapy which consequently should be taken for long time; other present intolerance to medical therapy; women with pregnancy need to withdraw dopamine agonists with consequent potential related problems: in these patients transsphenoidal surgery can be requested...
March 8, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28265841/surgical-outcomes-in-patients-with-cushing-s-disease-the-cleveland-clinic-experience
#16
Philip C Johnston, Laurence Kennedy, Amir H Hamrahian, Zahrae Sandouk, James Bena, Betul Hatipoglu, Robert J Weil
CONTEXT: Transsphenoidal surgery (TSS) to resect a pituitary adenoma is considered first-line treatment for patients with Cushing's disease (CD). Early, post-operative remission rates >80% are expected for patients with a microadenoma (≤ 10 mm) visible on magnetic resonance (MR) imaging. OBJECTIVE: To report surgical outcomes and predictors of remission in a specialist center for patients with CD. PATIENTS AND METHODS: Clinical data was obtained from a prospective CD database in addition to review of all electronic medical, laboratory and surgical patient records...
March 6, 2017: Pituitary
https://www.readbyqxmd.com/read/28225994/a-rare-case-of-ectopic-acth-syndrome-originating-from-malignant-renal-paraganglioma
#17
Esra Tutal, Demet Yılmazer, Taner Demirci, Evrim Cakır, Salih Sinan Gültekin, Bahadır Celep, Oya Topaloğlu, Erman Çakal
Ectopic adrenocorticotropic hormone (ACTH) syndrome is characterized by hypercortisolism due to the hypersecretion of a non-pituitary ACTH-secreting tumor leading to Cushing's syndrome. Only a few cases have been reported previously as causing ectopic ACTH related to paraganglioma. Herein, we present a case of Cushing's syndrome, in who was proved to be attributable to an ACTH-secreting renal malignant paraganglioma. A 40-year-old woman presented with a five-month history of newly diagnosed hypertension and diabetes, weakness, hyperpigmentation, oligomenorrhea, hirsutism, and acneiform lesions...
February 13, 2017: Archives of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28170483/diagnosis-and-treatment-of-pituitary-adenomas-a-review
#18
REVIEW
Mark E Molitch
Importance: Pituitary adenomas may hypersecrete hormones or cause mass effects. Therefore, early diagnosis and treatment are important. Observations: Prevalence of pituitary adenomas ranges from 1 in 865 adults to 1 in 2688 adults. Approximately 50% are microadenomas (<10 mm); the remainder are macroadenomas (≥10 mm). Mass effects cause headache, hypopituitarism, and visual field defects. Treatments include transsphenoidal surgery, medical therapies, and radiotherapy...
February 7, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28145933/an-economic-analysis-of-bromocriptine-versus-trans-sphenoidal-surgery-for-the-treatment-of-prolactinoma
#19
Lian Duan, Hua Yan, Minqiang Huang, Yuhui Zhang, Feng Gu
Prolactinomas account for ∼40% of all pituitary adenomas and are important causes of infertility and gonadal dysfunction. In general, most prolactinomas are treated medically with dopaminergic agonists, while surgery is reserved for patients intolerant or nonresponsive to these medications. The aim of this study was to carry out a comparative analysis of the cost-effectiveness of medical therapy with bromocriptine and surgical therapy with trans-sphenoidal surgery. A Markov model was developed based on retrospective data from 126 patients with prolactinoma treated in our hospital between October 2008 and May 2009, and from data published previously...
January 31, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28120060/efficacy-of-microsurgical-sublabial-approach-msa-versus-endoscopic-endonasal-approach-eea-for-the-treatment-of-pituitary-adenomas-based-on-radiological-and-hormonal-outcome
#20
Pier Paolo Mattogno, Annunziato Mangiola, Giorgio Lofrese, Vera Vigo, Carmelo Anile
BACKGROUND: The purpose of this study was to compare the surgical efficacy of the microsurgical sublabial approach (MSA) versus the endoscopic endonasal approach (EEA) for the treatment of pituitary adenomas, based on short-term (12 months) radiological and endocrinological follow-up. METHODS: One hundred and fourteen patients affected by pituitary adenoma were enrolled at our Unit between January 2007 and February 2012; 72 were treated with MSA, and 42 with EEA...
2017: Acta Neurochirurgica. Supplement
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