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acromegaly neurosurgery

Jana Ježková, Josef Marek, Manuela Vaněčková
Pituitary adenomas are the most common tumours of the sellar region. A combination of neurosurgery, radiation and pharmacological approaches are applied for the treatment of pituitary adenomas. In certain cases, patient observation is another option. Neurosurgery is the first-choice treatment for acromegaly, Cushing´s disease and TSH secreting adenomas. Leksell gamma knife irradiation is used in the treatment of tumour residues. Until the effect of the irradiation is evident, pharmacological treatment must be administered...
2017: Casopís Lékar̆ů C̆eských
Ray-Bernard Portier, Afshin Afarin, Sara Pope
BACKGROUND: Acromegaly is caused by elevated secretion of human growth hormone, which is frequently because of intracranial tumors. This diagnosis is fairly uncommon with an incidence of 3 to 4 cases per million patients per year. We are presenting a case of acromegaly diagnosed in an active duty Chief Petty Officer. MATERIALS AND METHODS: A 38-year-old male Chief Petty Officer with no previous mental health diagnosis experienced post-traumatic stress disorder (PTSD)-like symptoms in early 2012 after deploying to Iraq and Afghanistan from 2010 to 2011...
July 2017: Military Medicine
Alessandro Prete, Salvatore Maria Corsello, Roberto Salvatori
Sellar and parasellar masses are a common finding, and most of them are treated surgically via transsphenoidal approach. This type of surgery has revolutionized the approach to several hypothalamic-pituitary diseases and is usually effective, and well-tolerated by the patient. However, given the complex anatomy and high density of glandular, neurological and vascular structures in a confined space, transsphenoidal surgery harbors a substantial risk of complications. Hypopituitarism is one of the most frequent sequelae, with central adrenal insufficiency being the deficit that requires a timely diagnosis and treatment...
March 2017: Therapeutic Advances in Endocrinology and Metabolism
F Ceccato, L Lizzul, M Zilio, M Barbot, L Denaro, E Emanuelli, L Alessio, G Rolma, R Manara, A Saller, M Boscaro, C Scaroni
Central adrenal insufficiency (CAI) in acromegaly may be related to pituitary adenoma or induced by various medical treatments, transsphenoidal neurosurgery (TNS) or radiotherapy (RT), alone or combined. We assessed the role of all available treatments for acromegaly in inducing CAI. We retrospectively studied 97 patients. CAI was diagnosed if morning serum cortisol was <138 nmol/l, or if its response was inadequate in the low-dose short synacthen test. Seventy-four subjects underwent TNS (and 17 of whom also underwent RT), and 23 were on primary medical therapy: overall we diagnosed 21 cases of CAI...
August 2016: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
S E Franck, A Muhammad, A J van der Lely, S J C M M Neggers
Treatment of acromegaly with monotherapy long-acting somatostatin analogues (LA-SSA) as primary treatment or after neurosurgery can only achieve complete normalization of insulin-like growth factor I (IGF-I) in roughly 40 % of patients. Recently, one of the acromegaly consensus groups has recommended switching to combined treatment of LA-SSA and pegvisomant (PEGV) in patients with partial response to LA-SSAs. This combination of LA-SSA and PEGV, a growth hormone receptor antagonist, can normalize IGF-I levels in virtually all patients, requiring that the adequate dose of PEGV is used...
May 2016: Endocrine
Pinaki Dutta, Abhishek Hajela, Ashish Pathak, Anil Bhansali, Bishan Das Radotra, Rakesh Kumar Vashishta, Márta Korbonits, Niranjan Khandelwal, Rama Walia, Naresh Sachdeva, Paramjeet Singh, Rajagopalan Murlidharan, Jagtar Singh Devgun, Kanchan Kumar Mukherjee
AIM: The diagnosis and treatment of acromegaly, a rare and possibly curable disease, has undergone a paradigm shift in the past few decades. Our aim was to study the changing trends in clinical presentation, management and outcome of the disease in the last fifteen years. METHODOLOGY: 271 consecutive patients with acromegaly treated at the Departments of Endocrinology and Neurosurgery, PGIMER, Chandigarh, between 2000 and 2014, were included in the study. Clinical and hormonal profiles, comorbidities, treatment modalities, outcome and mortality data were evaluated...
May 2015: Neurology India
Cheng Huan, Guihua Cui, Chao Lu, Xin Qu, Tao Han
To evaluate the specific characteristics in acromegalic patients with hyperprolactinemia by analyzing the differences between patients with different Ki-67 values. Between 2002 and 2010, a set of data on 61 patients undergoing transsphenoidal surgery was available at the Department of Neurosurgery, Provincial Hospital Affiliated to Shandong University. Patients were divided into Ki-67 >3% group and <3% group. A retrospective analysis of clinical, hormonal, immunohistochemical, and imaging was observed in all patients...
March 2015: Pakistan Journal of Pharmaceutical Sciences
N Sandow, W Klene, U Elbelt, C J Strasburger, P Vajkoczy
PURPOSE: Initial successful surgical treatment of pituitary adenomas is crucial to reach long-term remission. Indocyanine green (ICG) videoangiography (VA) is well established in vascular neurosurgery nowadays and several reports described ICG application in brain tumor surgery. We designed this study to evaluate the feasibility of intravenous application of ICG and visualisation of a pituitary lesion via the fluorescence mode of the operation microscope. METHODS: 22 patients with pituitary adenomas were treated with transsphenoidal microsurgery and were included in this study...
October 2015: Pituitary
Jorge Torales, Irene Halperin, Felicia Hanzu, Mireia Mora, Isam Alobid, Mateo De Notaris, Enrique Ferrer, Joaquim Enseñat
INTRODUCTION: Pituitary adenomas account for approximately 15% of intracranial benign tumors. The neurosurgical results achieved since the endoscopic endonasal transsphenoidal (EET) approach was introduced in our center in 2005 are reported here. PATIENTS AND METHODS: A retrospective analysis of 121 patients with sellar lesions (58% females, age 55.7 ± 16 years, range 18-82) who underwent EET surgery from February 2005 to January 2012 and were followed up for a mean time of 4...
October 2014: Endocrinología y Nutrición: órgano de la Sociedad Española de Endocrinología y Nutrición
Murat Altas, Alpay Serefhan, Gokalp Silav, Ajlan Cerci, Kerim Kenan Coskun, Ilhan Elmaci
AIM: Pituitary abscess is a disorder characterized with central nervous system (CNS) infection, mass effect, and endocrine dysfunction. These abscesses generally occur due to hematogenous spread in conditions such as paranasal sinusitis, sepsis, and where the blood brain barrier breaks down. This paper aims to discuss four cases of preoperatively diagnosed pituitary abscess in the light of the literature. MATERIAL AND METHODS: Following detailed clinical and hormonal examinations and imaging tests, 210 cases of pituitary adenoma and other sellar pathologies were operated on at the Neurosurgery clinic of Göztepe Training and Research Hospital...
2013: Turkish Neurosurgery
Marcy G Lake, Linda S Krook, Samya V Cruz
Prolactinomas and nonfunctioning adenomas are the most common types of pituitary adenomas. Patients with pituitary adenomas may present initially with symptoms of endocrine dysfunction such as infertility, decreased libido, and galactorrhea, or with neurologic symptoms such as headache and visual changes. The diagnosis may also be made following imaging done for an unrelated issue in an asymptomatic patient; this is termed a pituitary incidentaloma. Oversecretion of hormones from a dysfunctional pituitary gland may result in classic clinical syndromes, the most common of which are hyperprolactinemia (from oversecretion of prolactin), acromegaly (from excess growth hormone), and Cushing disease (from overproduction of adrenocorticotropic hormone)...
September 1, 2013: American Family Physician
Fausto Bogazzi, Annamaria Colao, Giuseppe Rossi, Martina Lombardi, Claudio Urbani, Chiara Sardella, Aldo Iannelli, Ilaria Scattina, Luca Manetti, Simone Del Sarto, Rosario Pivonello, Ludovica Francesca Stella Grasso, Isabella Lupi, Renata Simona Auriemma, Gaetano Lombardi, Enio Martino
OBJECTIVE: Acromegalic patients have an increased risk of mortality. The objective of this study was to compare the effect of different therapies for acromegaly on mortality. DESIGN AND METHODS: The mortality rate of 438 consecutive acromegalic patients was compared with that of the general population using the standardized mortality ratio (SMR); the effect of different therapies on survival was evaluated using Cox regression analysis. RESULTS: Twenty patients (4...
September 2013: European Journal of Endocrinology
J Marek
In pregnancy, the volume of pituitary increases by multiplication of lactotopic and gonadotropic cells and developing placenta is the source of numerous hormones and enzymes that significantly affect and alter the function of the endocrine system. This naturally has an impact on the course of pituitary disorders and their treatment. The most common disorders of pituitary gland, which we can meet in pregnancy, are adenomas, particularly prolactinomas, and functionless adenomas. During pregnancy we avoid the treatment of microprolactinomas, but in macroprolactinomas where there is the risk of their enlargement by stimulation of placental estrogens, we administer preventively the dopaminergic agonists...
June 2013: Vnitr̆ní Lékar̆ství
Francisco Pita-Gutierrez, Sonia Pertega-Diaz, Salvador Pita-Fernandez, Lara Pena, Gloria Lugo, Susana Sangiao-Alvarellos, Fernando Cordido
CONTEXT: Transsphenoidal neurosurgery is the accepted first-line treatment of acromegaly in the majority of patients. Previous studies addressing preoperative somatostatin analog (SSA) treatment and subsequent surgical cure rates are conflicting, reporting either benefits or no significant differences. OBJECTIVE: The aim of this study, based on a meta-analysis of all published reports, was to investigate whether treatment with SSA before surgery improves the surgical outcome of acromegaly...
2013: PloS One
Salha Fendri, Pelin Karaca, Evelyne Tiev, Michael Buchfelder, Jean-Daniel Lalau
We report on a 30-year-old female acromegalic patient treated with the growth hormone (GH) receptor antagonist pegvisomant at a low dose after the failure of long-acting lanreotide, neurosurgery and radiotherapy treatment to restore IGF-1 levels. The combination treatment was well tolerated and produced a dramatic improvement in the patient's condition (reduction in visual field defects, relief of headache and excessive perspiration), normalization of IGF-I levels and a considerable decrease in tumor size, enabling a dramatic decrease in lanreotide dosage and, ultimately, its withdrawal...
February 2013: Annales D'endocrinologie
Alison M Boyce, McKinley Glover, Marilyn H Kelly, Beth A Brillante, John A Butman, Edmond J Fitzgibbon, Carmen C Brewer, Christopher K Zalewski, Carolee M Cutler Peck, H Jeffrey Kim, Michael T Collins
CONTEXT: GH excess is a serious complication of McCune-Albright syndrome (MAS) and has been associated with craniofacial morbidity. OBJECTIVE: The aim of the study was to determine whether early diagnosis and treatment of MAS-associated GH excess prevents optic neuropathy and hearing impairment, the major morbidities associated with GH excess. DESIGN AND SETTING: A retrospective cross-sectional analysis was conducted at a clinical research center...
January 2013: Journal of Clinical Endocrinology and Metabolism
Sibylle Kohler, Oliver Tschopp, René Ludwig Bernays, Christoph Schmid
The authors present the case of a 30-year-old female patient with acromegaly whose disease had not been cured after transcranial neurosurgery, two transsphenoidal surgeries and stereotactic radiosurgery. She required treatment with octreotide and pegvisomant to normalise growth hormone levels. Seven years after the diagnosis of acromegaly, she noticed acute vision loss in her left eye and presented with meningism. She had an intrasellar abscess which was confirmed and treated by surgical drainage. As a result of the abscess, she was cured of acromegaly and able to discontinue both octreotide and pegvisomant...
2012: BMJ Case Reports
E C T Geijteman, E G van den Berg, C R van Rooijen, F Stam, S Simsek
In patients with hyperglycaemia plus obesity and cardiovascular disease, the diagnosis of type 2 diabetes mellitus is likely to be made and this is usually followed by the start of antihyperglycaemic therapy. This pragmatic approach, however, does not always turn out to be the correct one. We describe two patients with occult conditions that had caused or aggravated diabetes mellitus (DM): a 46-year-old man with acromegaly and a 41-year-old woman with Cushing's disease. After neurosurgeries were performed, the requirement for antihyperglycaemic treatment markedly decreased (case 2) or even disappeared (case 1)...
2012: Nederlands Tijdschrift Voor Geneeskunde
Anna Krzentowska-Korek, Filip Gołkowski, Agata Bałdys-Waligórska, Alicja Hubalewska-Dydejczyk
The aim of the study was to evaluate the frequency of occurrence of pituitary failure following neurosurgery and the efficacy of transsphenoidal tumour resection in acromegalic patients. We retrospectively evaluated 85 patients (60 female and 25 male), of mean age 43.9 ± 13.2 years, treated by transsphenoidal neurosurgery. Macroadenoma and microadenoma of pituitary were found in 66 (77.6%) and 19 (22.4%) of these patients, respectively. Criteria of cure following neurosurgery were: basal GH<2.5 μg/l, GH at 120 min in OGTT<1...
June 2011: Pituitary
A Giustina, M D Bronstein, F F Casanueva, P Chanson, E Ghigo, K K Y Ho, A Klibanski, S Lamberts, P Trainer, S Melmed
To determine whether peer-reviewed consensus statements have changed clinical practice, we surveyed acromegaly care in specialist centers across the globe, and determined the degree of adherence to published consensus guidelines on acromegaly management. Sixty-five acromegaly experts who participated in the 7th Acromegaly Consensus Workshop in March 2009 responded. Results indicated that the most common referring sources for acromegaly patients were other endocrinologists (in 26% of centers), neurosurgeons (25%) and primary care physicians (21%)...
June 2011: Pituitary
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