Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Pituitary Adenoma [keywords]
- Carotid Artery Injury During Endoscopic Endonasal Skull Base Surgery: Incidence and Outcomes. [JOURNAL ARTICLE]
- Neurosurgery 2013 May 20.
BACKGROUND::Injury to the internal carotid artery (ICA) during endoscopic endonasal skull base surgery (ESBS) is a feared complication that is not well studied or reported.
OBJECTIVE::To evaluate the incidence, identify potential risk factors, and present management strategies and outcomes of ICA injury during ESBS at our institution.
METHODS::We performed a retrospective review of all endoscopic endonasal operations performed at our institution between 1998-2011 to examine potential factors predisposing to ICA injury. We also document the perioperative management and outcomes following injury.
RESULTS::There were 7 ICA injuries encountered in 2015 ESBSs, giving an incidence of 0.3%. Most injuries (5/7) involved the left ICA and the most common diagnosis was chondroid neoplasm (chordoma, chondrosarcoma; 3/7 (2% of 142 cases)). There were 2/660 injuries during pituitary adenoma resection (0.3%). The paraclival ICA segment was the most commonly injured site (5/7) and transclival and transpterygoid approaches had a higher incidence of injury, though neither factor reached statistical significance. 4/7 injured ICAs were sacrificed, either intra- or postoperatively. No patient suffered a stroke or neurologic deficit. There were no intraoperative mortalities; one patient died postoperatively due to cardiac ischemia. One of the 3 preserved ICAs developed a pseudoaneurysm over a mean follow-up period of 5 months, which was treated endovascularly.
CONCLUSION:: ICA injury during ESBS is an infrequent and manageable complication. Preservation of the vessel remains difficult. Chondroid tumors represent a higher risk and should be resected by surgical teams with significant experience.
- Wnt signalling in pituitary development and tumorigenesis. [Journal Article]
- Endocr Relat Cancer 2013; 20(3):R101-11.
Wnt signalling is activated in both pituitary organogenesis and its mature function. Wnt ligands and Wnt signalling pathways are critical for the regulation of the formation of the pituitary. In the mature pituitary, Wnt signalling pathways control cell activity and may stimulate cell proliferation in both physiological and pathological processes. This review compares Wnt signalling pathways active in the developing and mature pituitary and explores how this gives us further insight into the development of pituitary adenomas.
- Endoscopic distinction between capsule and pseudocapsule of pituitary adenomas. [JOURNAL ARTICLE]
- Acta Neurochir (Wien) 2013 May 18.
BACKGROUND:Pseudocapsules were first identified in pituitary adenoma surgery in 1936. Since then, the distinction between pituitary capsules and pseudocapsules has been unclear, and the definitions of these entities have varied. In this study, pituitary capsules and extracapsular dissection were examined retrospectively, intra- and extrapseudocapsular resection was evaluated, and dissection of the pituitary adenoma and pseudocapsule was examined prospectively.
METHODS:Between January 2009 and May 2012, endoscopic transsphenoidal pituitary surgery was performed on 224 patients in the Department of Neurosurgery, Kocaeli University Faculty of Medicine, Turkey. Data for 174 patients were analyzed retrospectively between January 2009 and December 2011, and 50 patients treated between December 2011 and May 2012 were included in a prospective study.
RESULTS:In the retrospective phase of the study, capsules were examined in 21 of the 174 patients on whom extracapsular resection had been performed. In the 50 cases treated between December 2011 and May 2012, dissection of the pituitary capsule, adenohypophysis, and pseudocapsule was performed. In 30 patients in the prospective phase of the study, pseudocapsules were identified during intraoperative endoscopic observation. Remission was achieved in 28 of 33 functioning adenomas in the prospective study. The mean follow-up period in this group was 13 months.
CONCLUSION:The endoscopic and histopathological evidence provided in this study demonstrates that the pituitary capsule and pseudocapsule are distinct structures. In addition, it is also shown that extracapsular dissection can be performed in functioning adenomas that invade the suprasellar region. Significantly higher rates of total resection and higher remission rates were observed in cases where extra- and intrapseudocapsular dissection was required.
- Subgaleal recurrence of craniopharyngioma of rapid growing pattern. [JOURNAL ARTICLE]
- Pituitary 2013 May 18.
The purpose of the present clinical case is to remind clinicians that craniopharyngiomas, which are benign neoplasms with a high incidence of local recurrences, may also present ectopic recurrences which may at first go unsuspected. These tumors most commonly arise in the suprasellar region and despite their benign histology, they may infiltrate the surrounding neurovascular structures making total removal challenging. Ectopic recurrences of craniopharyngiomas are very rare. We describe an adult patient with ectopic recurrence of craniopharyngioma, emphasizing unique features of the case presentation and its physiopathological aspects. A 49-year-old male presented with headache and visual field defect and was diagnosed with a suprasellar tumor. He was submitted to neurosurgery and histological examination revealed an adamantinomatous craniopharyngioma. Postoperative magnetic resonance imaging (MRI) showed complete tumor resection. The patient remained asymptomatic with no imaging signs of local recurrence during follow up. Five years after surgery, the patient noticed a rapidly growing lump at the surgical incision site. He reported a mild to moderate local trauma 4 months before. A MRI showed a subgaleal cystic tumor arising in the pathway of the craniotomy. Surgical resection of that cystic lesion was performed and histological examination revealed an adamantinomatous craniopharyngioma. One year later no recurrences have been detected. The case reported has two particular features: the local trauma as a potential trigger for tumor progression and the rapidly growing pattern of the ectopic recurrent tumor. We emphasize that although ectopic recurrences of craniopharyngiomas are rare, they may occur away from the primary tumor and quite late in the follow up of the patient.
- AIP Mutation Identified in a Patient with Acromegaly Caused by Pituitary Somatotroph Adenoma with Neuronal Choristoma. [Journal Article]
- Exp Clin Endocrinol Diabetes 2013 May; 121(5):295-9.
Pituitary adenoma with neuronal choristoma (PANCH) is a rare condition that includes ganglion cells and GH-producing tumor that is characterized by sparsely granulated somatotroph cell type. However, the pathophysiology of this condition remains to be elucidated. We report a case of 46-year-old woman with acromegaly caused by PANCH. The patient had a large and invasive macroadenoma that was resistant to preoperative therapy with somatostatin analogue (SSA) and dopamine agonist. Histological examination showed typical diffuse, chromophobe-type adenoma containing ganglion cells, and sparsely granulated somatotroph cell type, which were consistent with PANCH. Genetic analysis showed heterozygous germline missense mutation in the AIP gene that results in Y261X amino acid substitution. The clinical characteristics of acromegaly associated with AIP mutations are reportedly macroadenomas with tumor extension and invasion, lower decreases in GH and IGF-I and less tumor shrinkage with SSA treatment, and sparsely granulated somatotroph cell type, which are comparable with those observed in PANCH. Taken together, the mutation in AIP gene may explain the clinical characteristics and pathogenesis of PANCH.
- New avenues in the medical treatment of Cushing's disease: corticotroph tumor targeted therapy. [JOURNAL ARTICLE]
- J Neurooncol 2013 May 15.
Cushing's disease (CD) is a condition of chronic hypercortisolism caused by an adrenocorticotropic hormone-secreting pituitary adenoma. First-line transsphenoidal surgery is not always curative and disease sometimes recurs. Radiotherapy often requires months or years to be effective, and is also not curative in many cases. Consequently, effective medical therapies for patients with CD are needed. Corticotroph adenomas frequently express both dopamine (D2) and somatostatin receptors (predominantly sstr5). Pasireotide, a somatostatin analog with high sstr5 binding affinity, has shown urinary free cortisol (UFC) reductions in most patients with CD in a large phase 3 trial, with UFC normalization and tumor shrinkage in a subset of patients. Adverse events were similar to other somatostatin analogs, with the exception of the degree and severity of hyperglycemia. Two small trials (one prospective and one retrospective) have suggested that cabergoline, a D2 receptor agonist, could be effective in normalizing UFC, but current long-term data results are conflicting. Combination treatment with pasireotide plus cabergoline and the adrenal steroidogenesis inhibitor ketoconazole has been successful, but further investigation in larger trials is necessary. Retinoic acid also showed interesting results in a recent very small prospective study. Glucocorticoid receptor blockade with mifepristone has recently demonstrated improvement in signs and symptoms of Cushing's and glycemic control; however, this modality does not address the etiology of the disease and has inherent adverse events related to its mechanism of action. Pituitary-targeted medical therapies will soon play a more prominent role in treating CD, and may potentially become first-line medical therapy when surgery fails or is contraindicated.
- Lycopene and Beta-Carotene Induce Growth Inhibition and Proapoptotic Effects on ACTH-Secreting Pituitary Adenoma Cells. [Journal Article]
- PLoS One 2013; 8(5):e62773.
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.
- Improvement of Insulin Resistance Following Transsphenoidal Surgery in Patients with Acromegaly: Correlation with Serum IGF-1 Levels. [JOURNAL ARTICLE]
- J Endocrinol Invest 2013 May 10.
Aim:The aim of this study was to determine the correlation between the growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis and glucose intolerance in acromegaly during the early postoperative period. Subjects and
Methods:The study included 20 patients with acromegaly caused by GH-secreting pituitary adenoma who received transsphenoidal surgery in our hospital. Glucose tolerance was evaluated with oral glucose tolerance tests (OGTTs) performed pre- and early postoperative periods (9 [7-18] days after surgery). Homeostasis model assessment of insulin resistance (HOMA-R) and insulinogenic index (IGI) were calculated, and correlation analyses were performed between these values and the GH- IGF-1 axis. Patients were divided according to postoperative changes of the axis, and glucose tolerance was compared between the groups.
Results:In preoperative OGTTs, nine patients had impaired glucose tolerance and two had diabetes mellitus patterns. Postoperatively, significant reduction was observed both in fasting plasma glucose levels (p < 0.01) and in HOMA-R (p < 0.01), whereas IGI showed no significant change. HOMA-R was significantly correlated with serum IGF-1 levels both before (r = 0.83, p < 0.01) and after (r = 0.57, p < 0.01) surgery, although it was not correlated with serum GH levels. Patients who achieved more than 50% postoperative reduction in serum IGF-1 levels showed significant improvement in OGTTs results (p < 0.05).
Conclusions:In patients with acromegaly, serum IGF-1 levels, but not GH levels, were significantly correlated with insulin resistance. Early postoperative improvement of glucose tolerance is observed in patients who achieved postoperative reduction in serum IGF-1 levels.
- Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing caused by a pituitary adenoma. [JOURNAL ARTICLE]
- J Clin Neurosci 2013 May 9.
Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome is a rare primary headache syndrome first described in 1978. We report on a 43-year-old man with a 10 year history of SUNCT in whom a pituitary macroadenoma was eventually detected. His pain rapidly improved with medical treatment of the prolactinoma and we propose that this is a case of symptomatic SUNCT.
- Practical guidelines for diagnosis and treatment of acromegaly. [JOURNAL ARTICLE]
- Endocrinol Nutr 2013 May 6.
Acromegaly and gigantism are due to excess GH secretion, usually by a pituitary adenoma. It is an uncommon disease. Diagnosis is made by showing elevated GH and IGF-I levels in patients with a clinical picture suggesting the condition. Once excess GH is confirmed by biochemical tests, MRI of the hypothalamic-pituitary area should be performed to ascertain the source of excess GH. Transsphenoidal surgery of the pituitary adenoma is the treatment of choice. However, introduction of new drugs has changed the treatment sequence in recent years. Medical treatment with somatostatin analogues may be indicated as primary treatment in patients in whom surgery is not expected to be curative or is contraindicated. The GH receptor antagonist should be use in patients not controlled after surgery who do not adequately respond to somatostatin analogues. Radiotherapy would be indicated in patients not controlled after surgery and medical treatment or with large tumor remnants after surgery.