Efficacy of cabergoline therapy in patients with non-functioning pituitary adenomas: A single center clinical experience

ABSTRACT Objective: To evaluate the response to cabergoline (CBG) treatment in patients with non-functioning pituitary adenomas (NFPA). Subjects and methods: Retrospective, single tertiary care center study. A total of 44 patients were treated with 3 mg/week of CBG, 32 after surgical treatment (transsphenoidal surgery [TSS] in 27 and TC in 5 patients) and 12 as primary therapy. Mean age was 59.2 ± 12 years and 23 (52.2%) were women. Response to therapy was ascertained by serial magnetic resonance imaging. The median duration of CBG therapy was 30 months (IQR 24-48). Response to CBG therapy was defined as a greater than 20% reduction in tumor size and volume. Results: A significant reduction in tumor size was documented in 29 patients (66%), whereas in 11 patients (25%) the tumor increased in size and in 4 (9%), it remained stable. Significant tumor shrinkage was documented in 4 (33.3%) of 12 patients treated primarily and in 23 (71.8%) of those treated secondarily. The three-year progression-free survival was 0.61. Conclusion: Cabergoline therapy is effective in reducing tumor growth in over two thirds of patients with NFPA, however 16% of patients will escape to this beneficial effect and will require alternative forms of treatment to halt tumor progression.

Genotype-phenotype landscape of pituitary adrenocorticotroph hormone adenoma / 中华内分泌代谢杂志

Objective:Cushing′s disease(CD) is caused by the pituitary adrenocorticotroph hormone(ACTH) secreting adenomas, leading to increased serum cortisol levels and various abnormal metabolic processes. Untreated CD is linked to high mortality, thus it is critical to elucidate its pathogenesis. This study aims to explore the pathogenesis of pituitary ACTH adenomas using whole-genome sequencing analysis.Methods:Fresh tumor tissues and peripheral blood samples were collected in 9 confirmed cases of pituitary ACTH adenomas who underwent surgery. Whole genome sequencing was then performed, followed by analysis and verification of single nucleotide mutations, copy number variation(CNV) and chromosome structure variations.Results:Somatic USP8 mutations(p.Ser718del, p. Ser718Pro, p. Pro720Arg, p. Pro720Gln) were found in 5 patients, with a rate of 55.6%; CNV of USP8 was detected in 1 patient; TP53(p.Cys135Tyr), NF1(p.Val1049Glufs*11) and KMT2C(c.3323+ 1G>A) mutations were identified in 1 patient harboring wild-type USP8. CNV analysis showed a loss of heterozygosity in multiple chromosomes in a wild-type USP8 patient. Structural variations were found in 2 with unknown significance. No germline gene mutations were detected in this study.Conclusion:Somatic USP8 mutations, increased copy number of USP8, variations of tumor-related genes such as TP53 and extensive somatic CNV all contribute to pathogenesis of CD. Chromosomal structure variations may suggest high-risk pituitary ACTH adenomas, and call for frequent follow-up and aggressive treatment.

Changes of miRNA-138 and miRNA-26b before and after transsphenoidal surgery for pituitary tumors and their clinical significance / 中华内分泌外科杂志

Objective:To explore and analyze the changes of miRNA-138 and miRNA-26b before and after transsphenoidal surgery for pituitary tumors and their clinical significance.Methods:86 patients with functional pituitary tumors who underwent transsphenoidal surgery in Linyi People’s Hospital from Apr. 2020 to Apr. 2021 were retrospectively analyzed. The recurrence within 1 year after operation was followed up and the patients were divided into unrecovered group (24 cases) and cured group (62 cases) . Clinical data such as age, gender, tumor pathological type, Knosp grade, first operation, tumor diameter, intraoperative tumor residue, Ki-67 and adjuvant therapy were collected. Fasting venous blood was collected before surgery and the next morning after surgery. Quantitative real-time PCR was used to detect the serum levels of mircoRNA-138 (miRNA-138) and miRNA-26b (mirNA-26B) , and the changes of serum miRNA-138 and miRNA-26b levels before and after surgery. Univariate and multivariate logistic regression were used to analyze the relationship between serum miRNA-138 and miRNA-26b levels and postoperative prognosis, and ROC curve was drawn to analyze their predictive value for postoperative prognosis.Results:Univariate analysis showed that Knosp grade, tumor diameter, intraoperative tumor residual, Ki-67, and adjuvant therapy were associated with the recurrence of body tumor after transsphenoidal surgery ( P<0.05) . After operation, the expression of miRNA-138 in serum was higher than that before operation, and the expression of miRNA-138 in unhealed group (4.13±1.12) was higher than that in cured group (3.56±0.84) ( P<0.05) . The expression of miRNA-26b in serum after operation was lower than that before operation, and the expression of miRNA-26b in the unhealed group (2.34±0.62) was lower than that in the cured group (2.75±0.58) ( P<0.05) . Pituitary tumor hormone increased before operation and returned to normal after operation. Multivariate logistic regression analysis showed that tumor diameter ≥40cm (OR=3.476, 95%CI: 1.267-9.539) , postoperative tumor residual (OR=3.155, 95%CI: 1.236-8.052) , Ki-67≥3% (OR=3.885, 95%CI: 2.038-7.403) , postoperative serum miRNA-138 expression ≤3.62 (OR=2.323, 95%CI: 1.536-3.513) , postoperative serum miRNA-26b expression ≥2.59 (OR0.453, 95 %CI: 0.286-0.717) was an independent risk factor for the recurrence of pituitary tumors after transsphenoidal surgery ( P<0.05) . When the optimal cut-off value of serum miRNA-138 was 3.62, the area under the curve for predicting the recurrence of pituitary tumors after transsphenoidal surgery was 0.78, the sensitivity was 81.35%, and the specificity was 71.46%; the optimal cut-off value of serum miRNA-26b When it was 2.59, the area under the curve for predicting and predicting the recurrence of pituitary tumors after transsphenoidal surgery was 0.75, at this time, the sensitivity was 78.62%, and the specificity was 72.33%. The lower area was 0.83, the sensitivity was 85.47%, and the specificity was 72.38%. Conclusion:The expression of serum miRNA-138 was up-regulated and the expression of miRNA-26b was down-regulated after transsphenoidal surgery for pituitary tumors, and its abnormal expression was associated with postoperative recurrence, which has a good predictive value for predicting postoperative recurrence.

Analysis the status and risk factors of nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas / 中国实用护理杂志

Objective:To understand the status of nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas and to explore its risk factors.Methods:By using the convenience sample way, a total of 413 patients in pituitary adenomas who were admitted to the endoscopic transsphenoidal resection from the Second Affiliated Hospital of Zhejiang University School of Medicine were selected as study objects from June, 2018 to December, 2019. The status questionnaire and factors questionnaire of nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas was used to measure the status and factors of nasal bleeding. The risk factors were analyzed by single factor analysis andlogistic regression analysis.Results:There were 38 patients with nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas, with a incidence rate of 9.2%. Among them, 25 patients (65.8%) had precipitating factors of nasal bleeding, mainly sneezing and coughing (11 cases) and constipation (9 cases), and the bleeding season were mainly winter (13 cases) and autumn (14 cases), the average time of postoperative nasal bleeding occurred on the 13th day. The single factor analysis indicated that nasal bleeding related to hyperlipidemia, smoking, anticoagulants, constipation, intraoperative sphenoid artery injury, surgical approach (single and double nostrils), duration of surgery, nasal irrigation, red blood cells, platelets ( P<0.05). The Logistic regression analysis showed that anticoagulants, constipation, intraoperative sphenoid artery injury, nasal irrigation, platelets related to nasal bleeding ( P<0.05). Conclusion:The incidence of nasal bleeding after endoscopic transsphenoidal resection in patients with pituitary adenomas high, and have obvious triggers. The medical staff should focus on preoperative and intraoperative assessment, for the patients had anticoagulant history, constipation, low platelet and possible sphenoid artery and branch injury, should wary the nasal bleeding, nasal irrigation should used to reduce the risk of postoperative nasal bleeding.

Apoplexy in sporadic pituitary adenomas: a single referral center experience and AIP mutation analysis

ABSTRACT Objective: To analyze the clinical, laboratory, and radiological findings and management of patients with clinical pituitary apoplexy and to screen for aryl hydrocarbon receptor-interacting protein (AIP) mutations. Subjects and methods: The clinical findings were collected from the medical records of consecutive sporadic pituitary adenoma patients with clinical apoplexy. Possible precipitating factors, laboratory data, magnetic resonance imaging (MRI) findings and treatment were also analyzed. Peripheral blood samples were obtained for DNA extraction from leukocytes, and the entire AIP coding region was sequenced. Results: Thirty-five patients with pituitary adenoma were included, and 23 (67%) had non-functioning pituitary adenomas. Headache was observed in 31 (89%) patients. No clear precipitating factor was identified. Hypopituitarism was observed in 14 (40%) patients. MRI from 20 patients was analyzed, and 10 (50%) maintained a hyperintense signal in MRI performed more than three weeks after pituitary apoplexy (PA). Surgery was performed in ten (28%) patients, and 25 (72%) were treated conservatively with good outcomes. No AIP mutation was found in this cohort. Conclusion: Patients with stable neuroophthalmological impairments can be treated conservatively if no significant visual loss is present. Our radiological findings suggest that hematoma absorption lasts more than that observed in other parts of the brain. Additionally, our study suggests no benefits of AIP mutation screening in sporadic patients with apoplexy.

Resolution of headache after reduction of prolactin levels in hyperprolactinemic patients / Resolução de cefaleia após redução dos níveis de prolactina em pacientes com hiperprolactinemia

Abstract Prolactin (PRL) secreting adenomas are associated with high incidence of headache. The role of hyperprolactinemia in the headache context is not clear, nor is the effect of its treatment on headache. Methods: The present longitudinal study evaluated hyperprolactinemic patients (69), in terms of presence and characteristics of headache before and after hyperprolactinemia treatment. Results: Headache was reported by 45 (65.2%) patients, independent of the etiology of hyperprolactinemia. The migraine phenotype was the most prevalent (66.6%). Medications used in the treatment of headache not changed during the study. The first line of treatment of hyperprolactinemia was dopaminergic agonists. In the last reevaluation, PRL level under treatment was within the reference range in 54.7% of the cases, and it was observed complete or partial resolution of the headache in 75% of the cases. The median PRL at this time in patients with complete headache resolution was 17 ng/mL, in those who reported partial recovery was 21 ng/mL, and in those in whom the headache did not change was 66 ng/mL, with a significant difference between the group with complete headache resolution vs. the group with unchanged headache (p=0.022). In the cases with complete headache resolution, the median fall on PRL levels was 89% and in those cases with partial headache resolution 86%, both significantly different (p<0.001) from the fall in the cases with an unchanged headache. Conclusion: Data allow us to conclude that, in this series, in the majority of cases the reduction in the level of PRL was followe3d by cessation or relief of the pain.

Resumo Os adenomas secretores de prolactina (PRL) estão associados à alta incidência de cefaleia. O papel da hiperprolactinemia no contexto da dor de cabeça não está claro, nem o efeito da redução dos níveis da PRL na cefaleia. Métodos: O presente estudo longitudinal avaliou pacientes hiperprolactinêmicos (69), quanto à presença e às características da cefaleia antes e após o tratamento da hiperprolactinemia. Resultados: Cefaleia foi relatada por 45 (65,2%) pacientes, independente da etiologia da hiperprolactinemia. O fenótipo de enxaqueca foi mais prevalente (66,6%). Os medicamentos usados ​​no tratamento da cefaleia não foram alterados durante o estudo. A primeira linha de tratamento da hiperprolactinemia foram os agonistas dopaminérgicos. Na última reavaliação, o nível de PRL sob tratamento estava dentro da faixa de referência em 54,7% dos casos, observando-se resolução completa ou parcial da cefaleia em 75% dos casos. A mediana de PRL neste momento em pacientes com resolução completa da cefaleia foi de 17 ng/mL, nos que relataram recuperação parcial foi de 21 ng/mL, e naqueles em que a cefaleia não se alterou foi de 66 ng/mL, com uma diferença significativa entre o grupo com resolução completa da cefaleia versus o grupo com cefaleia inalterada (p=0,022). Nos casos com resolução completa da cefaleia, a queda mediana nos níveis de PRL foi de 89% e nos casos com resolução parcial de cefaleia de 86%, ambos significativamente diferentes (p<0,001) da queda nos casos com cefaleia inalterada. Conclusão: Os dados permitem concluir que, nesta série, na maioria dos casos, a redução do nível de PRL foi seguida pela cessação ou alívio da dor.

The occurrence and characteristics of ectopic pituitary adenoma in China / 中华内分泌外科杂志

Objective To determine the occurrence and clinical characteristics of ectopic pituitary adenoma (EPA) in China.Methods The study are done by searching systematically and comprehensively on major Chinese and English medical literature databases and conference papers before 2015,which are only limited to collected,summarized,sorted and analyzed EPA cases that reported by Chinese authors in English or Chinese occurred in China.Results ① Among the 86 Chinese articles and 27 English articles related to ectopic pituitary adenoma (EPA) gathered by the author,except for cases that have been confirmed as repeated reports,a total of 73 EPA cases were found.Of 70 cases with complete data,31 were male cases,accounting for 44.29％;39 were female cases,accounting for 55.71％;the ratio is 1:1.3.The frequency of EPA occurrence according to the location of the lesion,from high to low in turn,was sphenoid sinus (31 cases,42.47％),nasopharynx (7 cases,9.59％),suprasellar region (7 cases,9.59％),clivus (5 cases,6.85％),followed by the third ventricle,sphenoid sinus/clivus,nasal cavity,and the temporal lobe of the brain,with the same incidence of 4.11％.According to the functional properties of EPA,the frequency of different secreting hormones adenoma was PRL-ma(21 cases,28.77％),NF-ma (21 cases,28.77％),ACTH-ma (15 cases,20.55％),GH-ma (10 cases,13.70％),TSH-ma (2 cases,2.74％) and FSH-ma (1 cases.1.37％).Three cases of EPA were uncertain in their property due to lack of information.The incidence of PRL and nonfunctional tumors was the highest,which was different from what was reported in other countries.Among them,one case of EPA was in pineal region and one in parapharyngeal space,which was even more rare and were never reported abroad.(② Except for 3 cases with incomplete medical records,15 out of 70 cases of EPA were accompanied by empty sella,accounting for 21.43％,among which 11 (73.33％) cases involved the sphenoid sinus,and 3 (20％) cases involved clivus.The sphenoid sinus and clivus cases together accounted for 93.33％.(③ 29 out of the 69 cases of EPA with complete record were invasive pituitary adenomas,accounting for 42.03％ and including 1 case of pituitary adenocarcinoma,which accounted for 1.45％.(④ All cases were treated with surgery as the first choice,and some of them were treated with radiotherapy or drug therapy.Conc lusion Ectopic pituitary adenoma is extremely rare.By the end of 2015,the total number of cases reported in China is only 73,which are mostly located in the sphenoid sinus,suprasellar region and nasopharynx.In the functional classification,the most common types are still PRL adenoma and nonfunctional adenoma as in situ pituitary adenoma.42.03％ of EPA adenomas are invasive.Surgical resection of EPA is the first choice and some cases can be treated with radiotherapy and drug therapy.

Risk factors and the prognosis of sexual dysfunction in male patients with pituitary adenomas: A multivariate analysis / 亚洲男科学杂志(英文版)

The impact of sexual dysfunction (SD) is distressing to many male patients with pituitary adenomas which affect both physical and psychological health. The research explored to identify risk factors affecting sexual function and the prognosis of male patients with pituitary adenomas. Two hundred and fifty-four male patients, who aged between 18 and 60 (mean ± s.d.: 44.16 ± 10.14) years and diagnosed with pituitary adenomas, were retrospectively analyzed. One hundred and fifty-nine patients (62.6%) complained of SD prior to surgery. The mean International Index of Erectile Function (IIEF-5) in patients with giant adenomas was 16.13 ± 2.51, much smaller than those with microadenomas or macroadenomas (P 0.05). Our results indicated that surgical therapy could be optimized for improvements in SD and that testosterone levels can be used as a sensitive indicator to predict the recovery rate of sexual function in patients with pituitary adenomas following surgery and the serum testosterone level will stay stable in 6 months after surgery.

Study of major genetic factors involved in pituitary tumorigenesis and their impact on clinical and biological characteristics of sporadic somatotropinomas and non-functioning pituitary adenomas

Genetic and functional aberrations of guanine nucleotide-binding protein, alpha stimulating (GNAS), aryl hydrocarbon receptor interacting protein (AIP), and pituitary tumor transforming gene (PTTG) are among the most prominent events in pituitary tumorigenesis. A cohort of Brazilian patients with somatotropinomas (n=41) and non-functioning pituitary adenomas (NFPA, n=21) from a single tertiary-referral center were evaluated for GNAS and AIP mutations and gene expression of AIP and PTTG. Results were compared to the clinical and biological (Ki67 and p53 expression) characteristics of tumors and their response to therapy, if applicable. Genetic analysis revealed that 27% of somatotropinomas and 4.8% of NFPA harbored GNAS mutations (P=0.05). However, no differences were observed in clinical characteristics, tumor extension, response to somatostatin analog therapy, hormonal/surgical remission rates, Ki67 index, and p53 expression between mutated and non-mutated somatotropinomas patients. PTTG overexpression (RQ mean=10.6, min=4.39, max=11.9) and AIP underexpression (RQ mean=0.56, min=0.46-max=0.92) were found in virtually all cases without a statistically significant relationship with clinical and biological tumor features. No patients exhibited somatic or germline pathogenic AIP mutations. In conclusion, mutations in GNAS and abnormal PTTG and AIP expression had no impact on tumor features and treatment outcomes in this cohort. Our data support some previous studies and point to the need for further investigations, probably involving epigenetic and transcriptome analysis, to improve our understanding of pituitary tumor behavior.

The relationship between RSUME and small ubiquitin related modifiers of HIF-1α with invasive pituitary adenomas / 中国神经精神疾病杂志

Objective AIM:To study whether the RWD containing sumoylation enhancer (RSUME) enhanced small ubiquitin related modifiers (SUMO) to competitively inhibit Ubiquitin B (UBB)-mediated degradation of hypoxia hypoxia-inducible factor 1α.(HIF-1α) and the invasive pituitary adenomas.Methods The expression of protein and mRNA levels of RSUME,SUMO-1,UBB and HIF-1α were detected by using immunohistochemistry,western blot and qPCR in 38 cases of non-invasive pituitary adenoma,38 cases of invasive pituitary adenomas and 10 cases of normal pituitary capsule.The expression of SUMO-1 was analyzed in different types of pituitary adenomas.Results The protein,and mRNA levels of RSUME,SUMO-HIF-1αwere significantly higher in the invasive pituitary adenomas than in the non-invasive pituitary adenomas and normal pituitary capsule (P＜0.01).The protein and mRNA levels of RSUME,SUMO-HIF-1αwas higher in non-invasive pituitary adenomas than in normal pituitary capsule(P＜0.01).However,the protein levels of UBB-HIF-1α were significantly lower in the invasive pituitary adenomas than in the non-invasive pituitary adenomas and normal pituitary capsule (P＜0.01).The protein of UBB-HIF-1α were lower in non-invasive pituitary adenomas than in normal pituitary capsule (P＜0.01).The expression levels of SUMO were not significantly different among different types of pituitary adenomas (P＞0.05).Conclusion RSUM may increase pituitary adenomas angiogenesis and promote tumor invasion through enhancement of SUMO of HIF-1α which competitively inhibits ubiquitination of HIF-1 α.

ADC and T2WI in differentiating skull base chordoma and invasive pituitary adenomas / 实用放射学杂志

Objective To investigate the value of ADC and T2WI in differentiating of skull base chordoma and invasive pituitary adenomas(IPA).Methods 15 patients with skull base chordoma and 19 patients with IPA which involve paranasal sinus were reviewed retrospectively.All diagnosis were demonstrated by pathology.Quantitative analysis of minimum ADC, normal ADC and rT2WI values were performed.Differences in minimum ADC, normal ADC and rT2WI values between skull base chordoma and IPA were evaluated using the independent samples t test and receiver operating curves(ROC).Results Statistical analysis revealed a significant difference among normal ADC, minimum ADC and rT2WI values (P<0.01),and the area under the ROC curves decreased in turn.Conclusion Both ADC values and rT2WI SI are effective parameter for differentiating diagnosis of skull base chordoma and IPA.

Literature review of ectopic GH-secreting pituitary adenomas / 中华内分泌外科杂志

To analyze relative literatures about ectopic GH-secreting pituitary adenomas,its embryology,anatomic distribution,clinical and imaging features,diagnosis,treatment and prognosis.Ectopic GH-secreting pituitary adenomas is a rare disease.Its pathogenesis originates from defects of embryonic migration of pituitary.The most common position is in sphenoid sinus.Clinical features include placeholder effects of tumor,effects of growth hormone secretion,and intracranial pressure symptoms,et al.Treatments include surgical treatment,radiation therapy and drug therapy.

A rare case of multiple pituitary adenomas in an adolescent Cushing disease presenting as a vertebral compression fracture

Cushing disease in children and adolescents, especially with multiple pituitary adenomas (MPAs), is very rare. We report 17-year-old boy with MPAs. He presented with a vertebral compression fracture, weight gain, short stature, headache, and hypertension. On magnetic resonance imaging (MRI), only a left pituitary microadenoma was found. After surgery, transient clinical improvement was observed but headache and hypertension were observed again after 3 months later. Follow-up MRI showed a newly developed right pituitary microadenoma 6 months after the surgery. The need for careful clinical and radiographic follow-up should be emphasized in the search for potential MPAs in patients with persistent Cushing disease.

Recent Progress in the Medical Therapy of Pituitary Tumors

Management of pituitary tumors is multidisciplinary, with medical therapy playing an increasingly important role. With the exception of prolactin-secreting tumors, surgery is still considered the first-line treatment for the majority of pituitary adenomas. However, medical/pharmacological therapy plays an important role in controlling hormone-producing pituitary adenomas, especially for patients with acromegaly and Cushing disease (CD). In the case of non-functioning pituitary adenomas (NFAs), pharmacological therapy plays a minor role, the main objective of which is to reduce tumor growth, but this role requires further studies. For pituitary carcinomas and atypical adenomas, medical therapy, including chemotherapy, acts as an adjuvant to surgery and radiation therapy, which is often required to control these aggressive tumors. In the last decade, knowledge about the pathophysiological mechanisms of various pituitary adenomas has increased, thus novel medical therapies that target specific pathways implicated in tumor synthesis and hormonal over secretion are now available. Advancement in patient selection and determination of prognostic factors has also helped to individualize therapy for patients with pituitary tumors. Improvements in biochemical and “tumor mass” disease control can positively affect patient quality of life, comorbidities and overall survival. In this review, the medical armamentarium for treating CD, acromegaly, prolactinomas, NFA, and carcinomas/aggressive atypical adenomas will be presented. Pharmacological therapies, including doses, mode of administration, efficacy, adverse effects, and use in special circumstances are provided. Medical therapies currently under clinical investigation are also briefly discussed.

Incidence and prevalence of clinically relevant pituitary adenomas: retrospective cohort study in a Health Management Organization in Buenos Aires, Argentina

ABSTRACT Objectives The main purpose of this study was to estimate the incidence rate and prevalence of clinically relevant pituitary adenomas (PAs) within the Hospital Italiano Medical Care Program (HIMCP), a well-defined population of 150,000 members living in the urban and suburban area of the city of Buenos Aires. We defined clinically relevant PAs as those associated with endocrine dysfunction and/or mass effect. Subjects and methods A retrospective open cohort study was conducted, including all members of the HIMCP over 18 years old, with active memberships during the period of the study, from January 1st 2003, to January 1, 2014. The incidence rates (IRs) were standardized (SIR) to the World Health Organization (WHO) 2000 standard population and were expressed per 100,000 members/year. Prevalence was estimated at January 1, 2014, and was expressed per 100,000 persons. The clinical records have been electronically managed since 2001. All lab and imaging studies were done in-house. Results The overall SIR was 7.39/100,000/year (95% CI 4.47-10.31). Female patients had a specific IR significantly higher than male patients (5.85 vs.1.54) and represented 73% of the affected members. Regarding tumor size, 61.4% were microadenomas, and the mean age at diagnosis was 46.4 years. Prolactinomas had the highest SIR (5.41), followed by acromegaly (Acro) and non-functioning adenomas (NFAs) with overlapping 95% CIs (0.44-1.41 and 0.31-0.99, respectively). Microprolactinomas were more frequent in female (72.6%) (p < 0.01) and younger members (38 vs.60 years; p < 0.04). The overall prevalence rate was 97.76/100,000. Prolactinomas had the highest prevalence (56.29), followed by NFAs (21.48), Acro (14.07) and CD (5.93). Conclusion Our results demonstrate that clinically relevant PAs are more common than usually suspected, especially prolactinomas and growth-hormone secreting PAs. These data highlight the need to increase the awareness of PAs, thereby enabling early diagnosis and treatment.

Manifestaciones neuroftalmológicas en enfermedades neuroendocrinas / Neurophthalmological findings in neuroendocrine diseases

La neuroftalmología es considerada una especialidad frontera por su vínculo con otras múltiples especialidades médicas, clínicas y quirúrgicas. Los tumores de hipófisis son de tal importancia desde el punto de vista neuroftalmológico que son tratados separadamente en casi todos los textos de la especialidad. El objetivo de la presente revisión es aproximarnos, sobre la base de los conocimientos actuales, a los hallazgos neuroftalmológicos de algunas enfermedades neuroendocrinas, haciendo hincapié en dos temas fundamentales: los adenomas hipofisarios y el síndrome de neoplasias endocrinas múltiples, y demostrar además el importante papel del neuroftalmólogo en estas dos entidades. Quedan aquí evidenciadas las variadas manifestaciones neuroftalmológicas de estas entidades neuroendocrinas, el importante cometido del oftalmólogo en el diagnóstico y el ulterior seguimiento de los pacientes con adenomas hipofisarios, así como lo decisiva que puede resultar su actuación en la identificación de los hallazgos asociados al síndrome de neoplasias endocrinas múltiples tipo 2 B(AU)

Neurophthalmology is considerate frontier speciality because of their relationships with many other medical and surgical specialities. Pituitary tumors are so important from neuro-ophthalmological point of view that they appear as special chapter in text books. Our objective in the present review is to refer the neurophthalmological finfings in two main entities: pituitary adenomas and multiple endocrine neoplasia syndromes and to establish the important role of neuro-ophthalmologist in those neuroendocrine conditions. It was proved the diversity of neurophthalmological findings in neuroendocrine entities, the important role of ophthalmologist in diagnosis and pursuance of patients with pituitary adenomas and its peremptory role in screening finding associated to 2 B type multiple endocrine neoplasia syndrome(AU)

Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications / Resultados cirúrgicos do acesso endonasal endoscópico transesfenoidal para adenomas hipofisários grandes e gigantes: experiência institucional com ênfase às complicações relacionadas ao acesso cirúrgico

ABSTRACT Objective In this study, we investigate our institutional experience of patients who underwent endoscopic endonasal transsphenoidal approach for treatment of large and giant pituitary adenomas emphasizing the surgical results and approach-related complications. Method The authors reviewed 28 consecutive patients who underwent surgery between March, 2010 and March, 2014. Results The mean preoperative tumor diameter was 4.6 cm. Gross-total resection was achieved in 14.3%, near-total in 10.7%, subtotal in 39.3%, and partial in 35.7%. Nine patients experienced improvement in visual acuity, while one patient worsened. The most common complications were transient diabetes insipidus (53%), new pituitary deficit (35.7%), endonasal adhesions (21.4%), and cerebrospinal fluid leak (17.8%). Surgical mortality was 7.1%. Conclusions Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for large or giant pituitary adenomas, which results in high rates of surgical decompression of cerebrovascular structures.

RESUMO Objetivo Neste manuscrito investigamos a experiência institucional com o acesso endonasal endoscópico transesfenoidal no tratamento de adenomas hipofisários grandes e gigantes com ênfase às complicações relacionadas ao acesso cirúrgico. Método Foram incluídos neste estudo 28 pacientes consecutivos submetidos à cirurgia entre Março de 2010 e Março de 2014. Resultados O diâmetro médio pré-operatório dos tumores era 4,6 cm. Uma ressecção total foi obtida em 14,3%; quase total, em 10,7%; subtotal, em 39,3% e parcial, em 35,7%. Nove pacientes evoluíram com melhora na acuidade visual, enquanto um paciente apresentou piora da função visual. As complicações mais comuns foram diabetes insipidus transitório (53%), novo défice hipofisário (35,7%), sinéquias endonasais (21,4%) e fistula liquórica (17,8%). A mortalidade cirúrgica foi 7,1%. Conclusões A cirurgia por via endonasal endoscópica transesfenoidal é uma opção terapêutica extremamente útil para adenomas hipofisários grandes e gigantes, a resultar numa significativa descompressão das estruturas cerebrovasculares.

Evaluation of adrenal function and hormone replacement in patients with pituitary adenoma after surgery / 中国综合临床

Objective Surgical treatment is the first choice for treatment in pituitary adenomas except for prolactinomas?In part of patients after operation would occur hypopituitarism,which with acute adrenal crisis is the most serious, and chronic adrenal insufficiency is different degree affects the patient's quality of life?Therefore,it is very important to accurately assess the hypothalamic pituitary adrenal( HPA) axis in patients with pituitary adenoma?But there is still a lack of reliable methods for evaluating adrenal axis?We reviewed the harm of adrenal insufficiency,HPA axis evaluation method of the new progress and postoperative glucocorticoid replacement treatment of new ideas, cleared the importance of reassessment and regular follow?up and the development of individual programs.

Clinical analysis of the related high risk factors of hyponatremia after transsphenoidal approach for ;pituitary adenomectomy andclinical nursing / 中国实用护理杂志

Objective To explore the related high risk factors of hyponatremia after transsphenoidal approach for pituitary adenomectomy and to direct postoperative nursing. Methods The clinical data of seventy-seven patients suffering from pituitary adenomas with the way of treatment by transsphenoidal pituitary adenomectomy from June 2014 to May 2015 were summarized retrospectively. According to the value of postoperative serum natremia, the data were divided into hyponatremia group and non-hyponatremia group. The different data between the 2 groups were compared and the high risk factors related to hyponatremia were analyzed. Results Univariate analysis showed that gender(P=0.254) and high blood pressure(P=0.742) were unrelated to postoperative hyponatremia and there was significant difference between two groups in age (P=0.038), max- diameter of tumors(P=0.004), preoperative pituitary dysfunction (P=0.013), visual deficit (P=0.000), operative procedure duration (P=0.008) and diabetes mellitus rate (P=0.023). While Logistic regression analysis showed that preoperative visual deficit (OR=0.152,P=0.004,95%CI 0.043-0.542) and preoperative pituitary dysfunction (OR=0.069, P=0.046,95%CI 0.005-0.950) were independent factors for postoperative hyponatremia. Conclusions Hyponatremia is a common complication after transsphenoidal pituitary adenomectomy. The optimal treatment can benefit the early recovery and more careful nursing should be focused on these patients who are in high risk of postoperative hyponatremia.

Clinical Guidelines for the Diagnosis and Treatment of Cushing's Disease in Korea

Cushing's disease (CD) is a rare disorder characterized by the overproduction of adrenocorticotropic hormone due to a pituitary adenoma that ultimately stimulates excessive cortisol secretion from the adrenal glands. Prior to the detection of pituitary adenomas, various clinical signs of CD such as central obesity, moon face, hirsutism, and facial plethora are usually already present. Uncontrolled hypercortisolism is associated with metabolic, cardiovascular, and psychological disorders that result in increased mortality. Hence, the early detection and treatment of CD are not only important but mandatory. Because its clinical manifestations vary from patient to patient and are common in other obesity-related conditions, the precise diagnosis of CD can be problematic. Thus, the present set of guidelines was compiled by Korean experts in this field to assist clinicians with the screening, diagnoses, and treatment of patients with CD using currently available tests and treatment modalities.