Endocrine Outcome of Endoscopic Endonasal Transsphenoidal Surgery in Functioning Pituitary Adenomas

OBJECTIVE: Microscopic and endoscopic transsphenoidal approach (TSA) are major surgical techniques in the treatment of pituitary adenoma. Endoscopic endonasal transsphenoidal approach (EETSA) has been increasingly used for pituitary adenomas, however, its surgical outcome particularly in functioning pituitary adenoma has been debated. Here, we investigated the endocrine outcome of the patients with growth hormone (GH) and adrenocorticotropic hormone (ACTH) secreting pituitary adenoma treated by EETSA. METHODS: We treated 80 patients with pituitary adenoma by EETSA since 2004, of which 12 patients were affected by functioning pituitary adenomas (9 GH, 3 ACTH, 0 PRL; 9 macro, 3 micro). Surgical outcome of those patients treated by EETSA was compared with that of the 11 functioning pituitary adenoma patients (8 GH, 3 ACTH; 8 macro, 3 micro) who underwent sublabial microscopic TSA between 1997 and 2003. RESULTS: Imaging remission based on postoperative MRI was achieved in 8 (73%) and hormonal remission in 5 (45%) of 11 patients treated by sublabial microscopic TSA. Imaging remission was observed in 10 (83%, p=0.640) and hormonal remission in 10 (83%, p=0.081) of 12 patients by EETSA. CSF leakage was noticed in 2 (17%) of EETSA group and in 2 (18%) of sublabial microscopic TSA group. Panhypopituitarism was observed in 1 (9%) of EETSA group and in 3 (27%) of sublabial microscopic TSA group. CONCLUSION: EETSA appears to be an effective and safe method for the treatment of functioning pituitary adenomas.

Relationship of angiogenesis and clinical characteristics of GA-secreting pituitary adenomas / 基础医学与临床

Objective To investigate MVD, TSP-1, TGF-?1 expression in GH-Secreting Pituitary Adenomas by immunohistochemistry, and to correlate data with clinical characteristics.Methods The protein expression of TSP-1, TGF-?1 in 48 surgical specimens (21 invasive cases; 27 non-invasive cases) of pituitary adenomas was measured using immunohistochemical method. The relationship between the expression and clinical properties was examined. MVD was measured by detecting CD34.Results Compared with the noninvasive group, no difference of expression of CD34(t=2.257; P=0.083) was observed. The expression of TSP-1 in invasive group was low. The expression of TGF-?1 was higher in invasive cases than that in noninvasive ones. The expression of TGF-?1 had positive correlations with MVD; but there was no correlation between the expression of CD34 and the invasion of pituitary adenomas. In addition, MVD count was not associated with the expression of TSP-1. Size, sex or rate of recurrence did not influence MVD and TSP-1 expression. Conclusion MVD values do not necessarily represent angiogenesis in pituitary adenomas. TGF-?1 may increase MVD, and TSP-1 does not affect MVD in pituitary adenomas and angiogenesis may be regulated by other pathway.

Gamma Knife Radiosurgery for Growth Hormone-secreting Pituitary Adenoma following Trans-sphenoidal Approach

OBJECTIVE: The results of gamma knife radiosurgery(GKRS) for growth hormone(GH)-secreting pituitary adenoma are investigated to identify the role of adjuvant GKRS for remnant or recurrent tumor following transsphenoidal approach(TSA). METHODS: From March 1992 to December 2001, 20 patients treated by GKRS for GH-secreting pituitary adenoma following TSA were followed up more than 3 years and evaluated their symptomatic, hormonal and radiological changes after radiosurgery. RESULTS: There were 6 men and 14 women and the mean age was 40.2 years (range 24-58 years). The maximal dose was 32 to 60Gy (mean 46.2Gy) and the marginal dose was 12.8 to 36Gy (mean 25.5Gy). The mean follow-up time was 5.9 years (range 3-10years). Normalization of GH level (below 2ng/ml) was achieved in 10 of 20 patients (50.0%), and the normalization of IGF-I was in 8 of 15 patients (53.3%). On follow up MR imaging, the tumor control rate was 100% and the tumor volume reduction rate was 25~50% in 4 patients, 50~75% in 13 patients and 75~100% in 3 patients. CONCLUSION: In the treatment of GH-secreting pituitary adenoma, tumor control rate and improvement of clinical symptom show good outcome without major complication after adjuvant GKRS following TSA, though the rate of normalization of GH level is unsatisfactory. The optimal marginal dose for GH-secreting pituitary adenoma is more than 25Gy, and secondary GKRS can be considered in the failed cases to achieve effective hormonal normalization after the first adjuvant GKRS.

Effcets of interferon-? and octreotide on GH-secreting pituitary adenoma / 临床神经病学杂志

Objective To investigate the effects of IFN ? and Somatostatin analog octreotide (SMS) on hormone secretion by cultured human GH secreting pituitary adenomas.Methods Each cultured GH secreting pituitary adenoma cells were equally distributed to culture tube and divided into 4 groups: control, IFN ?, SMS, and IFN ?+SMS. Different drugs were added into different groups. The hormone secretion in each group were detected after 2 and 4 days' incubation.Results After 2 and 4 days' incubation with IFN ?(100 IU/ml) GH secretion was significantly inhibited in 6 of 10 and 7 of 10 pituitary adenoma cultures ,reduced by 22%～54% and 30%～61% vs control ( P