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1.
Chinese Journal of Geriatrics ; (12): 521-523, 2013.
Artigo em Chinês | WPRIM | ID: wpr-436218

RESUMO

Objective To discuss the operative techniques of endoscopic endonasal transsphenoidal surgery for the resection of pituitary adenoma in elderly patients.Methods From June 2003 to June 2012,a retrospective analysis of 42 elderly patients with pituitary adenoma was conducted.Computed tomography (CT) scan,magnetic resonance imaging (MRI) scan,and endocrinological examinations were performed in all patients before operation.All patients underwent endoscopic endonasal transsphenoidal surgery for the resection of pituitary adenoma.Results The tumors were totally removed in 25 cases (59.5%),sub-totally removed in 8 cases (19.1%) and partly removed in 9 cases (21.4%).1 patient died after operaion.Patients were followed up for 6-36 months.The visual acuity and visual field were improved.Hormone replacement therapy were needed in 20 patients due to hypopituitarism.Tumor residuals were found in 12 patients,among whom 5 patients were treated by γ-knife radiosurgery.Conclusions The endoscopic endonasal transsphenoidal operation is minimally invasive and safe for the treatment of pituitary adenoma in elderly patients.The strengthening of perioperative management is the key to the successful operation.

2.
Chinese Journal of Endocrinology and Metabolism ; (12): 546-550, 2012.
Artigo em Chinês | WPRIM | ID: wpr-427182

RESUMO

Objective To investigate the outcome of postoperative hypopituitarism and hormone replacement in patients with pituitary adenoma,and to analyze the potential factors related to postoperative hypopituitarism.Methods A total of 215 postoperative patients with pituitary adenoma were analyzed.Pituitary functions( including gonadal,thyroid,and adrenal axes ) were asessed by strict criteria.Data of surgery history and hormone replacement situation were collected for statistical analysis.Results The prevalence of hypopituitarism was 54.0%,including 36.7% hypogonadism,32.6% hypothyroidism,and 28.4% hypoadrenalism.Replacements of gonadal steroid,glucocorticoid,and thyroxine were carried out in 25.6%,84.3%,and 80.6% of the cases,respectively.Univariate analysis showed that male sex and large tumor were related to hypopituitarism. Conclusion After pituitary adenomectomy,approximately half of the patients present anterior pituitary dysfunction,while quite a number of them have not been treated appropriately.

3.
Journal of Korean Neurosurgical Society ; : 94-97, 2012.
Artigo em Inglês | WPRIM | ID: wpr-211798

RESUMO

Tumors that metastasize to the pituitary gland are unusual, and are typically seen in elderly patients with diffuse malignant disease. The most common metastases to the pituitary are from primary breast and lung cancers. We report a 65-year-old woman with pituitary metastasis from breast cancer who presented with recent-onset left progressive deterioration of visual acuity and visual field. The clinical diagnosis was made after brain and sellar magnetic resonance imaging showed a large sellar mass compressing the optic chiasm and invading the pituitary stalk. An otorhinolaryngology and neurosurgery team removed the tumor via a transsphenoidal approach, and this procedure obtained symptomatic relief. Postoperatively, metastasis from breast invasive ductal adenocarcinoma was confirmed histologically. We report this unusual case with a review of the relevant literature.


Assuntos
Idoso , Feminino , Humanos , Adenocarcinoma , Encéfalo , Mama , Neoplasias da Mama , Diabetes Insípido , Hemianopsia , Neoplasias Pulmonares , Imageamento por Ressonância Magnética , Metástase Neoplásica , Neurocirurgia , Quiasma Óptico , Otolaringologia , Hipófise , Neoplasias Hipofisárias , Acuidade Visual , Campos Visuais
4.
Korean Journal of Otolaryngology - Head and Neck Surgery ; : 124-130, 2011.
Artigo em Coreano | WPRIM | ID: wpr-652220

RESUMO

BACKGROUND AND OBJECTIVES: The aim of this study was to compare endoscopic endonasal transsphenoidal hypophysectomy (EETSA) with microscopic transseptal transsphenoidal hypophysectomy (MTTSA) in terms of clinical results during an acceleration of learning curve. SUBJECTS AND METHOD: A retrospective chart review was performed of the first 14 cases of EETSA and previous 14 cases of MTTSA. Resection results, endocrinologic outcomes, complication rates, operating time, and duration of hospital stay were investigated. A non-parametric analysis was performed to determine the significance of differences between groups. RESULTS: EETSA was performed, achieving gross total removal, based on postoperative MRI, for 12 of the 14 patients (86%) and hormonal remission for 4 of the 5 patients (80%); on the other hand, MTTSA was performed, achieving gross total removal for 9 of the 14 patients (64%) and hormonal remission for 1 of the 5 patients (20%). We found better resection results in patients who underwent EETSA than in those who did MTTSA with respect to tumors extending into suprasellar area (p<0.05). Visual improvement was achieved in all the cases with visual defect (n=5) after EETSA, whereas 4 of 6 cases (66%) were improved after MTTSA. Significant differences in complication rates, operating time and hospital stay could not be determined. All cases with CSF leakage in EETSA were successfully managed by using the nasoseptal flap. CONCLUSION: EETSA provided better resection results than MTTSA did, especially in cases extending into the suprasellar area, showing good hormonal cure and visual improvement rates. Two approaches were comparable with respect to complications during the learning curve.


Assuntos
Humanos , Aceleração , Endoscópios , Mãos , Hipofisectomia , Aprendizagem , Curva de Aprendizado , Tempo de Internação , Neoplasias Hipofisárias , Estudos Retrospectivos
5.
Korean Journal of Medicine ; : S97-S102, 2009.
Artigo em Coreano | WPRIM | ID: wpr-197363

RESUMO

Growth hormone (GH) and thyrotropin (TSH)-secreting pituitary adenomas are very rare and account for only 0.5% of all pituitary adenomas. We report a case of a GH/TSH-secreting pituitary adenoma in a 53-year-old male patient. He presented with symptoms of thyrotoxicosis, clinical features of acromegaly, and diabetes mellitus. The laboratory examinations showed high serum levels of free T4, TSH, and free alpha-subunit. Additionally, serum levels of GH and insulin-like growth factor (IGF-1) wereincreased. GH was not suppressed below 1 microgram/L by an oral 75 g glucose loading test, and TSH was not stimulated by thyrotropin- releasing hormone. A sellar MRI showed a large lobulated mass on the pituitary gland, so transcranial surgery was performed. Immunohistochemical staining showed anti-GH and anti-TSH positive tumor cells in the cytoplasm. Serum GH, IGF-1, free T4, and TSH levels normalized after surgery.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Acromegalia , Citoplasma , Diabetes Mellitus , Glucose , Hormônio do Crescimento , Fator de Crescimento Insulin-Like I , Hipófise , Neoplasias Hipofisárias , Tireotoxicose , Tireotrofos , Tireotropina
6.
Chinese Journal of General Practitioners ; (6): 705-706, 2008.
Artigo em Chinês | WPRIM | ID: wpr-398483

RESUMO

We retrospectively analyzed the etiology of 26 new-onset pituitary neoplasms, which were diagnosed at outpatient department of internal medicine over the last 2 years. Our results showed that most patients visited doctors for hypertension, diabetes, obesity, and menstrual cycle disorder. In addition,gynecomastia, visual field defect, and headache could also be the primary condition. This study indicates that it should be critical to raise awareness of diverse clinical manifestation of pituitary neoplasm.

7.
Journal of Korean Medical Science ; : S61-S65, 2007.
Artigo em Inglês | WPRIM | ID: wpr-79230

RESUMO

To investigate the characteristics of incidental pituitary microadenomas, we examined 120 pituitary glands from Korean forensic autopsy cases, from which eight tumors were identified (incidence 6.7%). The average age of the affected subjects was 50 yr (range: 33-96 yr) with a female predominance. The maximum diameters of the tumors ranged from 0.4 to 5.4 mm (mean: 2.8 mm). Immunohistochemical analysis of pituitary hormones revealed three growth hormone-secreting adenomas, one prolactin-producing adenoma, one gonadotropin-producing adenoma, one plurihormonal adenoma, and two null cell adenomas. MIB-1 staining for Ki-67 antigen showed no positive expression. The microvessel density (MVD) of the pituitary microadenomas ranged from 2.3 to 11.6% (mean: 5.3%) and was significantly lower than that of nonneoplastic pituitary glands (11.9-20.1%, mean: 14.8%). Our study provides reference data on incidental pituitary microadenomas in the Korean population.


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenoma/irrigação sanguínea , Autopsia , Imuno-Histoquímica , Antígeno Ki-67/metabolismo , Coreia (Geográfico)/epidemiologia , Microcirculação/patologia , Hormônios Hipofisários/metabolismo , Neoplasias Hipofisárias/irrigação sanguínea
8.
Korean Journal of Otolaryngology - Head and Neck Surgery ; : 331-334, 2004.
Artigo em Coreano | WPRIM | ID: wpr-654842

RESUMO

BACKGROUND AND OBJECTIVES: Transseptal transsphenoidal approach (TSTS) to pituitary neoplasms has been accepted as a safe and relatively atraumatic means of removing pituitary tumors. This study was performed to analyze the efficacy of TSTS and its influences on nasal symptoms and external nasal deformities in pediatric patients. MATERIALS AND METHOD: Medical records of 18 patients under the age of 15 years, and who underwent TSTS between 1985 and 2001, were reviewed retrospectively. To analyze long-term results, all 18 patients were interviewed in a standardized telephone survey. RESULTS: The most common presenting symptom was visual disturbance (56%) followed by headache (44%). Revision operations were needed in 5 (28%) patients. There were no significant complications such as intractable epistaxis, recurrent sinusitis, anosmia or external nasal deformity. The most common surgical complication was nasal obstruction (17%). CONCLUSION: TSTS is an effective means of removing pituitary neoplasms in pediatric patients and does not produce severe adverse effects on the nasal function and cosmesis.


Assuntos
Criança , Humanos , Anormalidades Congênitas , Epistaxe , Cefaleia , Prontuários Médicos , Obstrução Nasal , Nariz , Transtornos do Olfato , Neoplasias Hipofisárias , Estudos Retrospectivos , Sinusite , Telefone
9.
Korean Journal of Medicine ; : 690-694, 2003.
Artigo em Coreano | WPRIM | ID: wpr-7408

RESUMO

We report a case of galactorrhea with acromegaly from the mixed prolactin and GH secreting pituitary microadenoma managed with a successful surgical complete removal. A 31-year-old woman visited our hospital complaining galactorrhea for more than 6 months after delivery. The physical findings of the patient were a prominent galactorrhea and mild acromegalic features of face and extremities. The laboratory findings of hematology and blood chemistry were normal. In addition, the basal levels of prolactin and GH were slightly elevated. The thyroid is in euthyroid state. The results of the combined anterior pituitary hormone-stimulation tests were that the prolactin and GH responses were stimulated exaggeratedly and the other hormonal ones were normal responses. The oral glucose loading test for acromegaly revealed non-responder results. The sellar MRI showed the 6 X 5 mm-sized pituitary microadenoma. She was operated for surgical removal of the lesions of which the immunohistochemistry findings were consistent with the positive findings for both prolactin and GH. She discharged without post-operative complication and has done well with normalized hormonal levels at outpatient department.


Assuntos
Adulto , Feminino , Humanos , Gravidez , Acromegalia , Química , Extremidades , Galactorreia , Glucose , Hematologia , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Pacientes Ambulatoriais , Neoplasias Hipofisárias , Prolactina , Glândula Tireoide
10.
Journal of Korean Neurosurgical Society ; : 131-135, 2002.
Artigo em Coreano | WPRIM | ID: wpr-162322

RESUMO

OBJECTIVE: The authors present a retrospective clinical analysis of transsphenoidal surgery for acromegaly including preoperative factors determining the therapeutic outcome. METHODS: Forty-three patients(24 females, mean age 45.3 years) harboring growth hormone(GH)-secreting adenomas(13 microadenomas and 30 macroadenomas) were treated between the years 1987 and 2001. The mean duration of follow-up was 69 months. RESULTS: The average estimated duration of symptoms prior to diagnosis was 8 years. The control rate following surgery was 51%(22 out of 43 cases). Of the patients with postoperative persistent disease, 11 patients had had additional bromocriptine therapy with or without irradiation, and consequently 7 patients achieved biochemical remission. The overall remission rate of multimodality treatment was 67%. The preoperative GH value, tumor size, extrasellar extension of tumor, the number of surgeons, and the extent of the surgical removal were significant univariative predictors of outcome(p<0.05). CONCLUSION: This study suggests that surgical outcome for acromegaly could be achieved by a experienced neurosurgeon. In the group of the patients of large or invasive adenomas, with the less probability of surgical control, adjunctive medical or radiation therapy to control GH hypersecretion should be considered.


Assuntos
Feminino , Humanos , Acromegalia , Adenoma , Bromocriptina , Diagnóstico , Seguimentos , Hormônio do Crescimento , Microcirurgia , Neoplasias Hipofisárias , Estudos Retrospectivos , Resultado do Tratamento
11.
Journal of Korean Neurosurgical Society ; : 395-398, 2002.
Artigo em Coreano | WPRIM | ID: wpr-48198

RESUMO

We report a case of coincidental pituitary adenoma and sphenoid meningioma. Computed tomographic scan had shown a large intrasellar rim enhancing mass and another well-enhancing mass with reactive bony thickening on the medial sphenoidal ridge. Magnetic resonance image revealed a snow-man shaped, expansile intrasellar mass, with small supra-sellar component, and a small enplaque-type enhancing dural thickening on the right medial sphenoidal ridge. Histopathologically, the intrasellar mass was diagnosed as pituitary adenoma and the other mass as secretory meningioma. We present clinical, radiological, and histopathological findings and review the reported cases of coincidental pituitary adenoma and meningioma without irradiation or trauma.


Assuntos
Neoplasias Encefálicas , Meningioma , Neoplasias Hipofisárias , Osso Esfenoide
12.
Medical Journal of Chinese People's Liberation Army ; (12)2001.
Artigo em Chinês | WPRIM | ID: wpr-552994

RESUMO

To probe the effect of transsphenoidal microsurgical removal on large pituitary adenomas (LPA), a total of 1 520 patients suffering from LPA were diagnosed by skull X ray plain films, CT, or MRI scanning. Operations were performed via a transsphenoidal approach under microscope. The results showed that gross total removal of an adenoma in 1 264 cases ( 83 2% ) and subtotal removal in 195 cases ( 12 8% ) were achieved; partial removal was carried out in the remaining 61 cases ( 4 0% ) of fibrous or dumbbell shaped adenomas. Death occurred in two patients (0 1%) after surgery. Long term follow up review( median: 3 5 years ) in 1 240 patients revealed that 1 219 cases( 98 3%) of those with preoperative diminished visual acuity had postoperative improvement; 21 cases (1 7%)had no change, and none deteriorated significantly. Among the 1 226 patients with preoperative visual field defects, postoperative improvement was good in 1 186 (96 7%), and poor in 40(3 3%).It is concluded that microsurgical removal of pituitary tumors by transsphenoidal approach is safe and very effective even for very large or giant adenomas except for fibrous and dumbbell shaped ones, since it allows rapid and adequate decompression of the optic nerves and chiasm.

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