Correlation analysis of anterior pituitary hormone and tumor size in patients with pituitary adenomas / 中华内科杂志

Objective:To summarize the correlation between anterior pituitary function and tumor size in patients with different hormone-secreting pituitary adenomas.Methods:This was a retrospective case series study. The clinical data of 1 946 patients with pituitary adenoma hospitalized in the First Medical Center of Chinese PLA General Hospital from January 1, 2005, to December 31, 2020, were collected. The correlation between tumor size and anterior pituitary hormone levels was analyzed using Spearman rank correlation analysis in different types of pituitary adenomas.Results:The median age of the 1 946 patients was 45.1 years, of which 857 (44.0%) were men. The maximum tumor diameter of the patients [ M ( Q1, Q3)] was 22 (14, 30) mm. Tumor size in nonfunctioning adenomas ( n=1 191) was negatively correlated with adrenocorticotropic hormone (ACTH) ( r=-0.11, P<0.001), growth hormone ( r=-0.13, P<0.001), and luteinizing hormone (men: r=-0.26, P<0.001, women: r=-0.31, all P<0.001). The tumor size of somatotropic adenomas ( n=297) was positively correlated with growth hormone ( r=0.46, P<0.001), but negatively correlated with male testosterone ( r=-0.41, P<0.001). The tumor size of ACTH-secreting pituitary adenomas ( n=155) was positively correlated with the ACTH level at 8∶00 AM ( r=0.25, P<0.001); however, no correlation was found with cortisol at 8∶00 AM ( P>0.05). The tumor size of prolactinomas ( n=303) was positively correlated with the prolactin level (men: r=0.34, P=0.001; women: r=0.13, P=0.070). Conclusions:The correlation between the function of the anterior pituitary and size of the tumor depends on the cellular origin of the pituitary adenoma and specific type of hormone secretion. In somatotroph adenomas, ACTH-secreting pituitary adenomas, and prolactinomas, there is a positive correlation between tumor size and level of hormones secreted by the corresponding tumors. In patients with nonfunctioning adenomas, the tumor size was negatively correlated with the hormone levels of the pituitary-adrenal and pituitary-growth hormone axes.

Acromegalia por macroadenoma hipofisiario en paciente con síndrome de McCune-Albright. Reporte de caso y revisión de la literatura / Acromegaly due to pituitary macroadenoma in a patient with McCune-Albright syndrome. Case report and literature overview

Introducción: El síndrome de McCune-Albright (SMA) es una enfermedad rara caracterizada por la triada: manchas cutáneas de color café con leche, displasia fibrosa poliostótica y pubertad precoz. Puede afectar a diversos ejes hormonales, entre ellos el de la hormona de crecimiento (GH), pudiendo asociarse a acromegalia. Reporte de caso: describimos el caso de una mujer de 44 años, con pubertad precoz periférica, hemorragia uterina anormal, crecimiento de manos y pies, prognatismo, prominencia frontal, manchas café con leche y tumoraciones pétreas en cara y antebrazos. Resultados: Apoyados con exámenes laboratoriales y de imágenes, se llegaron a los diagnósticos de acromegalia, hipogonadismo hipogonadotropo y síndrome de McCune-Albright. La paciente fue sometida a tratamiento quirúrgico con persistencia de enfermedad clínica y laboratorial. Conclusión: El diagnóstico y tratamiento oportunos de la acromegalia y sus complicaciones brindará un mejor pronóstico a los pacientes con SMA.

Background: McCune-Albright syndrome (MAS) is a rare disease characterized by the triad: café-au-lait skin spots, polyostotic fibrous dysplasia, and precocious puberty. It can affect various hormonal axes, including growth hormone (GH), and may be associated with acromegaly. We describe the case Case report:of a 44-year-old woman with peripheral precocious puberty, abnormal uterinebleeding, growthof thehands and feet, prognathism, frontal prominence, café-au-lait spots, and stony tumorsonthefaceandforearms.Supportedby Results:laboratory and imaging tests, the diagnoses of acromegaly, hypogonadotropic hypogonadism and McCune-Albright syndrome were reached. The patient underwent surgical treatment with persistence of clinical and laboratory disease. Conclusion: Timely diagnosis and treatment of acromegaly and its complications will provide a better prognosis for patients with MAS

Syndrome of resistance to thyroid hormone and thyrotropin-secreting pituitary adenoma: Case series study / 中华内分泌代谢杂志

Objective:To outline clinical features in syndrome of resistance to thyroid hormone(RTH) and thyrotropin-secreting pituitary adenoma(TSH adenoma) based on a case series, and to assess the value of octreotide suppression test and high-dose dexamethasone suppression test(HDDST) in differentiating the two diseases.Methods:A total of 22 cases with RTH and TSH adenoma clinically diagnosed in Xiangya Hospital of Central South University from October 2010 to December 2021 were retrieved. The clinical characteristics of the two diseases and results to different tests were analyzed and summarized.Results:(1) The tumors in TSH adenoma patients were larger than those with RTH complicated with pituitary mass, which presented chiasmatic compression on images( P<0.05). (2) In octreotide suppression test, thyrotropin(TSH) inhibition rate in RTH patients was lower than that in TSH adenoma patients( P<0.05). In HDDST, TSH inhibition rate was higher in patients with RTH than in patients with TSH adenoma( P<0.05). (3) The TSH inhibition rate was calculated by receiver operating characteristic(ROC) curve. The sensitivity and specificity of octreotide suppression test were 91.9% and 55.6%, respectively, and the threshold value of TSH inhibition rate was 64.24%. The sensitivity and specificity of HDDST were 54.4% and 89.0%, respectively, and the threshold value of TSH inhibition rate was 65.73%.The combined sensitivity and specificity of the two tests were 77.8% and 90.9%, indicating better diagnostic value( P<0.05). Conclusions:The combination of octreotide suppression test and HDDST is of clinical value in differentiating RTH from TSH adenoma. TSH adenoma is more aggressive than that of pituitary adenoma with RTH.

Sampling of the petrosal sinuses. Indications, results and usefulness / Muestreo de senos petrosos. Indicaciones, resultados y utilidad

Abstract Objectives: to analyze, evaluate and describe the usefulness of petrosal sinus sampling for diagnosing central Cushing's syndrome. Materials and methods: the technical aspects and results of bilateral venous sampling of the petrosal sinuses at the Hospital Universitario San Vicente de Paul in Medellín, Colombia, from January 1, 2012 to December 31, 2018, were analyzed. Results: the average age was 43.3 years, with a range from 19 to 69 years. Laterality could be shown in 68.2% of cases, with a tendency to be located on the left in 53.3%. The central source of ACTH production could be shown in 95.4% of cases, with a basal average central/peripheral ratio of 21.7, and 70.8 after stimulation. All samples at 3, 5 and 10 minutes were confirmatory following stimulation. Conclusion: in our retrospective study, petrosal sinus catheterization provided laboratory confirmation of the central source of ACTH production in a high percentage of patients, with no immediate complications.

Resumen Objetivos: analizar, evaluar y describir la utilidad del muestreo de senos petrosos para diagnóstico del síndrome de Cushing de origen central. Material y métodos: se analizaron los aspectos técnicos y resultados del muestreo bilateral venoso de senos petrosos, desde el 1° de enero de 2012 a 31 de diciembre de 2018 en el Hospital Universitario San Vicente de Paúl en Medellín, Colombia. Resultados: el promedio de edad fue 43.3 años con un rango de edad desde los 19 hasta los 69 años. La lateralidad pudo ser demostrada en 68.2% de los casos con una tendencia a la localización en el lado izquierdo en 53.3%. El origen central de producción de ACTH logró ser demostrado en 95.4% de los casos, con una relación central/periferia basal promedio de 21.7 y postestimulación de 70.8. Todas las muestras a los 3, 5 y 10 minutos fueron confirmatorias tras la estimulación. Conclusión: en nuestro estudio retrospectivo el cateterismo de senos petrosos confirmó la fuente central de producción de ACTH por laboratorio en un alto porcentaje de pacientes sin ninguna complicación inmediata.

Caracterización de tumores secretores de hormona de crecimiento de acuerdo al patrón granular y su rol en el pronóstico / Prognostic value of granular pattern of growth hormone secreting tumors

Background: Classification of growth hormone (GH) - secreting tumors by the granular pattern might predict their clinical behavior in acromegalic patients. There are several other prognostic factors. Aim: To compare the features at presentation and cure rates of patients with GH secreting tumors according to the granular pattern, and to define independent prognostic factors for surgical treatment in these patients. Material and Methods: A retrospective, observational study of 85 active acromegalic patients surgically treated in two medical centers. Results: Seventy-four patients (87%) were classified as having densely granulated (DG) and 11 (13%) as sparsely granulated (SG) tumors. The latter were less active biochemically, had a higher rate of macroadenoma and cavernous sinus invasion and had a lower rate of biochemical cure than the DG group. Several characteristics were associated with disease persistence but only age (Odds ratio (OR) = 0.93) and cavernous sinus invasion (OR = 21.7) were independently associated in the logistic regression model. Conclusions: The sparsely granulated pattern is associated with a more aggressive behavior, but the main determinants of prognosis are age and cavernous sinus invasion.

Effect of lncRNA HULC knockdown on rat secreting pituitary adenoma GH3 cells

Pituitary adenoma is one of the most common tumors in the neuroendocrine system. This study investigated the effects of long non-coding RNAs (lncRNAs) highly up-regulated in liver cancer (HULC) on rat secreting pituitary adenoma GH3 cell viability, migration, invasion, apoptosis, and hormone secretion, as well as the underlying potential mechanisms. Cell transfection and qRT-PCR were used to change and measure the expression levels of HULC, miR-130b, and FOXM1. Cell viability, migration, invasion, and apoptosis were assessed using trypan blue staining assay, MTT assay, two-chamber transwell assay, Guava Nexin assay, and western blotting. The concentrations of prolactin (PRL) and growth hormone (GH) in culture supernatant of GH3 cells were assessed using ELISA. The targeting relationship between miR-130b and FOXM1 was verified using dual luciferase activity. Finally, the expression levels of key factors involved in PI3K/AKT/mTOR and JAK1/STAT3 pathways were evaluated using western blotting. We found that HULC was highly expressed in GH3 cells. Overexpression of HULC promoted GH3 cell viability, migration, invasion, PRL and GH secretion, as well as activated PI3K/AKT/mTOR and JAK1/STAT3 pathways. Knockdown of HULC had opposite effects and induced cell apoptosis. HULC negatively regulated the expression of miR-130b, and miR-130b participated in the effects of HULC on GH3 cells. FOXM1 was a target gene of miR-130b, which was involved in the regulation of GH3 cell viability, migration, invasion, and apoptosis, as well as PI3K/AKT/mTOR and JAK1/STAT3 pathways. In conclusion, HULC tumor-promoting roles in secreting pituitary adenoma might be via down-regulating miR-130b, up-regulating FOXM1, and activating PI3K/AKT/mTOR and JAK1/STAT3 pathways.

Efficacy and safety of pituitary adenomectomy purely endoscopically via a transsphenoidal approach in elderly patients / 中华老年医学杂志

Objective@#To investigate the clinical effect of surgical treatment of pituitary adenoma via neuroendoscopic-assisted transsphenoidal approach in elderly patients.@*Methods@#This was a prospective case-control study.Eighty-five patients with senile pituitary adenoma admitted to our hospital from May 2015 to February 2018 were consecutively enrolled in our study.Patients with pituitary adenoma were divided into the control group(n=42)undergoing conventional microsurgery and the observation group(n=43)receiving microsurgery via neuroendoscopic-assisted transsphenoidal approach.The effect of surgery, perioperative indexes(intraoperative blood loss, operation time, hospitalization time)and the serum level changes of prolactin(PRL), growth hormone(GH)and adrenocorticotropic hormone(ACTH)before and after surgery were recorded and compared between two groups.The incidences of complications in both groups and the dimensions of life quality(physical, cognitive, emotional, social activities)before and after surgery were calculated and assessed.@*Results@#The total effective rate was higher in the observation group(88.4%, 38/43)than in the control group(69.0%, 29/42)(P<0.05). The intraoperative blood loss, operation time and hospital days were less in the observation group than in the control group(P<0.05). No significant differences were found in serum levels of PRL, GH and ACTH between the two groups before and at 3 days after surgery(P>0.05). However, serum levels of PRL, GH and ACTH were deceased in both groups at 3 days after operation compared with before operation.The incidence of complications was lower in the observation group than in the control group(4.7% or 2/43 vs.21.4% or 9/42, P<0.05). The quality of life scores of the cognitive, role, physical, emotional and social dimensions were higher in the observation group than in the control group(P<0.01).@*Conclusions@#Neuroendoscopic-assisted transsphenoidal approach for surgical treatment of senile pituitary adenomas has less intraoperative blood loss, shorter operation time and lower complication rate, improves the endocrine hormone levels and the quality of life, and shortens the hospital stays.

Efficacy and safety of pituitary adenomectomy purely endoscopically via a transsphenoidal approach in elderly patients / 中华老年医学杂志

Objective To investigate the clinical effect of surgical treatment of pituitary adenoma via neuroendoscopic-assisted transsphenoidal approach in elderly patients.Methods This was a prospective case-control study.Eighty-five patients with senile pituitary adenoma admitted to our hospital from May 2015 to February 2018 were consecutively enrolled in our study.Patients with pituitary adenoma were divided into the control group(n=42)undergoing conventional microsurgery and the observation group(n=43)receiving microsurgery via neuroendoscopic-assisted transsphenoidal approach.The effect of surgery,perioperative indexes (intraoperative blood loss,operation time,hospitalization time) and the serum level changes of prolactin (PRL),growth hormone (GH) and adrenocorticotropic hormone(ACTH)before and after surgery were recorded and compared between two groups.The incidences of complications in both groups and the dimensions of life quality(physical,cognitive,emotional,social activities)before and after surgery were calculated and assessed.Results The total effective rate was higher in the observation group(88.4 ％,38/43)than in the control group (69.0 ％,29/42) (P ＜ 0.05).The intraoperative blood loss,operation time and hospital days were less in the observation group than in the control group(P＜0.05).No significant differences were found in serum levels of PRL,GH and ACTH between the two groups before and at 3 days after surgery (P＞0.05).However,serum levels of PRL,GH and ACTH were deceased in both groups at 3 days after operation compared with before operation.The incidence of complications was lower in the observation group than in the control group(4.7％ or 2/43 vs.21.4％ or 9/42,P＜0.05).The quality of life scores of the cognitive,role,physical,emotional and social dimensions were higher in the observation group than in the control group (P ＜ 0.01).Conclusions Neuroendoscopic-assisted transsphenoidal approach for surgical treatment of senile pituitary adenomas has less intraoperative blood loss,shorter operation time and lower complication rate,improves the endocrine hormone levels and the quality of life,and shortens the hospital stays.

Correlation analysis of serum uric acid level and disease activity in patients with growth hormone-secreting pituitary adenoma / 中国医师进修杂志

Objective To explore the correlation between serum uric acid level and disease activity in patients with growth hormone-secreting pituitary adenoma. Methods The clinical data of 76 patients with growth hormone-secreting pituitary adenoma in the Department of Endocrinology of Beijing Tiantan Hospital, Capital Medical University from 2012 to 2018 were retrospectively analyzed. The patients were divided into 4 groups according to serum uric acid quartiles with 19 cases each, uric acid﹤233.9 μmol/L in Q1 group, uric acid 233.9 to 275.9 μmol/L in Q2 group, uric acid 276.0 to 366.7 μmol/L in Q3 group, uric acid＞366.7 μmol/L in Q4 group. The sex, age, duration of disease, height, weight and blood pressure were collected, and the body mass index (BMI) was calculated. The fasting blood glucose (FBG), glycated hemoglobin, fasting insulin (FINS), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), uric acid, basal growth hormone, insulin-like growth factor-1 (IGF-1) were examined, and the IGF-1 index and homeostasis model assessment of insulin resistance (HMOA-IR) were calculated. Pearson correlation analysis was performed to explore the correlation between serum uric acid levels and disease activity. Results In 76 patients, 8 cases were diagnosed with hyperuricemia, accounting for 10.5% . There were no statistical differences in sex constituent, duration of disease, systolic blood pressure, diastolic blood pressure, FBG, glycated hemoglobin, TG, TC, LDL-C, growth hormone and IGF-1 index among 4 groups (P＞0.05). As uric acid level increased, age and HDL-C decreased gradually from Q1 group to Q4 group: (43.58 ± 8.95), (42.58 ± 10.89), (36.58 ± 9.79), (35.37 ± 11.51) years, (1.28 ± 0.22), (1.29 ± 0.23), (1.17 ± 0.28), (1.04 ± 0.22) mmol/L; while BMI, uric acid, IGF-1 and HOMA-IR increased gradually: (25.75 ± 2.86), (27.33 ± 3.94), (26.16 ± 2.94), (28.76 ± 3.69) kg/m2, (190.73 ± 28.80), (249.57 ± 12.00), (325.75 ± 25.61), (430.39 ± 58.41) mmol/L, (594.50 ± 222.45), (733.06 ± 212.42), (774.90 ± 287.87), (962.00 ± 323.36) μg/L, 2.09 (1.64, 2.09), 3.02 (0.94, 3.55), 3.53 (2.31, 6.48), 4.09 (2.52, 5.41), there were statistical differences (P﹤0.05 or﹤0.01). Pearson correlation analysis result showed that uric acid was positive correlation with IGF-1, IGF-1 index, HOMA-IR, TG and systolic blood pressure (r=0.491, 0.341, 0.372, 0.240 and 0.266; P﹤0.01 or﹤0.05), and uric acid was negative correlation with HDL-C (r =-0.367, P﹤0.01). After adjustment for sex, age, duration of disease and BMI, uric acid was still positive correlation with IGF-1 and IGF-1 index (r=0.352 and 0.318, P﹤0.01). Conclusions Serum uric acid level is associated with disease activity in patients with growth-hormone secreting pituitary adenoma.

Correlation analysis of serum uric acid level and disease activity in patients with growth hormone-secreting pituitary adenoma / 中国医师进修杂志

Objective@#To explore the correlation between serum uric acid level and disease activity in patients with growth hormone-secreting pituitary adenoma.@*Methods@#The clinical data of 76 patients with growth hormone-secreting pituitary adenoma in the Department of Endocrinology of Beijing Tiantan Hospital, Capital Medical University from 2012 to 2018 were retrospectively analyzed. The patients were divided into 4 groups according to serum uric acid quartiles with 19 cases each, uric acid <233.9 μmol/L in Q1 group, uric acid 233.9 to 275.9 μmol/L in Q2 group, uric acid 276.0 to 366.7 μmol/L in Q3 group, uric acid >366.7 μmol/L in Q4 group. The sex, age, duration of disease, height, weight and blood pressure were collected, and the body mass index (BMI) was calculated. The fasting blood glucose (FBG), glycated hemoglobin, fasting insulin (FINS), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), uric acid, basal growth hormone, insulin-like growth factor-1 (IGF-1) were examined, and the IGF-1 index and homeostasis model assessment of insulin resistance (HMOA-IR) were calculated. Pearson correlation analysis was performed to explore the correlation between serum uric acid levels and disease activity.@*Results@#In 76 patients, 8 cases were diagnosed with hyperuricemia, accounting for 10.5%. There were no statistical differences in sex constituent, duration of disease, systolic blood pressure, diastolic blood pressure, FBG, glycated hemoglobin, TG, TC, LDL-C, growth hormone and IGF-1 index among 4 groups (P>0.05). As uric acid level increased, age and HDL-C decreased gradually from Q1 group to Q4 group: (43.58 ± 8.95), (42.58 ± 10.89), (36.58 ± 9.79), (35.37 ± 11.51) years, (1.28 ± 0.22), (1.29 ± 0.23), (1.17 ± 0.28), (1.04 ± 0.22) mmol/L; while BMI, uric acid, IGF-1 and HOMA-IR increased gradually: (25.75 ± 2.86), (27.33 ± 3.94), (26.16 ± 2.94), (28.76 ± 3.69) kg/m2, (190.73 ± 28.80), (249.57 ± 12.00), (325.75 ± 25.61), (430.39 ± 58.41) mmol/L, (594.50 ± 222.45), (733.06 ± 212.42), (774.90 ± 287.87), (962.00 ± 323.36) μg/L, 2.09 (1.64, 2.09), 3.02 (0.94, 3.55), 3.53 (2.31, 6.48), 4.09 (2.52, 5.41), there were statistical differences (P<0.05 or <0.01). Pearson correlation analysis result showed that uric acid was positive correlation with IGF-1, IGF-1 index, HOMA-IR, TG and systolic blood pressure (r = 0.491, 0.341, 0.372, 0.240 and 0.266; P<0.01 or <0.05), and uric acid was negative correlation with HDL-C (r = -0.367, P<0.01). After adjustment for sex, age, duration of disease and BMI, uric acid was still positive correlation with IGF-1 and IGF-1 index (r = 0.352 and 0.318, P<0.01).@*Conclusions@#Serum uric acid level is associated with disease activity in patients with growth-hormone secreting pituitary adenoma.

Effects of Oxytocin on Cell Proliferation in a Corticotroph Adenoma Cell Line

BACKGROUND: Oxytocin (OXT) has been reported to act as a growth regulator in various tumor cells. However, there is a paucity of data on the influence of OXT on cell proliferation of corticotroph adenomas. This study aimed to examine whether OXT affects cell growth in pituitary tumor cell lines (AtT20 and GH3 cells) with a focus on corticotroph adenoma cells. METHODS: Reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay were conducted with AtT20 cells to confirm the effects of OXT on hormonal activity; flow cytometry was used to assess changes in the cell cycle after OXT treatment. Moreover, the impact of OXT on proliferating cell nuclear antigen (PCNA), nuclear factor κB, and mitogen-activated protein kinase signaling pathway was analyzed by Western blot. RESULTS: OXT treatment of 50 nM changed the gene expression of OXT receptor and pro-opiomelanocortin within a short time. In addition, OXT significantly reduced adrenocorticotropic hormone secretion within 1 hour. S and G2/M populations of AtT20 cells treated with OXT for 24 hours were significantly decreased compared to the control. Furthermore, OXT treatment decreased the protein levels of PCNA and phosphorylated extracellular-signal-regulated kinase (P-ERK) in AtT20 cells. CONCLUSION: Although the cytotoxic effect of OXT in AtT20 cells was not definite, OXT may blunt cell proliferation of corticotroph adenomas by altering the cell cycle or reducing PCNA and P-ERK levels. Further research is required to investigate the role of OXT as a potential therapeutic target in corticotroph adenomas.

Recidiva de macroadenoma hipofisario posterior a tratamiento estándar / Pituitary macroadenoma relapse after standard treatment

RESUMEN Introducción: la acromegalia es una patología de larga evolución y compromiso multisistémico, originada por un aumento en la liberación de hormona de crecimiento luego del cierre metafisario de los huesos largos. Su diagnóstico es complejo y suele presentarse entre la quinta y sexta década de la vida. El tratamiento incluye la resección quirúrgica y manejo mediante quimioterapia y radioterapia, así como control endocrino fármacológico. La enfermedad presenta una tasa de recidiva comprendida entre el 2 a 14%. Presentación de caso: paciente femenina de 67 años de edad con diagnóstico de acromegalia hace 15 años, quien luego de ser sometida a tratamiento estándar, presenta manifestaciones clínicas progresivas y compatibles con una función hipofisaria activa. Conclusiones: la paciente en efecto presentó recidiva de la enfermedad con persistencia del tumor benigno, debido a la interrupción del tratamiento y el insuficiente seguimiento del caso; por tanto, es fundamental el seguimiento estricto en el paciente que recibe manejo quirúrgico y tratamiento farmacológico por parte del equipo de salud. MÉD.UIS. 2017;30(2):89-93.

ABSTRACT Introduction: acromegaly is a disease of long evolution and multisystemic involvement, caused by an increased release of growth hormone after the metaphyseal closure of long bones. Diagnosis is often difficult and usually occurs between the fifth and sixth decade of life. The treatment is based on surgical resection, chemotherapy and radiotherapy, as on endocrine control by drugs. The disease has a low recurrence rate of from 2 to 14%. Case presentation: a 67 year old female patient with a diagnosis of acromegaly 15 years ago, who, after being subjected to standard treatment, presents progressive and clinical manifestations compatible with an active pituitary function. Conclusions: the patient relapsed effect of the disease with persistency of the benign tumor, due to the discontinuation of treatment and insufficient monitoring of the case; therefore strict monitoring is essential in patients receiving pharmacological therapy and surgical management by the health team. MÉD.UIS. 2017;30(2):89-93.

Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery / Seguimento de longo prazo de adenomas hipofisários secretores do hormônio do crescimento submetidos à cirurgia endoscópica endonasal

ABSTRACT Objective The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas. Methods A retrospective analysis based on medical records of 23 acromegalic patients submitted to endoscopic transsphenoidal surgery. Biochemical control was defined as basal GH < 1ng/ml, nadir GH < 0.4ng/ml after glucose load and age-adjusted IGF-1 normal at the last follow-up. Results The overall endocrinological remission rate was 39.1%. While all microademonas achieved a cure, just one third of macroadenomas went into remission. Suprasellar extension, cavernous sinus invasion and high GH levels were associated with lower rates of disease control. The most common complication was diabetes insipidus and the most severe was an ischemic stroke. Conclusion The endoscopic transsphenoidal approach is a safe and effective technique to control GH-secreting adenomas. The transcavernous approach may increase the risk of complications. Suprasellar and cavernous sinus extensions may preclude gross total resection of these tumors.

RESUMO Objetivo O objetivo do estudo é analisar os resultados da cirurgia de ressecção endoscópica transesfenoidal para adenomas secretores do hormônio do crescimento (GH). Métodos Revisão retrospectiva baseada em análise de prontuários de 23 pacientes acromegálicos submetidos à cirurgia endoscópica. Remissão foi definida por GH < 1ng/ml, nadir de GH ≤ 0,4ng/ml no teste oral de tolerância a glicose e IGF-1 normal para idade. Resultados A taxa de remissão endocrinológica foi 39,1%. Enquanto todos microadenomas alcançaram controle hormonal, apenas um terço dos macroadenomas obtiveram remissão. Extensão suprasselar, invasão do seio cavernoso e altos níveis de GH foram associados a menores taxas de controle da doença. A complicação mais comum foi diabetes insipidus e a mais grave foi acidente vascular encefálico isquêmico. Conclusão A abordagem endoscópica transesfenoidal é segura e efetiva para controle de adenomas hipofisários secretores de GH. A abordagem ao seio cavernoso pode aumentar a morbidade da cirurgia. Extensões suprasselares e no seio cavernoso podem dificultar a ressecção completa e o controle da doença.

A comparative study of the clinical features of thyrotropin-secreting pituitary adenomas / 解放军医学杂志

Objective To comparatively analyze the clinical characteristics of thyrotropin-secreting pituitary adenomas (TSH-omas).Methods The clinical features, laboratory variables, imaging and pathological Results were retrospectively compared and analyzed of 26 cases with TSH-omas admitted in Chinese PLA General Hospital from Feb. 2006 to Oct. 2016 and 20 cases with TSH-omas admitted in Shanghai Huashan Hospital from Apr. 2006 to Apr. 2013.Results The female ratio was slightly higher in patients of Chinese PLA General Hospital than in Huashan Hospital [(57.7%(15/26)vs. 45.0%(9/20)], while the mean age was similar [39.5±14.1(18-67 years)vs. 40.0±14.5(17-74 years)]. The most common chief complaint was thyrotoxicosis [73.1%(19/26)vs. 55.0%(11/20)], and mild-to-moderate goiter was the most common symptom. The mean serum TSH levels in Chinese PLA General Hospital and in Huashan Hospital were 5.06(2.97-6.27)mU/L and 6.16(3.76-10.91)mU/L respectively, and patients with normal serum TSH levels were more common in Chinese PLA General Hospital than in Huashan Hospital [57.7%(15/26)vs. 40.0%(8/20)]. Microadenoma was more common in Chinese PLA General Hospital than in Huashan Hospital [34.62%(9/26)vs. 20.0%(4/20)], while macroadenoma was more common in Huashan Hospital than in Chinese PLA General Hospital [20.0%(4/20)vs. 7.7%(2/26)]. Microadenoma was more common in female patients of the both groups [66.7%(6/9)vs. 75.0%(3/4)], while macroadenoma was all found in male patients. Tumor invasion of surrounding tissue and structure was often found in macroadenoma. In terms of octreotide inhibition test, the range of 24h TSH inhibition rate was roughly the same in the two groups (37.4%-91.8% and 46.5%-94.1%, respectively). Mixed adenoma was rare among all the pathologically confirmed cases. In Chinese PLA General Hospitals, TSH immunoreactive negative neoplastic cells were found in 3 of 8 cases, and octreotide scanning showed negative in 2 of 12 cases.Conclusions Patients with TSH-omas in the two hospitals show similarities but also some significant differences in the clinical features. Overall, the domestic patients with TSH-omas are diagnosed without gender difference according to the reports in China. The mean age at diagnosis is significantly younger than that in foreign data. Microadenoma is more common in females, while macroadenoma is more common in males. Serum TSH levels can be normal in patients with TSH-omas. Immunostaining and/or octreotide scanning for TSH can be negative.

Clinical study on the effectiveness of long-acting octreotide in acromegaly patients after surgery or gamma knife therapy of growth hormone-secreting pituitary adenoma / 中国医师进修杂志

Objective To observe the effectiveness of long-acting octreotide in the treatment of acromegaly patients who did not achieve biochemical control after neurosurgery or gamma knife therapy of growth hormone-secreting pituitary adenoma. Methods Six acromegaly patients who received long-acting octreotide treatment regularly were included. Five patients had received prior trans-sphenoidal surgery and 1 patient had received prior gamma knife therapy before admission. All patients were admitted monthly for evaluation of pituitary-target gland function and octreotide therapy. Data of treatment with octreotide for 6 months were retrospectively summarized. Results Symptoms were reported to be alleviated. Two patients achieved biochemical control of the disease. Two patients had fasting growth hormone level less than 2.5 μg/L,but insulin-like growth factor-1(IGF-1)level was still higher than the age-adjusted normal range.Another 2 patients had decreased growth hormone and IGF-1 level, but both still higher than the normal range. Compared with baseline, IGF-1 level was decreased after treatment:(371.83 ± 217.46)μg/L vs.(713.33 ± 198.29)μg/L,and there was statistical difference (P = 0.017). There were no statistical differences in glycated hemoglobin and fasting plasma glucose before and after octreotide treatment (P > 0.05). Conclusions For acromegaly patients who do not achieve biochemical control after neurosurgery or gamma knife therapy, long-acting octreotide can effectively control IGF-1 level and increase the biochemical control rate of the disease.

One case of a thyrotropin-secreting microadenoma and resistance to thyroid hormone with P453T mutation in TRβgene / 中华内分泌代谢杂志

[Summary] We investigated a 12-year-old girl with elevated serum FT3 , FT4 , and TSH levels. The sequence of thyroid hormone receptorβ( TRβ) exons revealed a CCT→ACT transition mutation at nucleotide 453 site within exon10,whichresultedinthesubstitutionofcytosinetoadenosinein(P453T). Pituitarymagneticresonanceimage showed a pituitary micoradenoma. The patient underwent transsphenoidal pituitary adenomectomy. Pathological results exhibited positive TSH-β, GH, prolactin, ACTH, and α-HCG staining for the tumor. This is the first case report with thyroid hormone resistance syndrome and thyrotropin-secreting adenoma.

Nursing of patients undergoing operations on growth hormone-secreting pituitary adenoma complicated by sleep apnea syndrome / 现代临床护理

Objective To summarize the effect of surgical treatment and nursing strategies of patients with growth hormone-secreting pituitary adenoma complicated by sleep apnea syndrome. Method Forty-three cases with growth hormone-secreting pituitary adenoma complicated by sleep apnea syndrome underwent surgical treatment in our department , with their history retrospectively analyzed to compare the hormone levels and blood oxygen saturation between pre-and post-operation. Result After the operation, both levels of the hormone and blood oxygen saturation were improved than those before operation; the incidence of sleep apnea syndrome was also lower than that before operation (all P<0.05). Conclusions Surgical treatment is better for patients with growth hormone-secreting pituitary adenoma complicated by sleep apnea syndrome. Reasonable treatment and effective nursing are favorable for the recovery of patients.

Pituitary macroadenoma presenting as a nasal tumor: case report / Macroadenoma hipofisário, apresentando-se como um tumor nasal: relato de caso

CONTEXT: Pituitary macroadenomas are rare intracranial tumors. In a few cases, they may present aggressive behavior and invade the sphenoid sinus and nasal cavity, causing unusual symptoms. In this paper, we report an atypical case of pituitary adenoma presenting as a nasal mass. CASE REPORT: The patient was a 44-year-old woman who had had amenorrhea and galactorrhea for ten months, with associated nasal obstruction, macroglossia and acromegaly. Both growth hormone and prolactin levels were increased. Magnetic resonance imaging showed a large mass originating from the lower surface of the pituitary gland, associated with sella turcica erosion and tumor extension through the sphenoid sinus and nasal cavity. Histopathological analysis demonstrated a chromophobe pituitary adenoma with densely packed rounded epithelial cells, with some atypias and rare mitotic figures. There was no evidence of metastases. CONCLUSION: Macroadenoma invading the nasal cavity is a rare condition and few similar cases have been reported in the literature. This study contributes towards showing that tumor extension to the sphenoid sinus and nasopharynx needs to be considered and investigated in order to make an early diagnosis when atypical symptoms like nasal obstruction are present. .

CONTEXTO: Macroadenomas hipofisários são tumores intracraniais raros. Em alguns casos, podem apresentar comportamento agressivo e invadir o seio esfenoidal e a cavidade nasal, causando sintomas não usuais. Neste relato de caso, descrevemos um caso atípico de adenoma hipofisário manifestando-se como uma massa nasal. RELATO DE CASO: A paciente de 44 anos, do sexo feminino, apresentava amenorreia e galactorreia por 10 meses associando-se a obstrução nasal, macroglossia e acromegalia. Os níveis do hormônio de crescimento e de prolactina apresentaram-se aumentados. Ressonância magnética mostrou uma grande massa originada da superfície inferior da glândula hipofisária associada com erosão da sela túrcica e extensão do tumor através do seio esfenoidal e cavidade nasal. Análise histopatológica demonstrou adenoma hipofisário cromófobo com células epiteliais arrendondadas densamente agrupadas com algumas atipias e escassas figuras de mitose. Não houve evidências de metástase. CONCLUSÃO: O macroadenoma invasivo para a cavidade nasal é uma condição rara e há poucos relatos similares descritos na literatura. Este trabalho contribui para mostrar que, na presença de sintomas atípicos como a obstrução nasal, a extensão para o seio esfenoidal e para a nasofaringe deve ser considerada e investigada para um diagnóstico precoce. .

Adenoma de hipófisis como forma infrecuente de insuficiencia suprarrenal secundaria. Presentación de un caso / Pituitary Adenoma as a Rare Form of Secondary Adrenal Insufficiency. A Case Report

Los adenomas de hipófisis son tumores benignos originados en uno de los cinco tipos celulares de la hipófisis anterior. La insuficiencia suprarrenal secundaria ocurre cuando las glándulas adrenales no producen hormonas por la falta de hormona adenocorticotrópica hipofisaria o del factor liberador de corticotropina hipotalámico. Se presenta el caso de una paciente de 37 años de edad, que un año atrás comenzó con fasciculaciones musculares de piernas y brazos, debilidad muscular, cansancio fácil, dolores musculares, cefalea hemicránea derecha, intensa y pulsátil, entre otros síntomas. Se le realizaron varios estudios (dosificación de cortisol en sangre, hormona adenocorticotrópica, calcio y fósforo en sangre y orina, resonancia magnética de cráneo) que permitieron el diagnóstico de adenoma de hipófisis con déficit aislado de hormona adenocorticotrópica e insuficiencia suprarrenal secundaria. El tratamiento con esteroides y suplementos de calcio garantizaron la evolución favorable.

Pituitary adenomas are benign tumors arising from one of the five cell types in the anterior pituitary. Secondary adrenal insufficiency occurs when the adrenal glands do not produce hormones due to the lack of pituary adrenocorticotropic hormone or hypothalamic corticotropin-releasing factor. The case of a 37-year-old female patient who started developing muscle twitching in legs and arms, muscular weakness, fatigue, muscle aches, severe and throbbing hemicrania on the right side, among other symptoms, a year ago is presented. Several tests were performed (cortisol level, adrenocorticotropic hormone, calcium and phosphorus in blood and urine, magnetic resonance imaging of the skull), leading to the diagnosis of pituitary adenoma with isolated adrenocorticotropic hormone deficiency and secondary adrenal insufficiency. Treatment with steroids and calcium supplements ensured a satisfactory recovery.

Postoperative structural complications after microscopic transsphenoidal surgery of GH secreting pituitary adenomas / Complicações estruturais pós-operatórias após microcirurgia transesfenoidal de adenomas pituitários produtores de GH

Objective: Analyzing the rate of structural complications after transsphenoidal surgery for removal of growth hormone (GH) secreting pituitary adenomas. Methods: Retrospective study of 58 patients who underwent microscopic transsphenoidal neurosurgery for GH secreting pituitary adenomas exeresis in Curitiba, Parana state, Brazil, between 1998 and 2011 by the same neurosurgeon. The Criteria for diagnosis of complications were clinical. Results: Five (8,6%) of the 58 patients who underwent transsphenoidal surgery developed postoperative anatomical complications, which was due to sixth cranial nerve palsy (3,4%), surgical wound infection (1,7%) and CSF fistula (3,4%). Conclusion: The rate of postoperative complications observed in the present study is likely the literature review. There is a drop in the rate of complications with increasing experience of the neurosurgeon.

Objetivo: Analisar a taxa de complicações anatômicas após cirurgia transesfenoidal para remoção de adenoma hipofisário produtor de hormônio do crescimento (GH). Métodos: Estudo retrospectivo de 58 pacientes operados por microcirurgia transesfenoidal para exérese de adenomas pituitários produtores de GH em Curitiba, Paraná, Brasil, entre 1998 e 2011, realizados pelo mesmo neurocirurgião. Diagnóstico das complicações foi clínico. Resultados: Dos 58 pacientes submetidos à cirurgia transesfenoidal, 5 (8,6%) desenvolveram complicações anatômicas, 3,4% foram em decorrência de paresia temporária do sexto nervo craniano, 1,7%, de infecção da ferida operatória, e 3,4%, de fístula liquórica. Conclusão: A taxa de complicações pós-operatórias observada no presente estudo está semelhante à da revisão literária. Há uma queda no índice de complicações conforme aumenta a experiência do neurocirurgião.