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1.
preprints.org; 2023.
Preprint in English | PREPRINT-PREPRINTS.ORG | ID: ppzbmed-10.20944.preprints202308.1412.v1

ABSTRACT

Immunostaining of transcription factors allows a more exact classification of pituitary neuroendocrine tumours (PitNETs), but not a better prediction of their clinical behaviour. This retrospective, single-centre study aims to classify a series of PitNETs using Trouillas et al.’s clinicopathological classification from 2013. We analysed 166 patients undergoing PitNET surgery in 2013–2023. Tumours were identified according to the gene and immunohistochemical expression of PitNET transcription factors plus adenohypophyseal hormones. Tumours were classified according to a grading system based on MRI invasion and Ki-67 index. Eighty-one (48.8%) patients had grade 2a tumours; 71 (42.8%), grade 1a; 8 (4.8%), 2b; and 6 (3.6%), 1b. At a mean follow-up of 57.8 (standard deviation 30) months, 13.9% (n=23) showed recurrence/progression; independent predictors of recurrence were tumour volume (p=0.031) and T2 signal intensity ratio (SIR) (p<0.001). This risk was 18.6-fold higher for a T2 SIR of 2 or more. Grade 2a and 2b tumours, T2 SIR, and silent corticotroph adenomas (SCAs) were associated with lower progression-free survival. Our results add more evidence to the prognostic value of the five-grade PitNET classification and suggest higher clinical surveillance of patients with SCAs is warranted. The MRI findings highlight the increasing value of radiological evaluation for managing PitNETs.


Subject(s)
Neoplasms , Adenoma , Pituitary Neoplasms
2.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-3136831.v1

ABSTRACT

Introduction:Pituitary tumors represent 10-15% of all intracranial tumors. Clinical manifestations depend on the size of the tumor such as microadenoma, macroadenoma or giant adenoma, and type of the tumor (secreting or non-secreting). Surgical treatment of pituitary adenoma can be managed via transcranial or transsphenoidal approach. Depending on the approach, there is a possibillity of postoperative complications such as meningitis, pneumocephalus, liquorrhea, transient diabetes insipidus and ect. Aim:The aim of this study was to establish the frequency of newly discovered pituitary tumors in the Emergency Center, University Clinical Center Of Serbia, during the COVID-19 pandemic in Serbia, and early postoperative complications in patients treated with an endoscopic and microscope transsphenoidal approach. Material and methods: During the time period during the pandemic, the study contains 119 patients, from January 1, 2020 to March 1, 2023, of which 64 are male (53.8%) and 55 are female (46.2%), age range is 14 to 85 years with a mean of 52.10. As for statistical analysis, assessment of frequency rate and relative numbers were used as methods of descriptive statistics. Results:Macroadenoma was present in 95 patients (79.83%), microadenoma in 22 patients (18.49%), and giant adenoma in 2 patients (1.69%). Transient DI developed postoperatively in 11 patients (9.24%). The average duration of hospitalization after surgery was 8 days. Conclusion: The duration of hospitalization depends on numerous factors where the COVID-19 pandemic can serve as an example for future similar crisis situations so that better organization and preoperative preparation of patients can be implemented.


Subject(s)
Neoplasms , COVID-19 , Adenoma , Pituitary Neoplasms , Meningitis , Postoperative Complications , Pneumocephalus , Brain Neoplasms , Diabetes Insipidus
3.
Front Endocrinol (Lausanne) ; 13: 1035482, 2022.
Article in English | MEDLINE | ID: covidwho-2224761

ABSTRACT

A 50-year-old man was admitted to our hospital for vomit, nausea, diplopia, and headache resistant to analgesic drugs. Symptoms started the day after his third COVID-19 mRNA vaccine (Moderna) whereas SARS-CoV-2 nasal swab was negative. Pituitary MRI showed recent bleeding in macroadenoma, consistent with pituitary apoplexy. Adverse Drug Reaction was reported to AIFA (Italian Medicines Agency).A stress dexamethasone dose was administered due to the risk of adrenal insufficiency and to reduce oedema. Biochemistry showed secondary hypogonadism; inflammatory markers were elevated as well as white blood cells count, fibrinogen and D-dimer. Pituitary tumour transsphenoidal resection was performed and pathology report was consistent with pituitary adenoma with focal haemorrhage and necrosis; we found immunohistochemical evidence for SARS-CoV-2 proteins next to pituitary capillaries, in the presence of an evident lymphocyte infiltrate.Few cases of pituitary apoplexy after COVID-19 vaccination and infection have been reported. Several hypotheses have been suggested to explain this clinical picture, including cross-reactivity between SARS-CoV-2 and pituitary proteins, COVID-19-associated coagulopathy, infection-driven acutely increased pituitary blood demand, anti-Platelet Factor 4/heparin antibodies development after vaccine administration. Ours is the first case of SARS-CoV-2 evidence in pituitary tissue, suggesting that endothelial infection of pituitary capillaries could be present before vaccination, possibly due to a previous asymptomatic SARS-CoV-2 infection. Our case underlines that SARS-CoV-2 can associate with apoplexy by penetrating the central nervous system, even in cases of negative nasal swab. Patients with pituitary tumours may develop pituitary apoplexy after exposure to SARS-CoV-2, therefore clinicians should be aware of this risk.


Subject(s)
COVID-19 , Pituitary Apoplexy , Pituitary Neoplasms , Male , Humans , Middle Aged , Pituitary Apoplexy/etiology , COVID-19 Vaccines/adverse effects , COVID-19/complications , SARS-CoV-2 , Vaccination
6.
Eur J Endocrinol ; 187(3): K19-K25, 2022 Sep 01.
Article in English | MEDLINE | ID: covidwho-1963085

ABSTRACT

Objective: Since the outbreak of the COVID-19 pandemic, several cases of pituitary apoplexy (PA) following a SARS-CoV-2 infection have been described in several countries. Here, we describe a case series of PA occurring in the aftermath of a SARS-CoV-2 infection to alert physicians about possible neuro-endocrinological damage caused by the virus that can lead to visual sequelae and hypopituitarism. Design and methods: We retrospectively identified all the adult patients treated at Amiens University Hospital between March 2020 and May 2021 for PA confirmed by cerebral imaging and following an RT-PCR-confirmed SARS-CoV-2 infection. Results: Eight cases (six women, two men) occurred between March 2020 and May 2021 and were reviewed in this study. The mean age at diagnosis was 67.5 ± 9.8 years. Only one patient had a 'known' non-functional pituitary macroadenoma. The most common symptom of PA was a sudden headache. Brain imaging was typical in all cases. Only two patients required decompression surgery, whereas the others were managed conservatively. The clinical outcome was favorable for all patients but without recovery of their pituitary deficiencies. There was no diabetes insipidus. Conclusion: This case series, the largest in the literature, reinforces the strength, consistency, and coherence of the association between SARS-CoV-2 infection and PA. Our study provides support for the hypothesis that SARS-CoV-2 may be a new precipitating factor for PA. It is essential that practitioners be alerted about possible pituitary disease due to the virus so that such patients are recognized and appropriately managed, hence improving their prognosis.


Subject(s)
COVID-19 , Hypopituitarism , Pituitary Apoplexy , Pituitary Neoplasms , Adult , COVID-19/complications , Female , Hospitals, University , Humans , Hypopituitarism/complications , Male , Pandemics , Pituitary Apoplexy/diagnosis , Pituitary Neoplasms/surgery , Retrospective Studies , SARS-CoV-2
8.
Surg Innov ; 29(2): 282-288, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1817058

ABSTRACT

Background. Ultrasound has been explored as an alternative, less bulky, less time-consuming and less expensive means of intraoperative imaging in pituitary surgery. However, its use has been limited by the size of its probes relative to the transsphenoidal corridor. We developed a novel prototype that is more slender than previously reported forward-viewing probes and, in this report, we assess its feasibility and safety in an initial patient cohort. Method. The probe was integrated into the transsphenoidal approach in patients with pituitary adenoma, following a single-centre prospective proof of concept study design, as defined by the Innovation, Development, Exploration, Assessment and Long-Term Study (IDEAL) guidelines for assessing innovation in surgery (IDEAL stage 1 - Idea phase). Results. The probe was employed in 5 cases, and its ability to be used alongside the standard surgical equipment was demonstrated in each case. No adverse events were encountered. The average surgical time was 20 minutes longer than that of 30 contemporaneous cases operated without intraoperative ultrasound. Conclusion. We demonstrate the safety and feasibility of our novel ultrasound probe during transsphenoidal procedures to the pituitary fossa, and, as a next step, plan to integrate the device into a surgical navigation system (IDEAL Stage 2a - Development phase).


Subject(s)
Adenoma , Pituitary Neoplasms , Adenoma/diagnostic imaging , Adenoma/surgery , Humans , Magnetic Resonance Imaging/methods , Microsurgery , Pituitary Neoplasms/diagnostic imaging , Pituitary Neoplasms/surgery , Prospective Studies , Treatment Outcome
11.
J Med Case Rep ; 15(1): 544, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1496217

ABSTRACT

BACKGROUND: This report describes the case of a patient whose pituitary microadenoma resolved after he contracted coronavirus disease 2019. To our knowledge, this is one of the first reported cases of pituitary tumor resolution due to viral illness. We present this case to further investigate the relationship between inflammatory response and tumor remission. CASE PRESENTATION: A 32-year-old man in Yemen presented to the hospital with fever, low blood oxygen saturation, and shortness of breath. The patient was diagnosed with coronavirus disease 2019. Past medical history included pituitary microadenoma that was diagnosed using magnetic resonance imaging and secondary adrenal insufficiency, which was treated with steroids. Due to the severity of coronavirus disease 2019, he was treated with steroids and supportive care. Three months after his initial presentation to the hospital, brain magnetic resonance imaging was performed and compared with past scans. Magnetic resonance imaging revealed changes in the microadenoma, including the disappearance of the hypointense lesion and hyperintense enhancement observed on the previous scan. CONCLUSIONS: Pituitary adenomas rarely undergo spontaneous resolution. Therefore, we hypothesized that tumor resolution was secondary to an immune response to coronavirus disease 2019.


Subject(s)
Adenoma , COVID-19 , Pituitary Neoplasms , Adenoma/complications , Adenoma/diagnostic imaging , Adult , Humans , Magnetic Resonance Imaging , Male , Pituitary Neoplasms/diagnostic imaging , Pituitary Neoplasms/drug therapy , SARS-CoV-2
12.
BMJ Case Rep ; 14(7)2021 Jul 28.
Article in English | MEDLINE | ID: covidwho-1331803

ABSTRACT

Pituitary apoplexy is an endocrine emergency, which commonly presents as hypopituitarism. Prompt diagnosis and treatment can be both life and vision saving. There are a growing number of published case reports postulating a link between COVID-19 and pituitary apoplexy. We report the case of a 75-year-old man who presented with a headache and was later diagnosed with hypopituitarism secondary to pituitary apoplexy. This occurred 1 month following a mild-to-moderate COVID-19 infection with no other risk factors commonly associated with pituitary apoplexy. This case, therefore, supplements an emerging evidence base supporting a link between COVID-19 and pituitary apoplexy.


Subject(s)
Adenoma , COVID-19 , Pituitary Apoplexy , Pituitary Neoplasms , Stroke , Adenoma/complications , Adenoma/diagnosis , Aged , Humans , Male , Pituitary Apoplexy/diagnosis , Pituitary Apoplexy/etiology , Pituitary Neoplasms/complications , Pituitary Neoplasms/diagnosis , SARS-CoV-2
13.
World Neurosurg ; 152: e678-e687, 2021 08.
Article in English | MEDLINE | ID: covidwho-1275760

ABSTRACT

BACKGROUND: Pituitary apoplexy (PA) is a rare, but life-threatening, condition characterized by pituitary infarction and hemorrhage, most often in the setting of a preexisting adenoma. The risk factors and mechanisms associated with PA are poorly understood. Although neurovascular manifestations of coronavirus disease 2019 (COVID-19) infection have been documented, its association with PA has not yet been determined. METHODS: From a prospectively collected database of patients treated at a tertiary care center for pituitary adenoma, we conducted a retrospective medical record review of PA cases during the COVID-19 pandemic from March 2020 to December 2020. We also conducted a literature review to identify other reported cases. RESULTS: We identified 3 consecutive cases of PA and concomitant COVID-19 infection. The most common symptoms at presentation were headache and vision changes. The included patients were successfully treated with surgical decompression and medical management of the associated endocrinopathy, ultimately experiencing improvement in their visual symptoms at the latest follow-up examination. COVID-19 infection in the perioperative period was corroborated by polymerase chain reaction test results in all the patients. CONCLUSIONS: With the addition of our series to the literature, 10 cases of PA in the setting of COVID-19 infection have been confirmed. The present series was limited in its ability to draw conclusions about the relationship between these 2 entities. However, COVID-19 infection might represent a risk factor for the development of PA. Further studies are required.


Subject(s)
Adenoma/surgery , COVID-19/surgery , Pituitary Apoplexy/surgery , Pituitary Neoplasms/surgery , Adult , COVID-19/complications , Female , Headache/complications , Humans , Hypopituitarism/complications , Male , Middle Aged
14.
World Neurosurg ; 152: 80-83, 2021 08.
Article in English | MEDLINE | ID: covidwho-1267966

ABSTRACT

BACKGROUND: The respiratory illness identified as coronavirus disease 2019 (COVID-19) has resulted in a pandemic illness that has changed the face of healthcare. As the COVID-19 pandemic continues, patients have continued to require neurosurgical interventions, and the endoscopic endonasal approach for surgery has continued to be a mainstay treatment of pituitary tumors and anterior skull base lesions. METHODS: We sought to highlight the current lack of recommendations regarding testing protocols for neurosurgical patients. RESULTS: We implemented a novel testing protocol for our patient populations at increased risk and have proposed a model that can be used at other institutions to mitigate the risk of complications associated with some forms of COVID-19 testing. CONCLUSION: Patients with anterior skull base defects may be at risk with current COVID-19 testing protocols, and may benefit from alternative specimen collection strategies.


Subject(s)
COVID-19 Testing , COVID-19/complications , Neurosurgical Procedures , SARS-CoV-2/pathogenicity , COVID-19/diagnosis , COVID-19 Testing/methods , Cerebrospinal Fluid Leak/etiology , Humans , Nasal Cavity/surgery , Neurosurgical Procedures/methods , Pituitary Neoplasms/surgery , Skull Base/surgery
15.
Front Endocrinol (Lausanne) ; 12: 596654, 2021.
Article in English | MEDLINE | ID: covidwho-1167312

ABSTRACT

In early 2020, a novel coronavirus leading to potentially death was discovered. Since then, the 2019 coronavirus disease (COVID-19) has spread to become a worldwide pandemic. Beyond the risks strictly related to the infection, concerns have been expressed for the endocrinological impact that COVID-19 may have, especially in vulnerable individuals with pre-existing endocrinological health conditions. To date new information is emerging regarding severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) in children but the literature is still scarce concerning this infection in patients with intracranial malignant neoplasms. We report a 9-year-old child infected with SARS-CoV-2 and recent diagnosis of suprasellar non-germinomatous germ cell tumor also suffering from diabetes insipidus and hypothalamic-pituitary failure (hypothyroidism, adrenal insufficiency, hypothalamic obesity and growth hormone deficiency) and its clinical course. The patient remained asymptomatic for the duration of the infection without requiring any change in the replacement therapeutic dosages taken before the infection. We then discuss the proposed approach to treat a pediatric patient with SARS-CoV-2 infection and hypothalamic-pituitary failure and we include a review of the literature. Our report suggests that SARS-CoV-2 infection is usually mild and self-limiting in children even those immunocompromised and with multiple endocrinological deficits. Patients are advised to keep any scheduled appointments unless informed otherwise.


Subject(s)
COVID-19/complications , Hypothalamo-Hypophyseal System/physiopathology , Neoplasms, Germ Cell and Embryonal/complications , Neoplasms, Germ Cell and Embryonal/therapy , Pituitary Neoplasms/complications , Pituitary Neoplasms/therapy , COVID-19/physiopathology , COVID-19/therapy , Child , Diabetes Insipidus/complications , Diabetes Insipidus/physiopathology , Female , Humans , Magnetic Resonance Imaging , Neoplasms, Germ Cell and Embryonal/physiopathology , Pituitary Neoplasms/physiopathology , Quarantine , Stem Cell Transplantation
16.
Indian J Ophthalmol ; 69(4): 992-994, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1138821

ABSTRACT

COVID-19 is a respiratory virus, which has affected various organ systems as well. Here we report a neuro-ophthalmic presentation of pituitary apoplexy under the setting of COVID-19 infection in a middle-aged man who presented to ophthalmic emergency with sudden bilateral loss of vision along with a history of fever past 10 days. There was sluggishly reacting pupils and RT-PCR for COVID was positive. Imaging pointed the diagnosis as pituitary macroadenoma with apopexy. In view of pandemic situation, patient was given symptomatic treatment as per the protocols and stabilized. Vision also showed improvement to some extent and the patient is awaiting neurosurgery.


Subject(s)
Adenoma/diagnosis , COVID-19/diagnosis , Eye Infections, Viral/diagnosis , Pituitary Apoplexy/diagnosis , Pituitary Neoplasms/diagnosis , SARS-CoV-2 , Adenoma/drug therapy , Adenoma/virology , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Glucocorticoids/therapeutic use , Humans , Magnetic Resonance Imaging , Male , Methylprednisolone/therapeutic use , Middle Aged , Pituitary Apoplexy/drug therapy , Pituitary Apoplexy/virology , Pituitary Neoplasms/drug therapy , Pituitary Neoplasms/virology , COVID-19 Drug Treatment
18.
Pituitary ; 24(4): 499-506, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1064567

ABSTRACT

PURPOSE: To determine the particle size, concentration, airborne duration and spread during endoscopic endonasal pituitary surgery in actual patients in a theatre setting. METHODS: This observational study recruited a convenience sample of three patients. Procedures were performed in a positive pressure operating room. Particle image velocimetry and spectrometry with air sampling were used for aerosol detection. RESULTS: Intubation and extubation generated small particles (< 5 µm) in mean concentrations 12 times greater than background noise (p < 0.001). The mean particle concentrations during endonasal access were 4.5 times greater than background (p = 0.01). Particles were typically large (> 75 µm), remained airborne for up to 10 s and travelled up to 1.1 m. Use of a microdebrider generated mean aerosol concentrations 18 times above baseline (p = 0.005). High-speed drilling did not produce aerosols greater than baseline. Pituitary tumour resection generated mean aerosol concentrations less than background (p = 0.18). Surgical drape removal generated small and large particles in mean concentrations 6.4 times greater than background (p < 0.001). CONCLUSION: Intubation and extubation generate large amounts of small particles that remain suspended in air for long durations and disperse through theatre. Endonasal access and pituitary tumour resection generate smaller concentrations of larger particles which are airborne for shorter periods and travel shorter distances.


Subject(s)
Aerosols/adverse effects , Endoscopy/adverse effects , Pituitary Neoplasms/surgery , Airway Extubation/adverse effects , Humans , Intubation, Intratracheal/adverse effects , Motion , Occupational Exposure/adverse effects , Occupational Health , Operating Rooms , Particle Size , Prospective Studies , Risk Assessment , Risk Factors , Time Factors
19.
World Neurosurg ; 146: 148-149, 2021 02.
Article in English | MEDLINE | ID: covidwho-971146

ABSTRACT

We present a case of a 28-year-old woman with a history of severe headaches and pituitary insufficiency. She was found to have a large, enhancing, sellar mass consistent with a pituitary adenoma. The patient's surgical care was delayed due to the coronavirus disease 2019 (COVID-19) pandemic, and follow-up imaging revealed spontaneous involution of the sellar mass. Spontaneous involution of pituitary masses has been described but not often encountered in clinical practice. This case highlights that follow-up imaging is necessary when scheduling elective surgeries during the COVID-19 pandemic.


Subject(s)
Adenoma/diagnostic imaging , COVID-19/prevention & control , Neoplasm Regression, Spontaneous , Pituitary Neoplasms/diagnostic imaging , Adult , COVID-19/epidemiology , Female , Follow-Up Studies , Humans , Neoplasm Regression, Spontaneous/pathology , Pandemics
20.
Braz J Anesthesiol ; 70(2): 165-170, 2020.
Article in Portuguese | MEDLINE | ID: covidwho-718653

ABSTRACT

The 2020 pandemic caused by the novel coronavirus, COVID-19, had its headquarters in China. It causes Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and presents a broad spectrum of clinical manifestations, ranging from entirely asymptomatic through severe acute respiratory failure and death. Presuming a significant quantity of ventilator-dependent patients, several institutions strategically delayed elective surgeries. Particularly procedures performed involving the nasal mucosa, such as a transsphenoidal approach of the pituitary gland, considering the tremendous level of viral shedding. Nevertheless, critical cases demand expeditious resolution. Those situations are severe pituitary apoplexy, declining consciousness level, or risk of acute visual loss. This case presents a successful urgent perioperative management of a 47 year-old male COVID-19 positive patient who presented to the Emergency Department with a left frontal headache that culminated with diplopia, left eye ptosis, and left visual acuity loss after 5 days. Transsphenoidal hypophysectomy was uneventfully performed, and the patient was discharged from the hospital on postoperative day four. It additionally describes in detail the University of Mississippi Medical Center airway management algorithm for patients infected with the novel coronavirus who need emergent surgical attention.


Subject(s)
Airway Management/methods , Coronavirus Infections/complications , Pituitary Neoplasms/surgery , Pneumonia, Viral/complications , Betacoronavirus/isolation & purification , COVID-19 , Humans , Male , Middle Aged , Pandemics , Perioperative Care , Pituitary Neoplasms/diagnosis , SARS-CoV-2 , Treatment Outcome
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