ABSTRACT
BACKGROUND: Double pituitary adenomas (DA) are two morphologically and immunohystochemically different tumours in the same gland. They are rare, generally small adenomas and divided in: separated, when clearly recognizable before or during surgery, and contiguous, when diagnosed only in the following histopathological examination. Acromegaly and Cushing's disease are the main prevalent clinical presentation. OBJECTIVE: We described two cases of DA in a surgical series over 16 years in a single center. METHODS: In September 2018, we diagnosed a DA in a man with acromegaly (case 1). In order to assess the presence of other cases of DA, we performed a retrospective analysis of the endonasal endoscopically operated sellar adenomas from January 2004 to December 2019. RESULTS: 468 pituitary adenomas were found. A DA with a Pit-1 positive macroadenoma (GH-TSH- PRL positive) and an ACTH microadenoma clinically silent in an acromegalic woman was retrospectively found (case 2). CONCLUSION: Our analysis confirms that DA are rare (0.4% of the pituitary adenomas) and often associated with acromegaly. Their pre-operatively diagnosis is difficult but clinician's awareness of DA can improve the diagnosis. The use of pituitary transcription factors could be useful in detecting DA.
Subject(s)
Adenoma/diagnosis , Growth Hormone-Secreting Pituitary Adenoma/diagnosis , Neoplasms, Multiple Primary/diagnosis , Acromegaly/diagnosis , Acromegaly/etiology , Acromegaly/metabolism , Acromegaly/surgery , Adenoma/metabolism , Adenoma/surgery , Adult , Female , Growth Hormone-Secreting Pituitary Adenoma/pathology , Growth Hormone-Secreting Pituitary Adenoma/surgery , Humans , Italy , Male , Middle Aged , Neoplasms, Multiple Primary/metabolism , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/surgery , Neurosurgical Procedures , Pituitary Gland/diagnostic imaging , Pituitary Gland/pathology , Pituitary Gland/surgery , Retrospective StudiesABSTRACT
Spontaneous intracranial hypotension is an increasingly recognized cause of atypical, secondary headaches. Nevertheless, its clinical and imaging spectrum is far from an exhaustive definition, ranging from straightforward cases with unambiguous findings and prompt response to treatment to more challenging ones, requiring advanced, more complex imaging and targeted therapies. We describe two unusual cases as a cue to draw a literature-based, practical approach to the management of the syndrome
La hipotensión intracraneal espontánea es cada vez más reconocida como causa de cefalea secundaria atípica. Su espectro clínico y de imágenes está lejos de ser exhaustivamente definido, y varía desde casos simples con hallazgos inequívocos y pronta respuesta al tratamiento a los más desafiantes, que requieren imágenes avanzadas y terapias dirigidas. Describimos 2 casos como una señal para dibujar un enfoque práctico basado en la literatura para el manejo de este síndrome
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Intracranial Hypotension/diagnostic imaging , Intracranial Hypotension/surgery , Hematoma, Subdural/diagnostic imaging , Intracranial Hypotension/etiology , Headache/etiology , Hematoma, Subdural/physiopathology , Hematoma, Subdural/surgeryABSTRACT
BACKGROUND: Pituitary tumors are a heterogeneous group of lesions that are usually benign. Therefore, a proper understanding of the anatomy, physiology, and pathology is mandatory to achieve favorable outcomes. Accordingly, diagnostic tests and treatment guidelines should be determined and implemented. Thus, we decided to perform a multicenter study among Italian neurosurgical centers performing pituitary surgery to provide an actual depiction from the neurosurgical standpoint. METHODS: On behalf of the SINch (Società Italiana di Neurochirurgia), a survey was undertaken with the participants to explore the activities in the field of pituitary surgery within 41 public institutions. RESULTS: Of the 41 centers, 37 participated in the present study. The total number of neurosurgical procedures performed in 2016 was 1479. Most of the procedures were performed using the transsphenoidal approach (1320 transsphenoidal [1204 endoscopic, 53 microscopic, 53 endoscope-assisted microscopic] vs. 159 transcranial). A multidisciplinary tumor board is convened regularly in 32 of 37 centers, and a research laboratory is present in 18 centers. CONCLUSIONS: Diagnosing pituitary/hypothalamus disorders and treating them is the result of teamwork, composed of several diverse experts. Regarding neurosurgery, our findings have confirmed the central role of the transsphenoidal approach, with preference toward the endoscopic technique. Better outcomes can be expected at centers with a multidisciplinary team and a full, or part of a, residency program, with a greater surgical caseload.
Subject(s)
Adenoma/surgery , Central Nervous System Cysts/surgery , Craniopharyngioma/surgery , Neurosurgical Procedures/statistics & numerical data , Pituitary Neoplasms/surgery , Adenoma/epidemiology , Central Nervous System Cysts/epidemiology , Craniopharyngioma/epidemiology , Humans , Italy/epidemiology , Needs Assessment , Patient Care Team/organization & administration , Pituitary Gland/surgery , Pituitary Neoplasms/epidemiologyABSTRACT
Spontaneous intracranial hypotension is an increasingly recognized cause of atypical, secondary headaches. Nevertheless, its clinical and imaging spectrum is far from an exhaustive definition, ranging from straightforward cases with unambiguous findings and prompt response to treatment to more challenging ones, requiring advanced, more complex imaging and targeted therapies. We describe two unusual cases as a cue to draw a literature-based, practical approach to the management of the syndrome.
