Diagnosis and Clinical Management of Aggressive Pituitary Tumors

Abstract BACKGROUND: Observational methods can be used in conjunction with the comparative effectiveness research (CER) paradigm to inform decisions between alternative patient management strategies in real-world clinical settings. OBJECTIVE: To present a brief review of current observational research regarding 3 strategies for predicting normal hypothalamic-pituitary-adrenal (HPA) axis function after surgical resection of pituitary tumors and to apply the CER model to compare these management alternatives. METHODS: We designed and conducted 2 prospective observational studies involving 183 patients undergoing microsurgical resection for pituitary tumors. These investigations yielded a comprehensive database comprising longitudinal data from multiple clinical domains. We investigated 3 potential strategies to predict normal postoperative HPA axis function in this cohort, including preoperative adrenocorticotrophic hormone stimulation testing and measurement of serum cortisol levels immediately after surgery or on the first postoperative day. We performed a focused comparative effectiveness review to help inform the decision between the 3 potential clinical management strategies. RESULTS: This investigation illustrates the use of observational research methods in conjunction with CER methodology as one means of informing clinical management decisions. Of the 3 strategies for assessing postoperative HPA axis function studied, preoperative and immediate postoperative adrenocorticotrophic hormone stimulation testing had the highest sensitivity, accuracy, and positive predictive value for normal HPA axis function postoperatively. The preoperative strategy was also the most cost-effective approach (12% reduction vs benchmark). CONCLUSION: The decision to use any of the 3 strategies outlined requires attention to a specific patient's clinical situation, but this decision may be aided by the results of this CER analysis.

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Two Distinct Types of Microfilaments in the Cytoplasm of Human Adenohypophysial Cells

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100073787 ◽

1973 ◽

Vol 31 ◽

pp. 668-669

Author(s):

E. Horvath ◽

K. Kovacs ◽

I. E. Stratmann ◽

C. Ezrin

Keyword(s):

Pituitary Tumors ◽

Average Diameter ◽

Anterior Lobe ◽

Uranyl Acetate ◽

Type I ◽

Breast Cancer Patients ◽

Human Pituitary ◽

Severe Diabetes ◽

Pituitary Glands ◽

Membrane Bound

Surgically removed human pituitary glands as well as pituitary tumors fixed in glutaraldehyde, postfixed in osmium tetroxide, embedded in epon resin, stained with uranyl acetate and lead citrate have been investigated by electron microscopy in order to correlate ultrastructure with functional activity. In the course of this study two distinct types of microfilaments have been identified in the cytoplasm of adenohypophysiocytes.Type I microfilaments (Fig. 1) were found in the cytoplasm of anterior lobe cells of five female subjects with disseminated mammary cancer and two patients with severe diabetes mellitus. The breast cancer patients were treated pre-operatively for various periods of time with different doses of oxysteroids. The microfilaments had an average diameter of JO A, formed parallel bundles, were scattered irregularly in the cytoplasm and were frequently located in the perikaryon. They were not membrane-bound and failed to show any periodicity.

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Ultrastructural Immunocytochemistry of Five Rat Pituitary Adenomas

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s1431927600003147 ◽

1980 ◽

Vol 38 ◽

pp. 724-725

Author(s):

D. J. McComb ◽

N. Ryan ◽

E. Horvath ◽

K. Kovacs ◽

E. Nagy ◽

...

Keyword(s):

Pituitary Adenomas ◽

Pituitary Tumors ◽

Electron Microscopic ◽

Electron Microscopic Immunocytochemistry ◽

Transmission Electron ◽

Rat Pituitary ◽

Radiation Induced ◽

Group 5 ◽

Group 2 ◽

Microscopic Techniques

Conventional light and electron microscopic techniques failed to clarify the cellular composition and derivation of spontaneous and induced, intrasellar and transplanted pituitary adenomas in rats (1). In the present work, electron microscopic immunocytochemistry was applied to evaluate five adenohypo-physial tumors using a technique described by Moriarty and Garner (2). Spontaneously occurring pituitary adenomas (group 1) were harvested from aging female Long-Evans rats. R-Amsterdam rats were treated with 2 x 1.0 mg estrone acetate (HogivaI) s.c. weekly for 6 months. Pituitary adenomas in excess of 30 mg were removed from these animals to make up the tumors of group 2. Groups 3 and 4 consisted of estrogen-induced autonomous transplan¬ted pituitary tumors MtT.WlO and MtT.F4. Group 5 was a radiation-induced transplanted autonomous pituitary tumor MtT.W5. The tumors of groups 3,4 and 5 were allowed to proliferate in host rats 6-8 weeks prior to removal for processing. Tissue was processed for transmission electron microscopy (glutaraldehyde fixation, OsO4 postfixation and epoxy resin embedding), and electron microscopic immunocytochemistry (3% paraformaldehyde fixation and Araldite embedding).

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Assessing the Use of Age-Equivalent Scores in Clinical Management

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.2301.06 ◽

1992 ◽

Vol 23 (1) ◽

pp. 6-8 ◽

Cited By ~ 7

Author(s):

Carol W. Lawrence

Keyword(s):

Case Management ◽

Clinical Management ◽

Management Decisions ◽

Language Deficits

Speech-language evaluation reports from many institutions present age-equivalent scores as the evidence for speech-language deficits. Yet, the value and interpretation of this measurement criterion requires clinical scrutiny. This article reviews the concept and derivation of age-equivalent scores and presents arguments against their use in case management decisions.

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Structural Aspects of Phonological Development

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.1901.05 ◽

1988 ◽

Vol 19 (1) ◽

pp. 5-16 ◽

Cited By ~ 5

Author(s):

Karen E. Pollock ◽

Richard G. Schwartz

Keyword(s):

Clinical Management ◽

Structural Complexity ◽

Strong Preference ◽

Phonological Development ◽

Structural Position ◽

Phonological Disorders ◽

Syllabic Structure ◽

The Relationship ◽

Structural Aspects ◽

Target Words

The relationship between syllabic structure and segmental development was examined longitudinally in a child with a severe phonological disorder. Six speech samples were collected over a 4-year period (3:5 to 7:3). Analyses revealed gradual increases in the complexity and diversity of the syllable structures produced, and positional preferences for sounds within these forms. With a strong preference for [d] and [n] at the beginning of syllables, other consonants appeared first at the end of syllables. Implications for clinical management of phonological disorders include the need to consider both structural position and structural complexity in assessing segmental skills and in choosing target words for intervention.

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