Patterns of extrasellar invasive growth of pituitary adenomas with normal sellar cavity size; A case-series

2021 ◽  
pp. 106942
Author(s):  
Guive Sharifi ◽  
Mohammadmahdi Sabahi ◽  
Amirarsalan Amin ◽  
Nader Akbari Dilmaghani ◽  
Ali Mousavi Nejad ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Case Series ◽  
Invasive Growth ◽  
Cavity Size

scholarly journals Aggressive pituitary adenomas occurring in young patients in a large Polynesian kindred with a germline R271W mutation in the AIP gene

2009 ◽  
Vol 161 (5) ◽  
pp. 799-804 ◽  
Author(s):  
Juliet E Jennings ◽  
Marianthi Georgitsi ◽  
Ian Holdaway ◽  
Adrian F Daly ◽  
Maria Tichomirowa ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Index Case ◽  
Young Patients ◽  
Case Series ◽  
Pituitary Tumors ◽  
Maximum Diameter ◽  
Interacting Protein ◽  
Functional Studies ◽  
Aryl Hydrocarbon ◽  
Aip Gene

ObjectiveMutations in the aryl hydrocarbon receptor-interacting protein (AIP) were recently shown to confer a pituitary adenoma predisposition in patients with familial isolated pituitary adenomas (FIPA). We report a large Samoan FIPA kindred from Australia/New Zealand with an R271W mutation that was associated with aggressive pituitary tumors.Design and methodsCase series with germline screening of AIP and haplotype analyses among R271W families.ResultsThis previously unreported kindred consisted of three affected individuals that either presented with or had first symptoms of a pituitary macroadenoma in late childhood or adolescence. The index case, a 15-year-old male with incipient gigantism and his maternal aunt, had somatotropinomas, and the maternal uncle of the index case had a prolactinoma. All tumors were large (15, 40, and 60 mm maximum diameter) and two required transcranial surgery and radiotherapy. All three affected subjects and ten other unaffected relatives were found to be positive for a germline R271W AIP mutation. Comparison of the single nucleotide polymorphism patterns among this family and two previously reported European FIPA families with the same R271W mutation demonstrated no common ancestry.ConclusionsThis kindred exemplifies the aggressive features of pituitary adenomas associated with AIP mutations, while genetic analyses among three R271W FIPA families indicate that R271W represents a mutational hotspot that should be studied further in functional studies.

scholarly journals MON-303 Giant Growth Hormone Secreting Pituitary Adenomas: A Single Institution Case Series

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Bahadir Koylu ◽  
Suleyman Nahit Sendur ◽  
Seda Hanife Oguz ◽  
Selcuk Dagdelen ◽  
Tomris A Erbas
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Postoperative Radiotherapy ◽  
Somatostatin Receptor ◽  
Case Series ◽  
Tumor Diameter ◽  
Somatostatin Receptor Ligands ◽  
The Mean

Abstract The prevalence of growth hormone (GH)-secreting pituitary adenoma is around 11-13% of all pituitary adenomas. Giant GH-secreting pituitary adenomas (≥ 4 cm) are rare tumors, and its prevalence of among acromegalic patients is <5%. This is a retrospective cohort study including patients with giant GH-secreting pituitary adenomas. The study population consisted of 10 patients (5 M/5 F). The mean age at diagnosis was 33.0±12.9 yrs (11-55 yrs). The mean delay between first symptom onset and diagnosis was 2.9 years. The most frequent symptoms were acral enlargement and facial changes (80%), followed by headache (70%) and visual deterioration (50%). One patient had epilepsy. Amenorrhea was presented in three females but obvious galactorrhea in two. The mean adenoma diameter was 42.6±4.7 mm (40-51 mm) at diagnosis. The vast majority of adenomas presented suprasellar extension (100%) or cavernous sinus invasion (80%). Cystic adenomas accounted for 50%. At presentation, mean GH and IGF-1 levels were 40.0±21.4 ng/mL (14.8-51.0) and 2.62±1.09 x ULN (1.08-3.96), respectively. Six patients presented with PRL cosecretion. At diagnosis maximal tumor diameter was not correlated with GH or IGF-1 levels. All patients underwent pituitary surgery as first-line treatment. Three cases were treated with an endoscopic approach and four cases with a microscopic approach. Transcranial approach was also employed in three cases. Postoperative mean GH and IGF-1 levels were 14.9±16.1 ng/mL (0.6-51.0) and 2.25.±0.82 x ULN (1.48-3.74), respectively. After first surgery, only one patient had more than 50% reduction in IGF-1 levels. Five patients (50%) underwent repeat surgery on two to three procedures because remission was not achieved. Postoperative somatostatin receptor ligands (SRLs) were used by all patients. Six patients were treated with dopamine agonist in combination with SRL. Six patients (60%) received postoperative radiotherapy. The mean follow-up period was 12.6±5.3 yrs (4-21 yrs). The mean GH and IGF-1 levels were 1.47±1.54 ng/mL (0.08-5.25) and 0.73±0.44 x ULN (0.08-1.56), respectively at the last visit. Residual adenoma was present at the last MRI in eight patients (mean diameter 9.0±3.6 mm). Panhypopituitarism rose from 10% at baseline to 30% at the last visit. During follow-up, one patient diagnosed breast cancer, while another diagnosed thyroid papillary cancer. Giant GH-secreting pituitary adenomas can have a clinically aggressive behavior with mass effect. Moreover, treatment in patients with giant GH-secreting pituitary adenoma is complex and multimodal therapy is necessary.

scholarly journals SUN-458 Use of Positron Emission Tomography in Pituitary Adenomas in Uruguay: a Case Series

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Maria Pineyro ◽  
Mariana Risso ◽  
Paula Montiglia ◽  
Andres Damian ◽  
Ramiro Lima ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Pituitary Adenomas ◽  
Case Series ◽  
Emission Tomography ◽  
Positron Emission

Endocrine Silent Pituitary Tumors

2018 ◽  
Author(s):  
Harminder Singh ◽  
Smeer Salam ◽  
Theodore H. Schwartz
Keyword(s):  
Pituitary Adenomas ◽  
Case Series ◽  
Pituitary Tumors ◽  
Visual Outcome ◽  
Mass Effect ◽  
Optic Chiasm ◽  
Pituitary Hormones ◽  
Pituitary Dysfunction ◽  
Normal Pituitary Gland ◽  
Field Disturbance

Pituitary adenomas are the most common intracranial neoplasms in adults, with a prevalence of 7% to 17%. Clinically, they can be divided into 2 categories based on whether they secrete pituitary hormones: functional (secretory) and nonfunctional (nonsecretory or endocrine silent) adenomas. The biologic latency of nonfunctional (endocrine silent) adenomas makes them usually diagnosed at the stage of macro (>1 cm) and giant (>4 cm) adenomas. Because these tumors are nonfunctioning, their primary symptoms are due to mass effect, particularly on the optic chiasm and normal pituitary gland and stalk superiorly, and the cavernous sinus laterally. Visual field disturbance is the most common presenting complaint, followed by pituitary dysfunction and headaches. Surgical outcomes, therefore, are aimed at determining visual outcome in addition to rates of gross total resection, recurrence, and postoperative pituitary dysfunction. Several recent case series have documented the increased success of the endonasal endoscopic transsphenoidal approach for resecting nonfunctioning pituitary adenomas, particularly in relation to the classic open cranial and microsurgical transsphenoidal techniques.

Outcomes Following Purely Endoscopic, Endonasal Resection of Pituitary Adenomas: A Case Series

Skull Base ◽  
2007 ◽  
Vol 16 (S 1) ◽  
Author(s):  
Paul Gardner ◽  
Amin Kassam ◽  
Carl Snyderman ◽  
Ricardo Carrau ◽  
Arlan Mintz
Keyword(s):  
Pituitary Adenomas ◽  
Case Series ◽  
Endoscopic Endonasal

Surgical Experience in Prevention of Postoperative CSF Leaks Using Abdominal Fat Grafts in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas

2020 ◽  
Author(s):  
Stephen Ahn ◽  
Jae-Sung Park ◽  
Do H. Kim ◽  
Sung W. Kim ◽  
Sin-Soo Jeun
Keyword(s):  
Pituitary Adenomas ◽  
Case Series ◽  
Abdominal Fat ◽  
Fat Graft ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Tertiary Referral Center ◽  
Fat Grafts ◽  
Sellar Floor ◽  
Csf Leaks

Abstract Objective Cerebrospinal fluid (CSF) leaks are the most common complication during endonasal endoscopic transsphenoidal approach (EETSA) and prevention of postoperative CSF leaks is critical. In this study, we report a single surgeon's experience of sellar floor reconstruction using abdominal fat grafts for prevention of postoperative CSF leaks in EETSA for pituitary adenomas. Design This study is presented as case series with retrospective chart review. Setting Present study was conducted at tertiary referral center. Participants A total of 216 patients who underwent surgery via EETSA for pituitary adenomas between 2008 and 2018 at our institution were evaluated. When an intraoperative CSF leak occurred, sellar floor reconstruction was performed using a fat graft harvested from the abdomen via a 2-cm skin incision. Main Outcome Measures Primary outcome and measures of this study was postoperative CSF leaks. Results A total of 53 patients showed intraoperative CSF leaks (24.5%) and 2 patients showed postoperative CSF leaks (0.93%). There were no postoperative CSF leaks in any patients who showed intraoperative CSF leaks and received sellar floor reconstruction using fat grafts. There were also no postoperative CSF leaks in 12 patients who received preventative sellar floor reconstruction using fat grafts due to extensive arachnoid herniation without intraoperative CSF leaks. However, there were two postoperative CSF leaks in patients who did not show intraoperative CSF leaks and did not receive sellar floor reconstruction. Conclusion The effectiveness of sellar floor reconstruction using abdominal fat grafts in patients receiving EETSA for pituitary adenoma was reported. We suggest that identification of intraoperative CSF leaks is important and preventive sellar floor reconstruction without evidence of intraoperative CSF leaks can also be beneficial.

The immunohistochemical and radiological features of nonfunctioning pituitary adenomas

2015 ◽  
Vol 61 (6) ◽  
pp. 4-9 ◽  
Author(s):  
Anna Konstantinovna Lipatenkova ◽  
Larisa Konstantinovna Dzeranova ◽  
Ekaterina Aleksandrovna Pigarova ◽  
Nadezhda Sergeevna Dalantaeva ◽  
Ljudmila Igorevna Astaf'eva ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Area Under The Curve ◽  
Pituitary Hormones ◽  
Serum Markers ◽  
Invasive Growth ◽  
Null Cell ◽  
Ki 67 ◽  
Nonfunctioning Pituitary Adenomas ◽  
Radiological Features ◽  
Null Cell Adenomas

Pituitary adenomas without clinically active hypersecretion are summarized under the term nonfunctioning pituitary adenomas (NFPAs). Since there are no specific serum markers, the differential diagnosis and treatment imply special difficulties.Aim.To investigate the immunohistochemical and radiological features of NFPAs and assess the granins — chromogranin A (CgA), secretogranin II (SgII), secretoneurin (Sn) as immunohistochemical markers of NFPAs.Matherial and methods.50 pituitary adenomas excised surgically were immunostained to reveal pituitary hormones, ki-67, CgА. SgII, Sn. All patients underwent MRI, invasive growth was estimated due to J.Hardy classification (1973).Results.24 (51,1%) were gonadotropic tumors, 12 (25,5%) — null cell adenomas. Immunopositivity for ACTH was determined in 6 cases (12,7%), for GH in 5 (10,6%) cases, for PRL in 4 (8,5%). The median level of ki-67 was 2% (min. — 0.5%, max. — 7%). The CgA, SgII, Sn immunopositivity was found in 83, 93,6, 85,1% respectively, being more expressed in gonadotropinomas and null cell adenomas. Invasive growth was detected in 28 (44%) cases, among the invasive adenomas 22 tumors were giant. CgA expression is adverse prognostic factor, area under the curve (AUC) with 0,705. We did not find any correlation between ACTH-, STH-, CgII- and Sn- immunopositivity, ki-67 and invasive growth.Conclusions.Our work shows that a majority of NFPAs are truly secreting adenomas with significant numbers comprising potentially hazardous cortico- and somatotropinomas. CgA, SgII and Sn have a high expression in most of the NFPAs.

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