scholarly journals C.02 Delayed new-onset hormone dysfunction following complete and incomplete resection of nonfunctioning pituitary adenomas

2017 ◽  
Vol 44 (S2) ◽  
pp. S12-S12
Author(s):  
J Han ◽  
AL Hebb ◽  
SA Imran ◽  
DB Clarke
Keyword(s):  
Pituitary Adenomas ◽  
Tumor Recurrence ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Incomplete Resection ◽  
Inclusion Criteria ◽  
Nonfunctioning Pituitary Adenomas ◽  
One Year ◽  
Complete Tumor

Background: Post-operative delayed hormone dysfunction (DHD) in patients with nonfunctioning pituitary adenomas (NFPA) is highly variable and is predicted based on limited evidence. This study was undertaken to assess the likelihood of developing new DHD and its relation to the extent of tumor resection and recurrence. Methods: Four hundred fifty-five prospectively collected patient files were reviewed from our Program’s database. Inclusion criteria: NFPA; underwent surgery; and minimum follow-up of two years. Tumor recurrence was correlated with DHD (starting one year post-operatively) based on standardized annual imaging and hormone testing. Results: Eighty-nine patients met our inclusion criteria: 39 males and 50 females; mean follow-up was 4.3yrs (ranging from 2 to 11yrs). With no post-op residual tumor, the probability of developing DHD was only 7% by six years; no patient in this group developed DHD after three years of follow-up. In contrast, by six years, the probability of DHD was 33% in patients with residual stable tumor, and 54% in those with tumor recurrence/growth. Conclusions: By six years, approximately one third of patients with incomplete resection, and over half with tumor regrowth, will likely develop DHD. In contrast, the risk of DHD with complete tumor resection is <10% and, when seen, occurs within three years of surgery.

Pituitary Adenomas with Changing Phenotype: A Systematic Review

2020 ◽  
Vol 128 (12) ◽  
pp. 835-844
Author(s):  
Fernando Guerrero-Pérez ◽  
Agustina Pia Marengo ◽  
Noemi Vidal ◽  
Carles Villabona
Keyword(s):  
Systematic Review ◽  
Cushing’S Disease ◽  
Pituitary Adenomas ◽  
Tumor Resection ◽  
Cushing's Disease ◽  
Complete Tumor Resection ◽  
Null Cell ◽  
Acth Secreting ◽  
Complete Tumor

Abstract Purpose and Methods Phenotype transformation in pituitary adenomas (PA) is a little known and unexpected clinical phenomenon. We describe two illustrative cases and performed a systematic review of cases reported in literature. Results Case 1: A 24-year-old woman underwent surgery because of Cushing’s disease. A complete tumor resection and hypercortisolism resolution was achieved. Two years later, tumor recurred but clinical and hormonal hypercortisolism were absent. Case 2: A 77-year-old woman underwent surgery due to acromegaly. A complete tumor resection and GH excess remission was achieved. Four years later, tumor recurred but clinical and hormonal acromegaly was ruled out. Search of literature: From 20 patients (including our cases), 75% were female with median age 45 (19) years. Ten patients (50%) had initially functioning PA: 8 switched to NFPA (5 ACTH-secreting PA, 2 prolactinomas and 1 acromegaly) and 2 exchanged to acromegaly from TSH-secreting PA and microprolactinoma. One patient developed a pituitary carcinoma from ACTH-secreting PA. Ten patients (50%) initially had NFPA; 9 developed Cushing’s disease (4 silent corticotroph adenomas, 4 null cell PA and 1 managed conservatively). One patient with silent somatotroph PA changed to acromegaly. Treatments before transformation were surgery (80%), radiotherapy (40%), pharmacological (40%) and in 2 patients switching happened without any treatment. Median follow-up until transformation was 72 months (range 12–276). Conclusion PA can change from functioning to (NF) non-functioning (vice versa) and even exchange their hormonal expression. Clinicians should be aware and a careful lifelong follow-up is mandatory to detect it.

scholarly journals Intraoperative magnetic resonance imaging–assisted transsphenoidal pituitary surgery in patients with acromegaly

2010 ◽  
Vol 29 (4) ◽  
pp. E9 ◽  
Author(s):  
David Bellut ◽  
Martin Hlavica ◽  
Christoph Schmid ◽  
René L. Bernays
Keyword(s):  
Pituitary Adenomas ◽  
High Field ◽  
Remission Rate ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Residual Tumor ◽  
Imaging Results ◽  
Duration Of Surgery

Object Acromegaly is a rare disease, usually caused by a growth hormone (GH)–producing pituitary adenoma. If untreated, severe cardiovascular, metabolic, cosmetic, and orthopedic disturbances will result. Surgery is generally recommended as the first-line treatment. Transsphenoidal surgical techniques were recently extended by the introduction of intraoperative MR (iMR) imaging. In the present study, the contribution of ultra-low-field (0.15-T) iMR imaging to tumor resection, complication avoidance, and endocrinological and neurological outcome was analyzed. Methods A series of 39 consecutive transsphenoidal iMR imaging–guided (using the PoleStar N20 device) surgical procedures performed between September 2005 and August 2009 for GH-producing pituitary adenomas was retrospectively analyzed. In addition to the patients' clinical data, the following criteria were evaluated independently: duration of surgery; length of hospital stay; endocrinological parameters; results of neurological examinations; and pre-, post-, and intraoperative MR imaging results. Results Thirty-seven patients with acromegaly underwent 39 transsphenoidal surgeries for pituitary adenomas. During a median follow-up period of 30 months (range 9–56 months), the remission rate was 73.5% in 34 patients with primary surgery and 20% in 5 cases with previous surgery; overall the remission rate was 66.7%. There were no serious postoperative complications. Detection of tumor remnant on iMR imaging led to a 5.1% increase in remission rate. Conclusions In this largest study to date of GH-producing pituitary adenomas in which iMR imaging–guided transsphenoidal surgery was analyzed, the results suggest that this method is a highly effective and safe treatment modality, even compared with previously published surgical series in which high-field iMR imaging was used. Limitations of iMR imaging are the detection of small residual tumor in the cavernous sinus and persisting disease that could not be observed, even on diagnostic high-field follow-up MR images. This points to a general limitation regarding remission rates that can be achieved using iMR imaging. Nevertheless, iMR imaging led to an increase of the remission rate in this study.

Use of the histological pseudocapsule in surgery for Cushing disease: rapid postoperative cortisol decline predicting complete tumor resection

2012 ◽  
Vol 116 (4) ◽  
pp. 721-727 ◽  
Author(s):  
Stephen J. Monteith ◽  
Robert M. Starke ◽  
John A. Jane ◽  
Edward H. Oldfield
Keyword(s):  
Tumor Resection ◽  
Residual Tumor ◽  
Serum Cortisol ◽  
Complete Resection ◽  
Incomplete Resection ◽  
Cushing Disease ◽  
Postoperative Serum ◽  
Piecemeal Resection ◽  
Complete Tumor

Object Subnormal postoperative serum cortisol levels indicate successful surgery and predict long-term remission of Cushing disease. Given the short serum half-lives of adrenocorticotropic hormone (ACTH) and cortisol, it is unclear why the decline in cortisol postoperatively is delayed for 18–36 hours. Furthermore, the relevance of the rate of cortisol drop immediately after surgery has not been investigated. Methods Patient data were analyzed from a prospectively accrued database. After surgery, cortisol replacement was withheld and serum cortisol measurements were obtained every 6 hours until values of 1.0–2.0 μg/dl or less were reached. The authors selected patients in whom serum cortisol dropped to 2 μg/dl or less after surgery (101 patients). Tumor resection was categorized as follows: 1) complete resection using the histological pseudocapsule as a surgical capsule, 2) complete piecemeal resection), 3) known incomplete resection, and 4) total hypophysectomy. Results The median time to reach a cortisol level of less than or equal to 2.0 μg/dl was 9.9, 19.4, 25.3, and 29.5 hours with hypophysectomy, pseudocapsule, incomplete resection, and piecemeal techniques, respectively. Pseudocapsule resection produced a faster decline in cortisol than piecemeal techniques (p = 0.0001), but not as rapid a decline as hypophysectomy (p = 0.033). Conclusions Complete resection by other techniques is associated with delayed cortisol decline compared with pseudocapsule surgery, which may represent the product of residual tumor cells and therefore may explain the higher rate of recurrent disease associated with piecemeal techniques. The prompt drop in cortisol after hypophysectomy compared with patients with pseudocapsule surgery suggests that the corticotrophs of the normal gland can secrete ACTH for 10–36 hours after surgery despite prolonged and severe hypercortisolism.

Proliferation Index of Nonfunctioning Pituitary Adenomas: Correlations with Clinical Characteristics and Long-term Follow-up Results

Neurosurgery ◽  
2000 ◽  
Vol 47 (6) ◽  
pp. 1313-1319 ◽  
Author(s):  
Marco Losa ◽  
Alberto Franzin ◽  
Francesca Mangili ◽  
Maria Rosa Terreni ◽  
Raffaella Barzaghi ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Tumor Recurrence ◽  
Clinical Characteristics ◽  
Ki 67 ◽  
Nonfunctioning Pituitary Adenomas ◽  
Age At Surgery ◽  
Long Term Follow Up ◽  
The Mean

ABSTRACT OBJECTIVE The recurrence of nonfunctioning pituitary adenomas (NFPAs) after surgical removal is common. The aim of our study was to investigate and correlate the growth fraction of NFPAs with clinical characteristics and long-term follow-up results. METHODS Tumor specimens were obtained from 101 consecutive patients with NFPAs (48 female patients and 53 male patients; mean age, 52.0 ± 1.5 yr). Specimens were immediately fixed in 10% buffered formalin and then embedded in paraffin. The Ki-67 antigen was assessed by immunocytochemical analysis using the monoclonal antibody MIB-1. The Ki-67 antigen labeling index (LI) was determined by counting a total of at least 1000 neoplastic nuclei. RESULTS The mean Ki-67 LI for the 101 patients was 2.4 ± 0.3% (range, 0–23.0%). Only age at surgery was inversely correlated with the Ki-67 LI; sex, maximal tumor diameter, and invasiveness into the cavernous sinuses did not significantly affect the Ki-67 LI. The mean follow-up period was 39.7 ± 2.1 months. During follow-up monitoring, 23 patients experienced tumor recurrence, after a mean period of 28.6 ± 4.8 months. Invasiveness of the tumor on preoperative magnetic resonance imaging scans was the strongest predictor of late tumor recurrence, followed by previous pituitary surgery, younger age, and lack of postoperative radiotherapy. The Ki-67 LI had no independent prognostic value. CONCLUSION Our study suggests that the clinical characteristics of patients with NFPAs, except for age at surgery, are not correlated with the Ki-67 LI. Moreover, the Ki-67 LI does not seem to provide independent information to identify patients at high risk for tumor recurrence.

scholarly journals P14.104 The outcomes of conservatively observed asymptomatic nonfunctioning pituitary adenomas with optic nerve compression

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii92-iii92
Author(s):  
K Hwang ◽  
Y Kim ◽  
C Kim ◽  
J Han
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Pituitary Adenomas ◽  
Surgical Intervention ◽  
Tumor Resection ◽  
Nerve Compression ◽  
Nonfunctioning Pituitary Adenomas ◽  
The Mean ◽  
Optic Nerve Compression

Abstract BACKGROUND We investigated the natural history of asymptomatic nonfunctioning pituitary adenomas (NFPAs) abutting on optic nerve. MATERIAL AND METHODS Eighty-three patients with asymptomatic NFPAs with documented optic nerve compression on magnetic resonance imaging (MRI) at the time of detection between 2000 and 2016 were included in this study. Patients were evaluated with a hormone test, visual acuity test, visual field test and MRI at the time of diagnosis, and then, yearly, without any treatment (including surgery and radiation). RESULTS The mean age was 57.7±13.6 (range, 15 - 81) years. The mean follow-up duration was 66.6±39.0 (range, 12 - 184) months. Tumor volume growth ≥ 20% was observed in 64 (77.1%) patients. Ten (12.2%) patients experienced any kind of hormonal dysfunction, and gonadotropin deficiency was the most common type of hormonal deficiency [n=9 (10.8%)]. Visual deterioration quantified by Visual Impairment Scale was seen 27 (32.5%) patients. There was no statistically significant factor for tumor growth or visual aggravation. Fourteen (16.9%) patients eventually underwent tumor resection. From multivariate analysis, the significant predictors for eventual surgical intervention were cavernous sinus invasion (OR=20.95; 95% CI, 2.754–159.3; p=0.003) and last follow-up visual field defect score (OR=1.170; 95% CI, 1.049–1.305; p=0.005). All patients who underwent surgery did not experience any neurologic or endocrinological deficits postoperatively. CONCLUSION The clinical outcomes of conservatively observed NFPAs with optic nerve compression can be acceptable. The decision for surgical intervention should be made by balancing the risk and benefits.

Evaluation of Surgical Resection Goal and Its Relationship to Extent of Resection and Patient Outcomes in a Multicenter Prospective Study of Patients With Surgically Treated, Nonfunctioning Pituitary Adenomas: A Case Series

2019 ◽  
Vol 18 (1) ◽  
pp. 26-33
Author(s):  
Andrew S Little ◽  
Michael R Chicoine ◽  
Daniel F Kelly ◽  
Christina E Sarris ◽  
Michael A Mooney ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Predictive Value ◽  
Pituitary Adenomas ◽  
Tumor Resection ◽  
Case Series ◽  
Residual Tumor ◽  
Pituitary Surgery ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Nonfunctioning Pituitary Adenomas

Abstract BACKGROUND The influence of the surgeon's preoperative goal regarding the extent of tumor resection on patient outcomes has not been carefully studied among patients with nonfunctioning pituitary adenomas. OBJECTIVE To analyze the relationship between surgical tumor removal goal and patient outcomes in a prospective multicenter study. METHODS Centrally adjudicated extent of tumor resection (gross total resection [GTR] and subtotal resection [STR]) data were analyzed using standard univariate and multivariable analyses. RESULTS GTR was accomplished in 148 of 171 (86.5%) patients with planned GTR and 32 of 50 (64.0%) patients with planned STR (P = .001). Sensitivity, specificity, positive predictive value, and negative predictive value of GTR goal were 82.2, 43.9, 86.5, and 36.0%, respectively. Knosp grade 0-2, first surgery, and being an experienced surgeon were associated with surgeons choosing GTR as the goal (P &lt; .01). There was no association between surgical goal and presence of pituitary deficiency at 6 mo (P = .31). Tumor Knosp grade (P = .004) and size (P = .001) were stronger predictors of GTR than was surgical goal (P = .014). The most common site of residual tumor was the cavernous sinus (29 of 41 patients; 70.1%). CONCLUSION This is the first pituitary surgery study to examine surgical goal regarding extent of tumor resection and associated patient outcomes. Surgical goal is a poor predictor of actual tumor resection. A more aggressive surgical goal does not correlate with pituitary gland dysfunction. A better understanding of the ability of surgeons to meet their expectations and of the factors associated with surgical result should improve prognostication and preoperative counseling.

scholarly journals Incidence, Characteristics, and Prognosis of Incidentally Discovered Hepatocellular Carcinoma after Liver Transplantation

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Walid El Moghazy ◽  
Samy Kashkoush ◽  
Glenda Meeberg ◽  
Norman Kneteman
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Tumor Recurrence ◽  
Patient Survival ◽  
Steady Increase ◽  
Liver Transplants ◽  
Significant Difference ◽  
One Year ◽  
Over Time

Background. We aimed to assess incidentally discovered hepatocellular carcinoma (iHCC) over time and to compare outcome to preoperatively diagnosed hepatocellular carcinoma (pdHCC) and nontumor liver transplants.Methods.We studied adults transplanted with a follow-up of at least one year. Patients were divided into 3 groups according to diagnosis of hepatocellular carcinoma.Results.Between 1990 and 2010, 887 adults were transplanted. Among them, 121 patients (13.6%) had pdHCC and 32 patients (3.6%) had iHCC; frequency of iHCC decreased markedly over years, in parallel with significant increase in pdHCC. Between 1990 and 1995, 120 patients had liver transplants, 4 (3.3%) of them had iHCC, and only 3 (2.5%) had pdHCC, while in the last 5 years, 263 patients were transplanted, 7 (0.03%) of them had iHCC, and 66 (25.1%) had pdHCC (P<0.001). There was no significant difference between groups regarding patient survival; 5-year survival was 74%, 75.5%, and 77.3% in iHCC, pdHCC, and non-HCC groups, respectively (P=0.702). Patients with iHCC had no recurrences after transplant, while pdHCC patients experienced 17 recurrences (15.3%) (P=0.016).Conclusions.iHCC has significantly decreased despite steady increase in number of transplants for hepatocellular carcinoma. Patients with iHCC had excellent outcomes with no tumor recurrence and survival comparable to pdHCC.

scholarly journals Tumor Recurrence or Regrowth in Adults With Nonfunctioning Pituitary Adenomas Using GH Replacement Therapy

2015 ◽  
Vol 100 (8) ◽  
pp. 3132-3139 ◽  
Author(s):  
N. C. van Varsseveld ◽  
C. C. van Bunderen ◽  
A. A. M. Franken ◽  
H. P. F. Koppeschaar ◽  
A. J. van der Lely ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Pituitary Adenomas ◽  
Tumor Recurrence ◽  
Nonfunctioning Pituitary Adenomas ◽  
Gh Replacement

Iodine-125 interstitial brachytherapy after tumor excision: an alternative eye-sparing surgery for lacrimal gland carcinoma

2021 ◽  
Author(s):  
Yang-jun Li ◽  
Ping Wang ◽  
Shao-bo Zhang ◽  
Xiao-na Ning ◽  
Chen-jun Guo ◽  
...  
Keyword(s):  
Lacrimal Gland ◽  
Tumor Recurrence ◽  
Tumor Resection ◽  
Interstitial Brachytherapy ◽  
Tumor Excision ◽  
Control Tumor ◽  
Gland Carcinoma ◽  
Iodine 125 ◽  
Good Cosmesis

Abstract Background:To describe the preliminary suppressive effects of iodine 125 brachytherapy for malignant lacrimal gland tumors after excisionMethods:The study recruit 9 patients with lacrimal gland carcinoma from May 2017 to December 2020. All patients underwent eye sparing surgical tumor resection first and then received iodine 125 interstitial brachytherapy to prevent tumor recurrence. We look over whether tumor recurred or metastasized by detecting the visual function and CT/MRI/PET MRI of every patient.Results1 patient was lost visit. The median follow up period was 29 months of other 8 patients (range, 7 43 months). One patient experienced recurrence two years later but was free from local disease after iodine 125 seeds were implanted one more time. The vision of one female patient was lost due to the seeds moving to the optic nerve. In the remaining 6 patients the vision was no changed, and CT/MRI showed no tumor was recurrencedConclusions:Permanent iodine 125 strip implantation in the orbit can be used as an alternative eye sparing surgery for malignant lacrimal gland tumors after tumor excision. It can control tumor recurrence and maintenance of vision and good cosmesis.

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