Clinically nonfunctioning pituitary tumours and gonadotropinomas

2011 ◽  
pp. 209-218 ◽  
Author(s):  
W. W. de Herder ◽  
R. A. Feelders ◽  
A. J. van der Lely
Keyword(s):  
Medical Treatment ◽  
Pituitary Adenomas ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Mass Effect ◽  
Tumour Resection ◽  
Ovarian Activity ◽  
Pituitary Tumours ◽  
Term Outcome ◽  
Nonfunctioning Pituitary Adenomas

The significant progress that has been made in the past years in the medical treatment of all pituitary adenomas is in stark contrast with the lack of progress in the medical treatment of clinically nonfunctioning pituitary tumours, or adenomas. In fact, only secreting, or functioning, tumours can be treated by medical therapy with at least modest to very impressive effect. Clinically nonfunctioning pituitary adenomas do not produce clinical signs of hormonal hypersecretion. Therefore, signs and symptoms will depend on the mass effect of these adenomas over the central nervous system (1–3). Due to the lack of hypersecretion of hormones, nonfunctioning pituitary adenomas present themselves because of their mass effect and compression or destruction of surrounding tissues. This could also lead to hypopituitarism, which can be the presenting symptom as well (1–3). Despite their histologically benign nature, giant and ‘invasive’ nonfunctioning pituitary adenomas are one of the most complex neurosurgical challenges. Large nonfunctioning pituitary tumours are usually confined inferiorly by the sellar dura, superiorly by the elevated sellar diaphragm, and laterally by an intact medial wall of the cavernous sinus. If the anatomical extensions of the tumour are understood and a radical tumour resection is achieved, the visual and long-term outcome can be very rewarding. The goals of surgery are twofold: first to make a pathological diagnosis, and second, because these tumours are endocrinologically silent, to decompress the neural tissue (4). The vast majority of nonfunctioning pituitary adenomas are gonadotroph cell adenomas, as demonstrated by immunocytochemistry. However, they are rarely associated with increased levels of dimeric luteinizing hormone or follicle-stimulating hormone. Increased levels of subunits (free α‎-subunit mainly, LH-B subunit more rarely), however, are more frequently encountered, but are generally modest (5). In this chapter the term ‘clinically nonfunctioning pituitary adenomas’ is used to describe pituitary tumours, which in most instances produce low quantities of hormones causing no clinically recognizable symptomatology. In the few instances, in which such tumours produce intact gonadotropins that activate testicular or ovarian activity, the term ‘gonadotropinomas’ is used.

scholarly journals Presenting Features in 269 Patients With Clinically Nonfunctioning Pituitary Adenomas Enrolled in a Prospective Study

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Pamela U Freda ◽  
Jeffrey N Bruce ◽  
Alexander G Khandji ◽  
Zhezhen Jin ◽  
Richard A Hickman ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Signs And Symptoms ◽  
Mass Effect ◽  
Outcome Data ◽  
Nonfunctioning Pituitary Adenomas ◽  
Pituitary Disease ◽  
Incidental Group ◽  
Incidental Discovery ◽  
A Prospective Study

Abstract Context Clinically nonfunctioning pituitary adenomas (CNFPAs) typically remain undetected until mass effect symptoms develop. However, currently, head imaging is performed commonly for many other indications, which may increase incidental discovery of CNFPAs. Since current presentation and outcome data are based on older, retrospective series, a prospective characterization of a contemporary CNFPA cohort was needed. Objective To determine the prevalence of incidental presentation and hypopituitarism and its predictors in a CNFPA cohort that spanned 6 to 9 mm micro- to macroadenoma included observational and surgical therapy. Methods At enrollment in a prospective, observational study, 269 patients with CNFPAs were studied by history, examination, blood sampling, and pituitary imaging analysis and categorized into incidental or symptoms presentation groups that were compared. Results Presentation was incidental in 48.7% of patients and due to tumor symptoms in 51.3%. In the symptoms and incidental groups, 58.7% and 27.4% of patients had hypopituitarism, respectively, and 25% of patients with microadenomas had hypopituitarism. Many had unappreciated signs and symptoms of pituitary disease. Most tumors were macroadenomas (87%) and were larger in the symptoms than incidental and hypopituitary groups than in the eupituitary groups. The patients in the incidental group were older, and males were older and had larger tumors in both the incidental and symptoms groups. Conclusions Patients with CNFPAs commonly present incidentally and with previously unrecognized hypopituitarism and symptoms that could have prompted earlier diagnosis. Our data support screening all large micro and macro-CNFPAs for hypopituitarism. Most patients with CNFPAs still have mass effect signs at presentation, suggesting the need for more awareness of pituitary disease. Our ongoing, prospective observation of this cohort will assess outcomes of these CNFPA groups.

scholarly journals Percutaneous transluminal angioplasty of intracranial artery stenosis: clinical results in 24 patients

1998 ◽  
Vol 5 (4) ◽  
pp. E15 ◽  
Author(s):  
Elisabeth Berg-Dammer ◽  
Hans Henkes ◽  
Werner Weber ◽  
Peter Berlit ◽  
Dietmar Kühne
Keyword(s):  
Medical Treatment ◽  
Percutaneous Transluminal Angioplasty ◽  
Cerebral Arteries ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Target Lesion ◽  
Transluminal Angioplasty ◽  
Vessel Occlusion ◽  
Clinical Signs And Symptoms ◽  
Percutaneous Transluminal

Circumscribed stenotic lesions of the intracranial arteries can cause cerebral ischemia by hemodynamic and/or thromboembolic mechanisms. Anticoagulation therapy, antiplatelet therapy, and bypass surgery are treatment strategies that have no direct impact on the underlying lesion. This study summarizes the experience of a single institution at which percutaneous transluminal angioplasty (PTA) of intracranial atherosclerotic stenoses was performed. The authors performed a retrospective analysis of 24 consecutive patients. Their medical histories (cardiovascular risk factors, current clinical signs and symptoms and their duration, previous stroke[s], and medical treatment) were evaluated together with findings from previous imaging studies. The site and degree of the stenoses to be treated (target lesion) were identified with the use of ultrasound and angiography studies. Additional vascular stenoses were noted. Percutaneous transluminal angioplasty was performed using single-lumen balloon microcatheters with appropriate diameters. The results of PTA were correlated with angiographic and ultrasound findings and the clinical outcome. Significant cardiovascular risk factors and clinical signs and symptoms related to the target lesion that persisted despite medical treatment were identified in all patients except one. The duration of symptoms varied from several days to 8 months. Previous stroke had occurred in four patients. The degree of stenosis was classified as “high grade” in 10 patients and as “subtotal” in 14. The target lesion (stenosis) was located in the anterior circulation in eight patients (four in the internal carotid and four in the middle cerebral arteries). Stenoses of posterior circulation vessels were treated in 16 patients (nine vertebral, six basilar, and one posterior cerebral arteries). Recanalization was rated “complete” in 15 patients and sufficient in six patients. In three patients residual stenosis remained. Complications were encountered in seven patients: two asymptomatic dissections, one transient vessel occlusion, one vessel occlusion with subsequent stroke, and three ischemic lesions likely due to thromboembolism, two of which caused only transient neurological symptoms. Percutaneous balloon dilation proved effective in the treatment of intracranial atherosclerotic stenosis. There are, however, potential complications and experience with this procedure is only limited. Long-term results need to be determined. The authors conclude from their preliminary results that PTA may be an alternative to bypass surgery and conservative management and may be considered for patients in whom ischemic neurological symptoms persist despite medical treatment.

scholarly journals MON-327 Soluble Alpha Klotho and IGF-I Before Surgery as Prognostic Factors to Acromegaly Long-term Remission

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Junia Ribeiro de Oliveira Longo Schweizer ◽  
Katharina Schilbach ◽  
Michael Haenelt ◽  
Xiao Wang ◽  
Mariana Ferreira Bizzi ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Surgical Outcome ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Somatostatin Analogues ◽  
Total N ◽  
Igf I ◽  
Treatment Naïve ◽  
Clinical Signs And Symptoms

Abstract BACKGROUND: Transsphenoidal surgery is the cornerstone of acromegaly treatment. However, cure is obtained in only ~50% of the cases. Until today, no biochemical marker has been identified to preoperatively predict surgical outcome and long-term remission. Recently, soluble alpha klotho (αKL) was proposed as new biomarker for diagnosis and follow-up of acromegaly. Therefore, we aimed to evaluate the potential of pre-surgery αKL concentrations as a prognostic factor to predict remission by surgery alone. Methods: We measured αKL concentrations (IBL-ELISA) and classical biomarkers (IGF-I and GHrandom, both by IDS-iSYS, GHnadir measured by IDS-iSYS (n=13) or DiaSorin-Liaison® (n=7)) in samples from a prospective study in treatment-naïve patients with acromegaly (total n=25). Patients were then followed for at least 6 months after surgery (median (range) 30.1 (6–142) months). Outcome was evaluated and classified as non-remission (NR: IGF-I>1.2xULN (n=2) or continued need for medical treatment with somatostatin analogues (n=10)) or remission (R: improvement on clinical signs and symptoms and IGF-I<1.2xULN without medical treatment, n=13). Results: Before surgery, all patients had elevated IGF-I (>1.2xULN), GHnadir (>0.4 ng/mL) and GHrandom (>1.0 ng/mL). As expected, αKL (pg/mL) was also high (>1.2xULN) in 92% patients. Before surgery, αKL was significantly higher in NR compared to R [6648 (4408–13951) vs. 3389 (2132–6837); p<0.05), as was IGF-I (ng/mL) [NR: 879.7 (771.8–961.5) vs. R: 640.2 (448.6–862.6); p<0.05). There was no difference in GHnadir and GHrandom (ng/mL) [10.42 (6.35–16.40) vs. 5.19 (1.19–10.70) and 12.39 (8.24–24.87) vs. 8.94 (4.24–15.55); p>0.05 for both comparisons). ROC analysis indicated that concentrations of αKL>4470pg/mL (~3.5xULN) (75% specificity, 62% sensitivity, AUC=0.72) and IGF-I>3.8xULN (67% specificity, 85% sensitivity, AUC=0.79) indicate lack of long-term remission. Conclusion: High αKL (>4470pg/mL, ~3.5xULN) and IGF-I (>3.8xULN) concentrations before surgery are significantly associated with persistent disease activity after surgery. However, both biomarkers alone or in combination have insufficient specificity (though acceptable sensitivity) as predictors of surgical outcome.

Advances in the Diagnosis, Treatment and Molecular Genetics of Pituitary Adenomas in Childhood

2008 ◽  
Vol 04 (01) ◽  
pp. 83
Author(s):  
F Keil Margaret ◽  
A Stratakis Constantine
Keyword(s):  
Molecular Genetics ◽  
Pituitary Adenomas ◽  
Reproductive Function ◽  
Normal Growth ◽  
Mass Effect ◽  
Cognitive Outcomes ◽  
Pituitary Hormone ◽  
Childhood And Adolescence ◽  
Critical Periods ◽  
Pituitary Tumours

The pituitary gland has an essential role in the maintenance of homeostasis, normal growth and reproductive function. Although pituitary tumours are rare in childhood and adolescence and are typically histologically benign, significant morbidity may result due to their location, mass effect and/or interference with normal pituitary hormone functions.1The early identification of pituitary tumours in children is necessary to avoid serious adverse effects on both physiological and cognitive outcomes as a result of pituitary hormone dysregulation during the critical periods of growth in childhood and adolescence. In this report, we review recent findings on the diagnosis, evaluation, treatment and molecular genetics of pituitary adenomas presenting in childhood.

The differences of clinical picture of macroprolactinomas and their response to medicamental therapy with dopamine agonists between men and women

2011 ◽  
Vol 57 (3) ◽  
pp. 11-16
Author(s):  
L I Astaf'eva ◽  
B A Kadashev ◽  
I I Dedov ◽  
P L Kalinin ◽  
M A Kutin ◽  
...  
Keyword(s):  
Young Women ◽  
Clinical Picture ◽  
Dopamine Agonists ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Mass Effect ◽  
Men And Women ◽  
Intermediate Size ◽  
Clinical Signs And Symptoms

The data about sex-specific differences of clinical signs and symptoms of macroprolactinomas and their response to medicamental therapy with dopamine agonists between men and women are reported. The present study included 306 patients (the men to women ratio 1.4:1) presenting with macroprolactinomas. Large and giant neoplasms were shown to predominate in men regardless of their age accompanied by clinical symptoms associated with the so-called «mass effect» of the tumour. The occurrence of macroprolactinomas of different size depended on the age of the patients. The majority of the young women had tumours of large and intermediate size and exhibited clinical features of hyperprolactinemic hypogonadism while those aged above 40 years had large and giant tumours accompanied by the symptoms of their «mass effect». The medicamental treatment with cabergolin was equally efficacious in both men and women.

scholarly journals Acute ischaemic stroke in Listeria monocytogenes meningoencephalitis

2020 ◽  
Vol 6 (1) ◽  
pp. 20190068
Author(s):  
Surrin S. Deen ◽  
Jennifer Boyes ◽  
Bankole Oyewole ◽  
Anna Bahk ◽  
George Thomas ◽  
...  
Keyword(s):  
Listeria Monocytogenes ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Mass Effect ◽  
Antimicrobial Treatment ◽  
Neurological Deficits ◽  
Limb Weakness ◽  
Number Of Patients ◽  
Clinical Signs And Symptoms ◽  
Stroke Mimic

Listeria monocytogenes is the third most frequent cause of bacterial meningitis and has a predilection for elderly patients and the immunosuppressed. A small number of patients with Listeria monocytogenes meningoencephalitis have previously been reported to experience stroke-like symptoms that were attributed to microabscess formation and the mass effect of collections of infection in the brain. These infections led to temporary neurological deficits that resolved with antimicrobial treatment, rather than to true strokes with permanent neurological deficits. This report discusses the case of an 80- year-old male, who was immunosuppressed with mesalazine for the treatment of Crohn’s disease, and who went on to develop Listeria monocytogenes meningoencephalitis. 1 week into his admission, for antibiotic therapy, the patient began to experience new onset right upper limb weakness, nystagmus and past pointing. These symptoms were initially thought to be a complication of the infection. However, subsequent diffusion-weighted MRI revealed that the patient had more likely suffered an acute ischaemic event and a contrast-enhanced MRI performed later could not detect any abscess or large infective focus in a region that could explain the symptoms. This case report highlights the fact that ischaemic and infective pathologists may coexist in immunosuppressed Listeria patients and that clinical signs and symptoms should guide the use of appropriate imaging modalities such as MRI to clarify differentials so that ischaemia is not mistaken for the more common stroke mimic caused by infection in these patients.

Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas

1986 ◽  
Vol 64 (5) ◽  
pp. 713-719 ◽  
Author(s):  
Michael J. Ebersold ◽  
Lynn M. Quast ◽  
Edward R. Laws ◽  
Berndt Scheithauer ◽  
Raymond V. Randall
Keyword(s):  
Pituitary Adenomas ◽  
Mass Effect ◽  
Pituitary Hormones ◽  
Long Term Results ◽  
Null Cell ◽  
Content Type ◽  
Nonfunctioning Pituitary Adenomas ◽  
Presenting Symptoms

✓ Little has been written about the long-term results of transsphenoidal treatment for clinically nonfunctioning pituitary adenomas. The records of 100 patients who had undergone a transsphenoidal procedure for excision of such tumors were reviewed. Immunocytology for pituitary hormones was performed in all cases. The group consisted predominantly of null-cell adenomas, although a small number of prolactinomas and gonadotropic tumors were found. The mean diameter of the tumors at the time of detection was slightly more than 2 cm. In most cases, the presenting symptoms were due to the mass effect of the tumor (that is, visual symptoms in 72 patients, hypopituitarism in 61, headache in 36, and cranial nerve disturbance other than visual loss in 10). Radiation therapy was recommended for patients in whom subtotal removal of the adenoma was expected. Six patients developed symptomatic tumor recurrence, and 10 patients demonstrated radiographic recurrence during the 48 to 100 months (mean 73.4 months) of follow-up observation. Only three of 10 deaths during the follow-up period were due to pituitary disease or treatment.

Encapsulating Peritoneal Sclerosis—A Clinician's Approach to Diagnosis and Medical Treatment

2005 ◽  
Vol 25 (4_suppl) ◽  
pp. 30-38 ◽  
Author(s):  
Hidetomo Nakamoto
Keyword(s):  
Medical Treatment ◽  
Abdominal Mass ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Therapeutic Approaches ◽  
Diagnostic Aspects ◽  
Radiologic Findings ◽  
Continuous Peritoneal Dialysis ◽  
Clinical Signs And Symptoms ◽  
Abdominal Fullness

Encapsulating peritoneal sclerosis (EPS) is recognized as a serious complication of continuous peritoneal dialysis. A preliminary diagnosis of EPS is usually based on clinical signs and symptoms, which commonly include abdominal pain, nausea, vomiting, anorexia, abdominal fullness, an abdominal mass, bowel obstruction, and radiologic findings, including abdominal roentgenogram, contrast studies, ultrasound studies, and computed tomography. The diagnosis is confirmed by laparoscopy or laparotomy showing the characteristic gross thickening of the peritoneum enclosing some or all of the small intestine in a cocoon of opaque tissue. A variety of therapeutic approaches to EPS have been reported. This review discusses medical treatment of EPS and includes an overview of the clinical features and diagnostic aspects of the condition.

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