scholarly journals SURG-24. A RISK SCORE FOR PREDICTING DEVELOPMENT OF DIABETES INSIPIDUS AFTER PITUITARY ADENOMA RESECTION

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi244-vi244
Author(s):  
Christina Jackson ◽  
Chau Vo ◽  
Marcus Daniels ◽  
Kaisorn Chaichana
Keyword(s):  
Pituitary Adenoma ◽  
Diabetes Insipidus ◽  
Cavernous Sinus ◽  
Risk Score ◽  
Protective Factor ◽  
Postoperative Management ◽  
Johns Hopkins Hospital ◽  
Clinical Predictors ◽  
Surgical Morbidity ◽  
Cavernous Sinus Invasion

Abstract INTRODUCTION The development of diabetes insipidus (DI) after pituitary adenoma resection is associated with worse post-surgical morbidity and longer hospital stay. Identification of clinical predictors of development of DI would allow for appropriate stratification of patients to optimize preoperative counseling and postoperative management. METHODS We conducted a retrospective review of 349 patients who underwent pituitary adenoma resection at Johns Hopkins Hospital between 2003 and 2017. We used unadjusted and adjusted logistic regression to identify predictors of developing DI. Factors which were associated with DI development (p< 0.1), were included in our multivariable model. Factors which remained associated with DI development were then used to develop a DI risk score. RESULT: 67 (19.2%) patients developed post-surgical DI. Patients who had symptoms of prolactinoma, surgery through one nare, or were on steroid treatment were more likely to develop DI. Conversely, patients who had unilateral cavernous sinus invasion were less likely to develop DI. We used these predictors to generate the DI risk score. Patients were assigned 1 point for each risk factor (symptoms of prolactinoma, steroids, or surgery through one nare) for developing DI, but 1 point was subtracted if they had a protective factor (unilateral cavernous sinus invasion). Patients with 0 points had a 10.7% probability of developing DI, patients with 1 point had a 18.5% probability of developing DI, patients with 2 points had a 41.2% probability of developing DI, and patients with 3 points had a 44.4% probability of DI. CONCLUSIONS We identified several predictors of DI development after pituitary adenoma resection, and used these to generate a DI risk score. The DI risk score could help stratify patients’ likelihood of postsurgical DI development, although validation through larger prospective multi-center studies are needed.

scholarly journals SURG-34. CLINICAL PREDICTORS OF TUMOR RECURRENCE AFTER PITUITARY ADENOMA RESECTION

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi246-vi247
Author(s):  
Christina Jackson ◽  
Chau Vo ◽  
Marcus Daniels ◽  
Kaisorn Chaichana
Keyword(s):  
Pituitary Adenoma ◽  
Tumor Recurrence ◽  
Gross Total Resection ◽  
Csf Leak ◽  
Johns Hopkins Hospital ◽  
Multivariable Model ◽  
Clinical Predictors ◽  
Total Resection ◽  
Repeat Surgery ◽  
Cavernous Sinus Invasion

Abstract INTRODUCTION Repeat surgery after tumor recurrence after pituitary adenoma resection can be challenging due to formation of scar tissue and loss of surgical landmarks, which can lead to increased rates of postoperative complications. Identification of clinical predictors of tumor recurrence would allow for appropriate stratification of patients to optimize preoperative counseling and postoperative management. METHODS We conducted a retrospective review of 349 patients who underwent pituitary adenoma resection at Johns Hopkins Hospital between 2003 and 2017. We used unadjusted and adjusted logistic regression to identify predictors of tumor recurrence. Factors which were associated with tumor recurrence in univariable models (p< 0.1), were included in our multivariable model. Factors that remained significantly associated with tumor recurrence (p< 0.05) in our multivariable model were considered predictors of recurrence. RESULTS 59 (16.9%) patients developed tumor recurrence at the time of our study. Patients who had surgery through one nare, transcranial surgery, visual field deficit, larger tumor volume, bilateral cavernous sinus invasion, carotid artery invasion, and postoperative cerebral spinal fluid (CSF) leak were more likely to have tumor recurrence. Conversely, patients who are younger in age, had sphenoid packing, and gross total resection were less likely to have tumor recurrence. In our multivariable model, only age (adjusted odds ratio[aOR]: 0.96), surgery through one nare (aOR: 2.05), gross total resection(aOR: 0.21), and presence of CSF leak(aOR: 4.43) remained significantly associated with tumor recurrence. CONCLUSIONS We identified several predictors of tumor recurrence after pituitary adenoma resection. Notably, having gross total resection of the primary tumor had the most significant protective effect on tumor recurrence. Given the increased complication associated with repeat surgery, gross total resection should be attempted in all patients, if feasible. Patients with other predictors of tumor recurrence should be monitored more frequently to allow for early detection of recurrence to optimize treatment strategies.

A possible mechanism of isolated oculomotor nerve palsy by apoplexy of pituitary adenoma without cavernous sinus invasion: a report of two cases

2011 ◽  
Vol 153 (12) ◽  
pp. 2453-2456 ◽  
Author(s):  
Hiroyuki Kobayashi ◽  
Masahito Kawabori ◽  
Shunsuke Terasaka ◽  
Junichi Murata ◽  
Kiyohiro Houkin
Keyword(s):  
Pituitary Adenoma ◽  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Cavernous Sinus Invasion

scholarly journals Pituitary Adenomas Associated with Intracranial Aneurysms – The Clinical Characteristics, Therapeutic Strategies, and Possible Effects of Vascular Remodeling Factors

2020 ◽  
Author(s):  
Yoshikazu Ogawa ◽  
Mika Watanabe ◽  
Teiji Tominaga
Keyword(s):  
Pituitary Adenoma ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Vascular Remodeling ◽  
Intracranial Aneurysms ◽  
Clinical Characteristics ◽  
Cerebral Aneurysms ◽  
Therapeutic Strategies ◽  
Cavernous Sinus Invasion ◽  
Endothelial Growth Factor

Abstract Objective: Pituitary adenoma coexists with intracranial aneurysms in 2.3% to 3.6%, and intracranial aneurysms is thought to be incidental. On the other hand higher age and cavernous sinus invasion are reported to increase the coexistence rate, so these two diseases may be related. Ten males and 14 females with coexistence of pituitary adenomas and intracranial aneurysms were retrospectively investigated among 923 patients (2.6%). Patients were subdivided into two groups with/without direct attachment of cerebral aneurysms to the pituitary adenomas. The clinical characteristics, therapeutic strategies, and possible effects of vascular remodeling factors were investigated.Results: Twelve patients had functioning pituitary adenomas, and cavernous sinus invasion was identified in 7 of 24 patients. Five of these 7 patients were treated with priority for the cerebral aneurysms until 2007, whereas 14 of 17 patients without involvement of the aneurysm tip in the tumor were treated with priority for pituitary adenomas in the later period. Among vascular remodeling factors strong expression of vascular endothelial growth factor (VEGF) was significantly associated with coexistence of pituitary adenoma and cerebral aneurysm (p < 0.05). So VEGF-induced arterial wall remodeling may be part of the mechanism of association between pituitary adenomas and cerebral aneurysms, suggesting possible causative mechanism.

Clinical Predictors of Diabetes Insipidus After Transcranial Surgery for Pituitary Adenoma

2017 ◽  
Vol 101 ◽  
pp. 1-10 ◽  
Author(s):  
Songquan Wang ◽  
Deling Li ◽  
Ming Ni ◽  
Wang Jia ◽  
Qing Zhang ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Diabetes Insipidus ◽  
Clinical Predictors ◽  
Transcranial Surgery

scholarly journals CCNB1 affects cavernous sinus invasion in pituitary adenomas through the epithelial–mesenchymal transition

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Bin Li ◽  
Jianhua Cheng ◽  
Hongyun Wang ◽  
Sida Zhao ◽  
Haibo Zhu ◽  
...  
Keyword(s):  
Gene Expression ◽  
Pituitary Adenoma ◽  
Cell Lines ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Epithelial Mesenchymal Transition ◽  
Mesenchymal Transition ◽  
Cavernous Sinus Invasion ◽  
The Relationship ◽  
E Cadherin

Abstract Background To investigate the relationship between cyclin B1 (CCNB1) gene expression and cavernous sinus invasion in pituitary adenomas. Methods Twenty-four pituitary adenoma tissue samples were examined by RT-qPCR and Western blot to assess the mRNA expression levels and protein levels of CCNB1, E-cadherin and N-cadherin. Correlation analyses between the expression levels of E-cadherin, N-cadherin and CCNB1 were performed. After lentivirus-mediated knockdown of CCNB1 in rat pituitary adenoma cell lines (GH3 and GT1-1), cell function changes were studied. The relationship between CCNB1 and epithelial-mesenchymal transition (EMT) was further verified by animal experiments. Results CCNB1 and N-cadherin gene expression were significantly higher in the invasive pituitary adenomas than in the non-invasive pituitary adenomas. Conversely, E-cadherin expression in the invasive pituitary adenomas was significantly lower. CCNB1 gene expression was downregulated in the GH3 and GT1-1 pituitary adenoma cell lines; N-cadherin expression was also decreased, but E-cadherin expression was increased. These results were confirmed in vivo. After downregulation of CCNB1, cell invasion and migration was significantly reduced in Transwell experiments. Conclusion High CCNB1 expression in pituitary adenoma affects cavernous sinus invasion through EMT.

Clinical characteristics and risk factors for headache associated with non-functioning pituitary adenomas

Cephalalgia ◽  
2016 ◽  
Vol 37 (4) ◽  
pp. 348-355 ◽  
Author(s):  
Bin Yu ◽  
Nan Ji ◽  
Yun Ma ◽  
Bao Yang ◽  
Peng Kang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pituitary Adenoma ◽  
Family History ◽  
Cavernous Sinus ◽  
Clinical Characteristics ◽  
Chinese Patients ◽  
Primary Headaches ◽  
Endocrine Activity ◽  
Cavernous Sinus Invasion ◽  
History Of

Background Headaches associated with pituitary adenoma have been reported to be related to the structural characteristics and endocrine factors of the tumour itself. Objectives The objective of this study was to investigate the prevalence and clinical characteristics of, and the risk factors for, non-functioning pituitary adenoma (NFPA)-associated headaches in Chinese patients with normal endocrine activity. Methods Ninety-seven patients with a NFPA with normal endocrine laboratory results were prospectively enrolled in this study. The relevant clinical demographic data were collected and examined with the appropriate statistical methods. Results The pre-operative prevalence of tumour-associated headaches was 48.5%; 87.2% of these patients had migraine-like headaches. A family history of primary headache (odds ratio (OR) 3.67; p = 0.032) and a higher tumour Knosp grade (OR 1.83; p = 0.001) were identified as risk factors for the occurrence of NFPA-associated headaches. The patient’s age, sex, visual disturbances, optic chiasm compression, tumour size and tumour volume were not significantly associated with NFPA-associated headaches ( p > 0.05). In addition, headache severity was significantly correlated with the Knosp grade ( r = 0.339; p = 0.001). The sides of the headaches and of cavernous sinus invasion were significantly concordant (48.9% agreement; κ = 0.257; p = 0.007). Conclusions Migraine-like headaches are a common clinical manifestation in patients with NFPAs. A family history of primary headaches and cavernous sinus invasion are risk factors for NFPA-associated headaches.

Sign in / Sign up

Export Citation Format

Share Document