Anterior Pituitary Function in Patients with Nonfunctioning Pituitary Adenoma: Results of Longitudinal Follow-up.

Abstract BACKGROUND During transsphenoidal surgery (TSS) for a pituitary adenoma with a large suprasellar extension, cerebrospinal fluid (CSF) leakage commonly develops from a defect in the arachnoid recess or the arachnoid membrane. OBJECTIVE To evaluate the usefulness of a newly developed clipping technique for the repair of intraoperative CSF leakage. METHODS Between September 2012 and November 2016, 698 patients with pituitary adenoma were operated on with TSS. Intraoperative CSF leakage was encountered in 301 patients (43.1%). The clipping technique was used to repair CSF leakage in 144 patients: from the arachnoid recess in 100 patients and from the arachnoid membrane in 44 patients. The clipping technique used titanium clips and a newly designed clip applier. We evaluated anterior pituitary function of the patients whose CSF leakage was closed by clipping, and compared this with function in another patient group treated with different repair techniques. RESULTS We successfully applied clip technique in 140 out of 144 patients. This clipping technique was faster and easier for repairing CSF leakage than our previously published suture technique. In our early series, 4 patients developed unexpected CSF rhinorrhea after TSS. We found no difference in anterior pituitary function between a clipping group and others. Although titanium clip was identified on postoperative MRI, its metallic scattered artifact was very minimal and did not hinder the detection of possible remnant and recurrent tumors. CONCLUSION This clipping technique is a very simple and reliable method for repairing intraoperative CSF leakage when properly applied with caution.

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Normal final height and apparent cure after pituitary irradiation for Cushing's disease in childhood: long-term follow-up of anterior pituitary function

Clinical Endocrinology ◽

10.1046/j.1365-2265.1998.00385.x ◽

1998 ◽

Vol 48 (5) ◽

pp. 663-667 ◽

Cited By ~ 4

Author(s):

L. B. Johnston ◽

A. B. Grossmann ◽

P. N. Plowman ◽

G. M. Besser ◽

M. O. Savage

Keyword(s):

Cushing’S Disease ◽

Anterior Pituitary ◽

Final Height ◽

Pituitary Function ◽

Cushing's Disease ◽

Long Term Follow Up ◽

Anterior Pituitary Function ◽

Pituitary Irradiation

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Sexual precocity in a boy due to hypersecretion of LH and prolactin by a pituitary adenoma

Acta Endocrinologica ◽

10.1530/acta.0.1020167 ◽

1983 ◽

Vol 102 (2) ◽

pp. 167-172 ◽

Cited By ~ 29

Author(s):

M. Faggiano ◽

T. Criscuolo ◽

L. Perrone ◽

C. Quarto ◽

A. A. Sinisi

Keyword(s):

Pituitary Adenoma ◽

Precocious Puberty ◽

Anterior Pituitary ◽

Pituitary Function ◽

Sexual Precocity ◽

Anterior Pituitary Function ◽

Suprasellar Extension

Abstract. The paper reports on precocious puberty and galactorrhoea in a 4 8/12 year old boy. Roentgenograms of the skull showed slight lateral bulging of sella floor and pneumoencephalography indicated a pituitary adenoma with a suprasellar extension. Pre-operative study of anterior pituitary function was normal except for increased values of LH (900 mIU/ml), testosterone (2000 ng/ml) and prolactin (215 ng/ml). After removal of a chromophobe pituitary adenoma by transfrontal surgery the galactorrhoea disappeared within 10 days. Post-operative endocrine evaluation showed immediate normalization of LH, testosterone and prolactin values.

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Apoplexy accompanying pituitary adenoma as a complication of preoperative anterior pituitary function tests

Acta Neurochirurgica ◽

10.1007/s00701-007-1155-8 ◽

2007 ◽

Vol 149 (6) ◽

pp. 557-565 ◽

Cited By ~ 13

Author(s):

A. Yoshino ◽

Y. Katayama ◽

T. Watanabe ◽

A. Ogino ◽

T. Ohta ◽

...

Keyword(s):

Pituitary Adenoma ◽

Anterior Pituitary ◽

Pituitary Function ◽

Function Tests ◽

Anterior Pituitary Function

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Long-term anterior pituitary function in patients with paediatric Cushing’s disease treated with pituitary radiotherapy

Acta Endocrinologica ◽

10.1530/eje-06-0588 ◽

2007 ◽

Vol 156 (4) ◽

pp. 477-482 ◽

Cited By ~ 20

Author(s):

L F Chan ◽

H L Storr ◽

P N Plowman ◽

L A Perry ◽

G M Besser ◽

...

Keyword(s):

Cushing’S Disease ◽

Anterior Pituitary ◽

Serum Cortisol ◽

Pituitary Function ◽

Cushing's Disease ◽

Serum Prolactin ◽

Second Line ◽

Anterior Pituitary Function

Background/objective: Pituitary radiotherapy (RT) is an effective second-line treatment for paediatric Cushing’s disease (CD). Although the short-term effects of pituitary RT are well documented, there are less data on possible long-term sequelae. We report the long-term anterior pituitary function in a cohort of paediatric CD patients treated with pituitary RT. Patients and methods: Between 1983 and 2006, 12 paediatric CD patients (10 males and 2 females) of mean age 11.4 years at diagnosis (range 6.4–17.4) underwent second-line pituitary RT (45 Gy in 25 fractions), following unsuccessful transsphenoidal surgery. Out of 12, 11 patients were cured by RT (cure interval 0.13–2.86 years) defined by mean serum cortisol of <150 nmol/l on 5-point day curve and midnight sleeping cortisol of <50 nmol/l. Long-term data are available for six male patients, who received RT at the age of 7.0–17.6 years. The mean follow-up from the completion of RT was 10.5 years (6.6–16.5). Results: At a mean of 1.0 year (0.11–2.54) following RT, GH deficiency (peak GH <1–17.9 mU/l) was present in five out of six patients. On retesting at a mean of 9.3 years (7.6–11.3) after RT, three out of four patients were GH sufficient (peak GH 19.2–50.4 mU/l). Other anterior pituitary functions including serum prolactin in five out of six patients were normal on follow-up. All the six patients had testicular volumes of 20–25 ml at the age of 14.5–28.5 years. Conclusion: This series of patients illustrates the absence of serious long-term pituitary deficiency after RT and emphasises the importance of continued surveillance.

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Deterioration of Growth Hormone (GH) Response and Anterior Pituitary Function in Young Adults with Childhood-Onset GH Deficiency and Ectopic Posterior Pituitary: A Two-Year Prospective Follow-Up Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-1081 ◽

2007 ◽

Vol 92 (10) ◽

pp. 3875-3884 ◽

Cited By ~ 28

Author(s):

Natascia di Iorgi ◽

Andrea Secco ◽

Flavia Napoli ◽

Carmine Tinelli ◽

Annalisa Calcagno ◽

...

Keyword(s):

Young Adults ◽

Waist Circumference ◽

Anterior Pituitary ◽

Pituitary Function ◽

Posterior Pituitary ◽

Childhood Onset ◽

Gh Secretion ◽

Igf I ◽

Anterior Pituitary Function

Abstract Context: The current criteria for definition of partial GHD in young adults are still a subject of debate. Objectives: The objective of the study was to reinvestigate anterior pituitary function in young adults with congenital childhood-onset GHD associated with structural hypothalamic-pituitary abnormalities and normal GH response at the time of first reassessment of GH secretion. Design and Setting: This was a prospective explorative study conducted in a university research hospital. Patients and Methods: Thirteen subjects with a mean age of 17.2 ± 0.7 yr and a peak GH after insulin tolerance test (ITT) higher than 5 μg/liter were recruited from a cohort of 42 patients with childhood-onset GHD and ectopic posterior pituitary at magnetic resonance imaging. GH secretion after ITT and GHRH plus arginine, IGF-I concentration, and body mass index, waist circumference, blood pressure, total cholesterol, and fibrinogen were evaluated at baseline and at 2-yr follow-up. Results: At mean age of 19.2 ± 0.7 yr, the mean peak GH response decreased significantly after ITT (P = 0.00001) and GHRH plus arginine (P = 0.0001). GH peak values after ITT and GHRH plus arginine were less than 5 and 9 μg/liter in 10 and eight patients, respectively. Additional pituitary defects were documented in eight patients. Significant changes were found in the values of IGF-I sd score (P = 0.0026), waist circumference (P = 0.00001), serum total cholesterol (P = 0.00001), and serum fibrinogen (P = 0.0004). Conclusions: The results of this study underline the importance of further reassessment of pituitary function in young adults with GHD of childhood-onset and poststimulation GH responses suggestive of partial GHD.

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Surgical treatment of craniopharyngiomas. Part II. Endocrine results

Neurosurgical FOCUS ◽

10.3171/foc.1997.3.6.6 ◽

1997 ◽

Vol 3 (6) ◽

pp. E5 ◽

Cited By ~ 3

Author(s):

Jürgen Honegger ◽

Michael Buchfelder ◽

Rudolf Fahlbusch

Keyword(s):

Diabetes Insipidus ◽

Anterior Pituitary ◽

Complete Removal ◽

Complete Recovery ◽

Pituitary Function ◽

Pituitary Stalk ◽

Primary Surgery ◽

Anterior Pituitary Function ◽

Endocrine Axis

This study aimed to elucidate the endocrine outcome of craniopharyngioma surgery. In particular, endocrine results were analyzed in relation to the surgical approach. The study includes 161 patients who underwent pre- and postoperative endocrine assessment, 143 of whom had not previously undergone surgery. Diabetes insipidus was the most common postoperative deficiency in both the transcranial and transsphenoidal groups. In the case of primary surgery (surgery as initial therapy), the overall percentage of patients with diabetes insipidus increased from 16.1% preoperatively to 59.4% postoperatively. After transcranial surgery, the rate of anterior pituitary deficiency also increased. However, normal preoperative anterior pituitary function was maintained in more than 50% of patients for each endocrine axis. Similar results were attained in the group of patients undergoing complete tumor removal. The best result was achieved for gonadal function: the incidence of hypogonadism increased only slightly from 77.4 to 79.8%. During transsphenoidal surgery, anterior pituitary function was generally preserved. An additional deficient axis was encountered postoperatively in only four (11.4%) of 35 primary surgery cases. Endocrine results were not inferior in patients with a ventrally displaced pituitary. This variant required midline incision of the gland for exposure of the craniopharyngioma. Panhypopituitarism was encountered in only one of eight patients in whom the pituitary stalk was partially resected because of tumor infiltration. None of the 88 patients who remained recurrence-free demonstrated endocrine deterioration during follow-up review, compared with the early postoperative assessment 3 months postsurgery. On the other hand, complete recovery of one endocrine axis was observed in nine of these patients during later follow-up evaluations. In five of them, diabetes insipidus had regressed. The authors conclude that it is worth preserving the pituitary stalk and gland at surgery because anterior pituitary function is more often maintained than is generally believed. Postoperative diabetes insipidus must be accepted as a consequence of complete removal of the pituitary. However, pituitary function may recover and diabetes insipidus in particular may abate with time.

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Effect of Distance from Target on Hypopituitarism After Stereotactic Radiosurgery for Pituitary Adenomas

10.21203/rs.3.rs-1037768/v1 ◽

2021 ◽

Author(s):

Natasha Ironside ◽

Harrison Snyder ◽

Zhiyuan Xu ◽

David Schlesinger ◽

Ching-Jen Chen ◽

...

Keyword(s):

Pituitary Gland ◽

Stereotactic Radiosurgery ◽

Predictive Value ◽

Pituitary Adenomas ◽

Anterior Pituitary ◽

Pituitary Function ◽

Anterior Pituitary Function ◽

Function Preservation ◽

Hypothalamic Pituitary Axis

Abstract IntroductionDelayed hypopituitarism is the most common complication after stereotactic radiosurgery (SRS) for pituitary adenomas. The aim of this study was to investigate the relationship between the distance from the hypothalamic-pituitary axis to the treatment target and anterior pituitary function preservation after SRS. MethodsBetween 2007 and 2020, consecutive adult patients who underwent single-session SRS for pituitary adenomas with ³6 months of follow-up were included. Distance measurements between hypothalamic-pituitary axis structures and the SRS target volume were quantified on MRI. The primary outcome was anterior pituitary function preservation. Outcomes were compared using multivariable regression and area under the receiver operator characteristic curve (AUROC) analyses. ResultsThe study cohort comprised 224 patients, who were categorized by preservation (n=168) and no preservation (n=56) of anterior pituitary function after SRS. Independent predictors of anterior pituitary function preservation were a greater distance between the center of the pituitary gland and center of the SRS target (OR=1.101 [1.000–1.213], p=0.050), and a shorter clinical follow-up duration (OR=0.985 [0.977–0.993], p<0.0001). The adjusted AUROC for the distance from the center of the pituitary gland and center of the SRS target in predicting anterior pituitary function preservation was 0.595. The sensitivity, specificity, positive predictive value and negative predictive value in predicting anterior pituitary function preservation at the optimal cut-off distance of 15mm were 30.0%, 88.0%, 89.9% and 26.2%, respectively.ConclusionsGreater distance between the normal pituitary gland and the SRS target is associated with anterior pituitary function preservation and increasing this distance should be a goal of adenoma resection. Larger prospective, multi-center studies are necessary to corroborate this finding and establish the effects of distance on hypopituitarism after SRS for pituitary adenomas.

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