scholarly journals Prospective evaluation of the characteristics and incidence of adenoma-associated dural invasion in Cushing disease

2012 ◽  
Vol 116 (2) ◽  
pp. 272-279 ◽  
Author(s):  
Russell R. Lonser ◽  
Alexander Ksendzovsky ◽  
Joshua J. Wind ◽  
Alexander O. Vortmeyer ◽  
Edward H. Oldfield
Keyword(s):  
Mr Imaging ◽  
Cavernous Sinus ◽  
Significant Risk ◽  
Pituitary Tumors ◽  
Significant Risk Factor ◽  
Incomplete Resection ◽  
Cushing Disease ◽  
Cavernous Sinus Invasion ◽  
Sinus Wall ◽  
Acth Secreting

Object Dural invasion by adrenocorticotropic hormone (ACTH)-secreting adenomas is a significant risk factor for incomplete resection and recurrence in Cushing disease (CD). Since ACTH-producing adenomas are often the smallest of the various types of pituitary tumors at the time of resection, examining their invasion provides the best opportunity to identify the precise sites of early dural invasion by pituitary adenomas. To characterize the incidence and anatomical distribution of dural invasion by ACTH-secreting adenomas, the authors prospectively and systematically analyzed features of dural invasion in patients with CD. Methods The authors prospectively studied consecutive patients with CD undergoing the systematic removal of ACTH-secreting adenoma and histological analysis of the anterior sella dura as well as other sites of dural invasion that were evident at surgery. Clinical, imaging, histological, and operative findings were analyzed. Results Eighty-seven patients with CD (58 females and 29 males) were included in the study. Overall, dural invasion by an ACTH-positive adenoma was histologically confirmed in 30 patients (34%). Eighteen patients (60% of dural invasion cases, 21% of all patients) had evidence of cavernous sinus wall invasion (4 of these patients also had other contiguous sites of invasion), and 12 patients (40% of dural invasion cases) had invasion of the sella dura excluding the cavernous sinus wall. Eleven patients (13% all patients) had invasion of the routinely procured anterior sella dura specimen. Preoperative MR imaging revealed an adenoma in 64 patients (74%) but accurately predicted dural invasion in only 4 patients (22%) with cavernous sinus invasion and none of the patients with non–cavernous sinus invasion. Adenomas associated with dural invasion (mean ± SD, 10.9 ± 7.8 mm, range 2–37 mm) were significantly larger than those not associated with dural invasion (5.7 ± 2.1 mm, range 2.5–12 mm; p = 0.0006, Mann-Whitney test). Conclusions Dural invasion by ACTH-producing adenomas preferentially occurs laterally into the wall of the cavernous sinus. Preoperative MR imaging infrequently detects dural invasion, including cavernous sinus invasion. Invasion is directly associated with tumor size. To provide a biochemical cure and avoid recurrence after resection, identification and removal of invaded sella dura, including the medial cavernous sinus wall, are necessary.

Experience of Endoscopic Endonasal Approach for 803 Pituitary Tumors With Cavernous Sinus Invasion

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Haibo Zhu ◽  
Chuzhong Li ◽  
Songbai Gui ◽  
Xinsheng Wang ◽  
Xuyi Zong ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Pituitary Tumors ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Cavernous Sinus Invasion

scholarly journals Cavernous sinus invasion by pituitary macroadenomas: neuroradiological, clinical and surgical correlation

1998 ◽  
Vol 56 (1) ◽  
pp. 107-110 ◽  
Author(s):  
ARTHUR CUKIERT ◽  
MARIO ANDRIOLI ◽  
JAYME GOLDMAN ◽  
MARCIA NERY ◽  
LUIS SALGADO ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Gold Standard ◽  
Pituitary Tumors ◽  
Medial Wall ◽  
Cavernous Sinus Invasion ◽  
Mri Features ◽  
Pituitary Macroadenomas

The classical imaging gold-standard for this diagnosis is the presence of tumor lateral to the carotid artery. Seventeen patients with pituitary macroadenomas with intraoperative confirmation of cavernous sinus invasion were studied with MRI. Only 8 patients had tumor lateral to the carotid artery; 13 had tumor within the carotid syphon and all lacked the ring enhancement of the medial wall of the cavernous sinus. In 10 patients, widening of the posterior double leaflets of the cavernous sinus could be. All patients were operated by the transesphenoidal route. Only one patient was cured by surgery alone. Only 3 patients disclosing the above mentioned MRI features were identified in a series of 250 patients and did not have cavernous sinus invasion. The present criteria proved to be useful in the pre-operative diagnosis of cavenous sinus invasion and patients' counselling. Pre-operative diagnosis of cavernous sinus invasion of pituitary tumors has a great impact in the management of such patients.

Assessment of magnetic resonance imaging criteria for the diagnosis of cavernous sinus invasion by pituitary tumors

2021 ◽  
Vol 90 ◽  
pp. 262-267
Author(s):  
Nicholas Chang ◽  
Jessica W. Grayson ◽  
João Mangussi-Gomes ◽  
Sebastian Fung ◽  
Raquel Alvarado ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cavernous Sinus ◽  
Pituitary Tumors ◽  
Resonance Imaging ◽  
Cavernous Sinus Invasion

scholarly journals Treatment options for Cushing disease after unsuccessful transsphenoidal surgery

2007 ◽  
Vol 23 (3) ◽  
pp. 1-7 ◽  
Author(s):  
James K. Liu ◽  
Maria Fleseriu ◽  
Johnny B. Delashaw ◽  
Ivan S. Ciric ◽  
William T. Couldwell ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Transsphenoidal Surgery ◽  
Treatment Options ◽  
Pituitary Tumors ◽  
Premature Death ◽  
Treatment Modalities ◽  
Definitive Treatment ◽  
Sustained Remission ◽  
Cushing Disease ◽  
Acth Secreting

✓Cushing disease is considered an aggressive pituitary endocrinopathy because of the devastating effects from untreated hypercortisolemia. Although they are histologically benign, these adrenocorticotropic hormone (ACTH)-secreting pituitary tumors are associated with significant morbidity and premature death. Currently, transsphenoidal surgery is the primary treatment of Cushing disease associated with an ACTH-secreting pituitary tumor, resulting in remission rates ranging from about 50 to 90%. Some patients, however, will not achieve sustained remission after transsphenoidal surgery and can exhibit persistent or recurrent Cushing disease that requires multimodal treatment to achieve remission. In these patients, options for treatment include repeat transsphenoidal resection, radiation therapy (including conventional fractionated radiation therapy and stereotactic radiosurgery), and medical therapy. Despite undergoing multiple treatment modalities, some patients may ultimately require bilateral adrenalectomy for definitive treatment to eliminate hypercortisolemia associated with Cushing disease. In this article, the authors review the treatment options for patients who have persistent or recurrent Cushing disease after unsuccessful transsphenoidal surgery. The indications, current results reported in the literature, and complications of each treatment modality are discussed.

scholarly journals Outcomes of Therapy for Cushing’s Disease due to Adrenocorticotropin-Secreting Pituitary Macroadenomas1

1998 ◽  
Vol 83 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Lewis S. Blevins ◽  
James H. Christy ◽  
Masheed Khajavi ◽  
George T. Tindall
Keyword(s):  
Confidence Interval ◽  
Cavernous Sinus ◽  
Cushing’S Disease ◽  
Odds Ratio ◽  
Remission Rate ◽  
Cushing's Disease ◽  
Tumor Diameter ◽  
Cavernous Sinus Invasion ◽  
Free Cortisol ◽  
Acth Secreting

We reviewed our experience with 21 patients who had Cushing’s disease due to ACTH-secreting macroadenomas to clarify the natural history of this disease. All patients had typical clinical and biochemical features of ACTH-dependent hypercortisolism. Their mean maximal tumor diameter was 1.6 ± 0.1 cm, and the range was 1.0–2.7 cm. Six patients had cavernous sinus invasion, three had invasion of the floor of their sella, and nine had suprasellar extension. The observed remission rate was significantly lower in macroadenoma patients than in microadenoma patients (67% vs. 91%; χ2 = 5.7; P < 0.02). Cavernous sinus invasion (odds ratio, 35; 95% confidence interval, 2.6–475; P < 0.008) and presence of a maximum tumor diameter 2.0 cm or more (odds ratio, 12.9; 95% confidence interval, 1.4–124; P< 0.02) emerged as the only predictors of residual disease after surgery. The observed recurrence rate was significantly higher in macroadenoma patients than in microadenoma patients (36% vs. 12%; χ2 = 4.2; P< 0.05). Macroadenoma patients tended to suffer from recurrences earlier than did microadenoma patients (16 vs. 49 months). Stepwise multiple logistic regression did not identify any predictors of disease recurrence in macroadenoma patients. Eight macroadenoma patients underwent a total of nine repeat surgical procedures, but none of these resulted in clinical remissions. Only four of seven (57%) patients followed for a sufficient period of time achieved normal urinary free cortisol levels after conventional radiotherapy. Three (75%) of these four patients had re-recurrent hypercortisolism after brief periods of eucortisolism. Pharmacological agents and adrenalectomy were effective in the management of hypercortisolism in patients with residual and recurrent disease. Our results indicate that ACTH-secreting macroadenomas are more refractory to conventional treatments than are ACTH-secreting microadenomas.

MR imaging of cavernous sinus invasion by mucormycosis: a case study

2001 ◽  
Vol 103 (2) ◽  
pp. 101-104 ◽  
Author(s):  
Pitchaiah Mandava ◽  
Gregory Chaljub ◽  
Kristine Patterson ◽  
John W. Hollingsworth
Keyword(s):  
Mr Imaging ◽  
Cavernous Sinus ◽  
Cavernous Sinus Invasion

scholarly journals Glucocorticoid Receptor Antagonism Upregulates Somatostatin Receptor Subtype 2 Expression in ACTH-Producing Neuroendocrine Tumors: New Insight Based on the Selective Glucocorticoid Receptor Modulator Relacorilant

2022 ◽  
Vol 12 ◽  
Author(s):  
Rosario Pivonello ◽  
Pamela N. Munster ◽  
Massimo Terzolo ◽  
Rosario Ferrigno ◽  
Chiara Simeoli ◽  
...  
Keyword(s):  
Glucocorticoid Receptor ◽  
Neuroendocrine Tumors ◽  
Tumor Size ◽  
Somatostatin Receptor ◽  
Pituitary Tumors ◽  
Receptor Subtype ◽  
Cushing Disease ◽  
Ectopic Acth ◽  
Somatostatin Receptor Subtype 2 ◽  
Acth Secreting

Somatostatin exhibits an inhibitory effect on pituitary hormone secretion, including inhibition of growth hormone and adrenocorticotropic hormone (ACTH), and it can have antisecretory and antitumor effects on neuroendocrine tumors (NETs) that express somatostatin receptors. Although the precise mechanism remains unclear, the finding that glucocorticoids downregulate somatostatin receptor subtype 2 (SSTR2) expression has been used to explain the lack of efficacy of traditional SSTR2-targeting analogs in patients with ACTH-secreting NETs. Glucocorticoid receptor (GR) antagonism with mifepristone has been shown to reverse the glucocorticoid-induced downregulation of SSTR2; however, the effects of GR modulation on SSTR2 expression in ACTH-secreting NETs, particularly corticotroph pituitary tumors, are not well known. The current study presents new insight from in vitro data using the highly selective GR modulator relacorilant, showing that GR modulation can overcome dexamethasone-induced suppression of SSTR2 in the murine At-T20 cell line. Additional data presented from clinical case observations in patients with ACTH-secreting NETs suggest that upregulation of SSTR2 via GR modulation may re-sensitize tumors to endogenous somatostatin and/or somatostatin analogs. Clinical, laboratory, and imaging findings from 4 patients [2 ACTH-secreting bronchial tumors and 2 ACTH-secreting pituitary tumors (Cushing disease)] who were treated with relacorilant as part of two clinical studies (NCT02804750 and NCT02762981) are described. In the patients with ectopic ACTH secretion, SSTR2-based imaging (Octreoscan and 68Ga-DOTATATE positron emission tomography) performed before and after treatment with relacorilant showed increased radiotracer uptake by the tumor following treatment with relacorilant without change in tumor size at computed tomography. In the patients with Cushing disease who received relacorilant prior to scheduled pituitary surgery, magnetic resonance imaging after a 3-month course of relacorilant showed a reduction in tumor size. Based on these findings, we propose that GR modulation in patients with ACTH-secreting NETs upregulates previously suppressed SSTR2s, resulting in tumor-specific antisecretory and anti-proliferative effects. The effect of relacorilant on pituitary corticotroph tumors is being investigated in an ongoing phase 3 study (NCT03697109; EudraCT 2018-003096-35).

scholarly journals MicroRNAs Differentially Expressed in ACTH-Secreting Pituitary Tumors

2009 ◽  
Vol 94 (1) ◽  
pp. 320-323 ◽  
Author(s):  
Fernando Colbari Amaral ◽  
Natalia Torres ◽  
Fabiano Saggioro ◽  
Luciano Neder ◽  
Hélio Rubens Machado ◽  
...  
Keyword(s):  
Mirna Expression ◽  
Tumor Size ◽  
Target Genes ◽  
Pituitary Tumors ◽  
Mirna Expression Profile ◽  
Fragile Sites ◽  
Cushing Disease ◽  
Small Noncoding Rnas ◽  
Mirna Genes ◽  
Acth Secreting

Abstract Context: MicroRNAs (miRNAs) are small noncoding RNAs, functioning as antisense regulators of gene expression by targeting mRNA and contributing to cancer development and progression. More than 50% of miRNA genes are located in cancer-associated genomic regions or in fragile sites of the genome. Objective: The aim of the study was to analyze the differential expression of let-7a, miR-15a, miR-16, miR-21, miR-141, miR-143, miR-145, and miR-150 in corticotropinomas and normal pituitary tissue and verify whether their profile of expression correlates with tumor size or remission after treatment. Material and Methods: ACTH-secreting pituitary tumor samples were obtained during transphenoidal surgery from patients with Cushing disease and normal pituitary tissues from autopsies. The relative expression of miRNAs was measured by real-time PCR using RNU44 and RNU49 as endogenous controls. Relative quantification of miRNA expression was calculated using the 2−ΔΔCt method. Results: We found underexpression of miR-145 (2.0-fold; P = 0.04), miR-21 (2.4-fold; P = 0.004), miR-141 (2.6-fold; P = 0.02), let-7a (3.3-fold; P = 0.003), miR-150 (3.8-fold; P = 0.04), miR-15a (4.5-fold; P = 0.03), miR-16 (5.0-fold; P = 0.004), and miR-143 (6.4-fold; P = 0.004) in ACTH-secreting pituitary tumors when compared to normal pituitary tissues. There were no differences between miRNA expression and tumor size as well as miRNA expression and ratio of remission after surgery, except in patients presenting lower miR-141 expression who showed a better chance of remission. Conclusion: Our results support the possibility that altered miRNA expression profile might be involved in corticotrophic tumorigenesis. However, the lack of knowledge about miRNA target genes postpones full understanding of the biological functions of down-regulated or up-regulated miRNAs in corticotropinomas.

Newly occurring cranial nerve palsy after endovascular treatment of cavernous sinus dural arteriovenous fistulas

2019 ◽  
Vol 11 (11) ◽  
pp. 1168-1172
Author(s):  
Su Hwan Lee ◽  
Won-Sang Cho ◽  
Hyun-Seung Kang ◽  
Jeong Eun Kim ◽  
Young Dae Cho ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Endovascular Intervention ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

ObjectiveCranial nerve palsy (CNP) is rarely reported after endovascular intervention for cavernous sinus dural arteriovenous fistulas (CS DAVFs). Our aim was to evaluate the treatment outcomes of CS DAVFs, and the clinical course and risk factors of newly occurring CNPs, with a review of the literature.Methods121 patients with 134 lesions treated in our institution were selected. They were retrospectively analyzed in terms of baseline characteristics, radiologic results, clinical outcome, and newly occurring CNPs after treatment. Angiographic and clinical follow-up data were available for 104 lesions (77.6%) and 130 lesions (97.0%), respectively.ResultsThe angiographic results showed partial:complete obliterations in 13:91 (87.5%) at the final follow-up. Clinical outcomes were deteriorated or no change:improved or completely recovered (3:126 (96.9%)) at the final follow-up. New CNPs occurred in 24 patients (19.8%), including the sixth CNP alone or mixed in 23 patients (95.8%). 23 cases were completely recovered or improved (21 and 2 cases, respectively), and 19 (90.4%) of 21 were completely recovered within 6 months after treatment. In the multivariate analysis, pretreatment cranial nerve symptoms (OR=0.33; 95% CI 0.14 to 0.76; P=0.010) and complete obliteration immediately after treatment (OR=0.32; 95% CI 0.12 to 0.85; P=0.021) were significant preventive factors for new CNPs. Embolization in the posterior compartments of the CS (OR=5.15; 95% CI 1.71 to 15.47; P=0.004) was a significant risk factor.ConclusionsEndovascular intervention was satisfactory in patients with CS DAVFs. The prognosis of newly occurring CNPs was favorable.

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