Predicting pituitary adenoma consistency with preoperative magnetic resonance elastography

2021 ◽  
pp. 1-8
Author(s):  
Salomon Cohen-Cohen ◽  
Ahmed Helal ◽  
Ziying Yin ◽  
Matthew K. Ball ◽  
Richard L. Ehman ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Gross Total Resection ◽  
Tumor Diameter ◽  
Total Resection ◽  
Cavernous Sinus Invasion ◽  
Multiple Imaging ◽  
The Mean ◽  
Tumor Consistency ◽  
Tumor Stiffness

OBJECTIVE Pituitary adenoma is one of the most common primary intracranial neoplasms. Most of these tumors are soft, but up to 17% may have a firmer consistency. Therefore, knowing the tumor consistency in the preoperative setting could be helpful. Multiple imaging methods have been proposed to predict tumor consistency, but the results are controversial. This study aimed to evaluate the efficacy of MR elastography (MRE) in predicting tumor consistency and its potential use in a series of patients with pituitary adenomas. METHODS Thirty-eight patients with pituitary adenomas (≥ 2.5 cm) were prospectively evaluated with MRI and MRE before surgery. Absolute MRE stiffness values and relative MRE stiffness ratios, as well as the relative ratio of T1 signal, T2 signal, and diffusion-weighted imaging apparent diffusion coefficient (ADC) values were determined prospectively by calculating the ratio of those values in the tumor to adjacent left temporal white matter. Tumors were classified into three groups according to surgical consistency (soft, intermediate, and firm). Statistical analysis was used to identify the predictive value of the different radiological parameters in determining pituitary adenoma consistency. RESULTS The authors included 32 (84.21%) nonfunctional and 6 (15.79%) functional adenomas. The mean maximum tumor diameter was 3.7 cm, and the mean preoperative tumor volume was 16.4 cm3. Cavernous sinus invasion was present in 20 patients (52.63%). A gross-total resection was possible in 9 (23.68%) patients. The entire cohort’s mean absolute tumor stiffness value was 1.8 kPa (range 1.1–3.7 kPa), whereas the mean tumor stiffness ratio was 0.66 (range 0.37–1.6). Intraoperative tumor consistency was significantly correlated with absolute and relative tumor stiffness (p = 0.0087 and 0.007, respectively). Tumor consistency alone was not a significant factor for predicting gross-total resection. Patients with intermediate and firm tumors had more complications compared to patients with soft tumors (50.00% vs 12.50%, p = 0.02) and also had longer operative times (p = 0.0002). CONCLUSIONS Whereas other MRI sequences have proven to be unreliable in determining tumor consistency, MRE has been shown to be a reliable tool for predicting adenoma consistency. Preoperative knowledge of tumor consistency could be potentially useful for surgical planning, counseling about potential surgical risks, and estimating the length of operative time.

Endoscopic endonasal surgery for nonadenomatous, nonmeningeal pathology involving the cavernous sinus

2017 ◽  
Vol 126 (3) ◽  
pp. 880-888 ◽  
Author(s):  
Aikaterini Patrona ◽  
Kunal S. Patel ◽  
Evan D. Bander ◽  
Alpesh Mehta ◽  
Apostolos John Tsiouris ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Tumor Board ◽  
Benign Tumors ◽  
Total Resection ◽  
Cranial Neuropathies ◽  
The Mean ◽  
Underlying Pathology

OBJECTIVE Surgery within the cavernous sinus (CS) remains a controversial topic because of the delicate and complex anatomy. The risk also varies with tumor consistency. Softer tumors such as pituitary adenomas are more likely to be surgically treated, while firm tumors such as meningiomas are often treated with radiosurgery. However, a wide range of pathologies that can involve the CS are amenable to surgery. The authors describe and analyze their results using endonasal endoscopic “medial-to-lateral” approaches for nonadenomatous, nonmeningeal tumors, in relation to the degree of invasion within the CS. METHODS A prospectively acquired database of consecutive endoscopic approaches for tumors with verified intraoperative CS invasion was reviewed. Pituitary adenomas and meningiomas were excluded. Degree of invasion of the CS was classified using the Knosp-Steiner (KS) grading system as well as the percentage of cavernous carotid artery (CCA) encasement. Extent of resection of the entire tumor and of the CS component was assessed by independent neuroradiologists using volumetric measurements of the pre- and postoperative MRI studies. Demographic data and complications were noted. RESULTS Fifteen patients (mean age 51.1 years who received endoscopic surgery between 2007 and 2013 met the selection criteria. There were 11 malignant tumors, including chordoma, chondrosarcoma, hemangiopericytoma, lymphoma, and metastatic cancer, and 4 benign tumors, including 3 cavernous hemangiomas and 1 dermoid. All cases were discussed before treatment in a tumor board. Adjuvant treatment options included chemotherapy and radiotherapy. The mean pre- and postoperative tumor volumes were 12.74 ml and 3.86 ml. Gross-total resection (GTR; ie, resection greater than 95%) was the goal in 13 cases and was achieved in 6 patients (46%) while in addition 5 patients had a greater than 80% resection. Gross-total resection in the CS was accomplished in 55% of the tumors with KS Grades 1–2 and in 16.6% of the tumors with KS grades 3–4, respectively. Likewise, GTR was accomplished in 55% of the tumors with CCA encasement under 75% and in 14.3% of the lesions with CCA encasement over 75%, irrespective of tumor volume and underlying pathology. There were 18 preexisting cranial neuropathies involving cranial nerves III–VI, of which 9 fully resolved, 4 improved, and 3 remained unchanged; 2 of these worsened with tumor recurrence. Surgical complications included 1 transient new cranial nerve VI palsy associated with Horner's syndrome and 1 case of panhypopituitarism. There were no postoperative CSF leaks and no infections. The mean extended follow-up was 34.4 months. CONCLUSIONS Endonasal endoscopic approaches can play a role in the management of nonmeningeal, nonadenomatous tumors invading the CS, either through biopsy, debulking, or GTR. An advantage of this method is the relief of preexisting cranial neuropathies with low risk for new neurological deficit. Extent of resection within the CS varies with KS grade and degree of carotid encasement irrespective of the underlying pathology. The goals of surgery should be clearly established preoperatively in consultation with radiation and medical oncologists.

scholarly journals MON-303 Giant Growth Hormone Secreting Pituitary Adenomas: A Single Institution Case Series

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Bahadir Koylu ◽  
Suleyman Nahit Sendur ◽  
Seda Hanife Oguz ◽  
Selcuk Dagdelen ◽  
Tomris A Erbas
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Postoperative Radiotherapy ◽  
Somatostatin Receptor ◽  
Case Series ◽  
Tumor Diameter ◽  
Somatostatin Receptor Ligands ◽  
The Mean

Abstract The prevalence of growth hormone (GH)-secreting pituitary adenoma is around 11-13% of all pituitary adenomas. Giant GH-secreting pituitary adenomas (≥ 4 cm) are rare tumors, and its prevalence of among acromegalic patients is <5%. This is a retrospective cohort study including patients with giant GH-secreting pituitary adenomas. The study population consisted of 10 patients (5 M/5 F). The mean age at diagnosis was 33.0±12.9 yrs (11-55 yrs). The mean delay between first symptom onset and diagnosis was 2.9 years. The most frequent symptoms were acral enlargement and facial changes (80%), followed by headache (70%) and visual deterioration (50%). One patient had epilepsy. Amenorrhea was presented in three females but obvious galactorrhea in two. The mean adenoma diameter was 42.6±4.7 mm (40-51 mm) at diagnosis. The vast majority of adenomas presented suprasellar extension (100%) or cavernous sinus invasion (80%). Cystic adenomas accounted for 50%. At presentation, mean GH and IGF-1 levels were 40.0±21.4 ng/mL (14.8-51.0) and 2.62±1.09 x ULN (1.08-3.96), respectively. Six patients presented with PRL cosecretion. At diagnosis maximal tumor diameter was not correlated with GH or IGF-1 levels. All patients underwent pituitary surgery as first-line treatment. Three cases were treated with an endoscopic approach and four cases with a microscopic approach. Transcranial approach was also employed in three cases. Postoperative mean GH and IGF-1 levels were 14.9±16.1 ng/mL (0.6-51.0) and 2.25.±0.82 x ULN (1.48-3.74), respectively. After first surgery, only one patient had more than 50% reduction in IGF-1 levels. Five patients (50%) underwent repeat surgery on two to three procedures because remission was not achieved. Postoperative somatostatin receptor ligands (SRLs) were used by all patients. Six patients were treated with dopamine agonist in combination with SRL. Six patients (60%) received postoperative radiotherapy. The mean follow-up period was 12.6±5.3 yrs (4-21 yrs). The mean GH and IGF-1 levels were 1.47±1.54 ng/mL (0.08-5.25) and 0.73±0.44 x ULN (0.08-1.56), respectively at the last visit. Residual adenoma was present at the last MRI in eight patients (mean diameter 9.0±3.6 mm). Panhypopituitarism rose from 10% at baseline to 30% at the last visit. During follow-up, one patient diagnosed breast cancer, while another diagnosed thyroid papillary cancer. Giant GH-secreting pituitary adenomas can have a clinically aggressive behavior with mass effect. Moreover, treatment in patients with giant GH-secreting pituitary adenoma is complex and multimodal therapy is necessary.

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.

scholarly journals Radiographic and clinical outcomes using intraoperative magnetic resonance imaging for transsphenoidal resection of pituitary adenomas

2020 ◽  
pp. 1-12
Author(s):  
Rupa G. Juthani ◽  
Anne S. Reiner ◽  
Ankur R. Patel ◽  
Aimee Cowan ◽  
Marie Roguski ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Total Resection ◽  
Cavernous Sinus Invasion ◽  
Treatment Groups ◽  
Postoperative Mri

OBJECTIVEThe utility and safety of intraoperative MRI (iMRI) for resection of pituitary adenomas is not clearly established in the context of advances in endoscopic approaches. The goal in this study was to evaluate the safety and efficacy of iMRI for pituitary adenoma resection, with endoscopic transsphenoidal (ETS) versus microscopic transsphenoidal (MTS) approaches.METHODSRadiographic and clinical outcomes of all pituitary adenomas resected using iMRI between 2008 and 2017 at a single institution were retrospectively evaluated.RESULTSOf 212 tumors treated, 131 (62%) underwent further resection based on iMRI findings, resulting in a significant increase in gross-total resection on postoperative MRI compared with iMRI (p = 0.0001) in both ETS and MTS groups. iMRI increased rates of gross-total resection for cavernous sinus invasion Knosp grades 1 and 2, but not in Knosp ≥ 3 across treatment groups (p < 0.0001). The extent of resection on postoperative MRI was significantly correlated with increased progression-free survival (p < 0.0001). Initial hormone remission off medical therapy was achieved in 64%, with a significantly higher rate of remission in tumors resected via the ETS approach (81%) compared with the MTS approach (55%) (p = 0.02). The rate of persistent new hormone deficit was low at 8%, including a 2.8% rate of permanent diabetes insipidus, and 45% of patients had improvement in preoperative hormone deficit following surgery. Serious postoperative complications including CSF leaks requiring reoperation were rare at 1%, with no postoperative infections.CONCLUSIONSThese results suggest that iMRI is a safe and effective method of increasing the extent of resection for pituitary adenomas while preserving hormone function. When paired with the endoscope, iMRI may offer the ability to tailor more aggressive removal of tumors while optimizing pituitary function, resulting in high rates of secretory hormone remission. Secretory tumors and adenomas with Knosp grade < 3 cavernous sinus invasion may benefit most from the use of iMRI.

Atypical pituitary adenoma: a clinicopathologic case series

2018 ◽  
Vol 128 (4) ◽  
pp. 1058-1065 ◽  
Author(s):  
Martin J. Rutkowski ◽  
Ryan M. Alward ◽  
Rebecca Chen ◽  
Jeffrey Wagner ◽  
Arman Jahangiri ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Mitotic Activity ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Cavernous Sinus Invasion ◽  
Female Patients ◽  
Mean Diameter ◽  
Atypical Pituitary Adenoma ◽  
Male Patients ◽  
The Mean

OBJECTIVEIn 2004, the WHO classified atypical pituitary adenoma as a distinct adenoma subtype. However, the clinical significance of this distinction remains undetermined. The authors sought to define patient characteristics, tumor features, and treatment outcomes associated with atypical pituitary adenoma.METHODSThe authors reviewed records of patients who underwent resection of pituitary adenoma at the University of California, San Francisco, between 2007 and 2014. Per institutional protocol, adenomas exhibiting mitotic activity underwent evaluation for all 3 markers of atypicality (mitotic index, extensive p53 staining, and MIB-1 index ≥ 3%). Statistical analyses were performed using χ2, Fisher’s exact test, t-test, log-rank, and logistic regression.RESULTSBetween 2007 and 2014, 701 patients underwent resection for pituitary adenoma. Among these patients, 122 adenomas exhibited mitotic activity and therefore were evaluated for all 3 markers of atypicality, with 36 tumors (5%) proving to be atypical. There were 21 female patients (58%) and 15 male patients (42%) in the atypical cohort, and 313 female patients (47%) and 352 male patients (53%) in the nonatypical cohort (p = 0.231). The mean age of patients in the atypical cohort was 37 years (range 10–65 years), which was significantly lower than the mean age of 49 years (range 10–93 years) for patients in the nonatypical cohort (p < 0.001). The most common presenting symptoms for patients with atypical adenomas were headaches (42%) and visual changes (33%). Atypical adenomas were more likely to be functional (78%) than nonatypical adenomas (42%; p < 0.001). Functional atypical adenomas were significantly larger than functional nonatypical adenomas (mean diameter 2.2 vs 1.4 cm; p = 0.009), as were nonfunctional atypical adenomas compared with nonfunctional nonatypical adenomas (mean diameter 3.3 vs 2.3 cm; p = 0.01). Among the entire adenoma cohort, larger presenting tumor size was associated with cavernous sinus invasion (p < 0.001), and subtotal resection was associated with cavernous sinus invasion (p < 0.001) and larger size (p < 0.001) on binomial multivariate regression. The median time until recurrence was 56 months for atypical adenomas, 129 months for functional nonatypical adenomas, and 204 months for nonfunctional nonatypical adenomas (p < 0.001). Functional atypical adenomas recurred more frequently and significantly earlier than functional nonatypical adenomas (p < 0.001). When accounting for extent of resection, cavernous sinus invasion, size, age, sex, and functional subtype, atypicality remained a significant predictor of earlier recurrence among functional adenomas (p = 0.002).CONCLUSIONSWhen compared with nonatypical pituitary adenomas, atypical adenomas are more likely to present in younger patients at a larger size, are more often hormonally hypersecretory, and are associated with earlier recurrence. These features lend credence to atypical pituitary adenomas being a distinct clinical entity in addition to a discrete pathological diagnosis.

scholarly journals ETMR-12. EMBRYONAL TUMOR WITH MULTILAYERED ROSETTES: A SINGLE CENTER EXPERIENCE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii325-iii325
Author(s):  
Sodai Yoshimura ◽  
Masahiro Sugawa ◽  
Kohei Fukuoka ◽  
Makiko Mori ◽  
Yuki Arakawa ◽  
...  
Keyword(s):  
Chromosome Region ◽  
Medical Center ◽  
Occipital Lobe ◽  
Gross Total Resection ◽  
Intrathecal Therapy ◽  
Tumor Diameter ◽  
Total Resection ◽  
Embryonal Tumor ◽  
Presenting Symptoms ◽  
The Mean

Abstract BACKGROUND Embryonal tumor with multilayered rosettes (ETMR) is a rare, highly malignant tumor of the central nervous system and is usually diagnosed in children aged &lt;2 years. Currently, because no defined treatment strategy has been reported, treatment regimens are often extrapolated from other embryonal tumors. Therefore, data collection of ETMR cases is important for further understanding EMTR. Here, we present our experience with four patients with ETMR. MATERIAL AND METHODS Patients with a pathological diagnosis of ETMR from 1999 to 2016 at Saitama Children’s Medical Center were included. Their clinical data were retrospectively analyzed. RESULTS This study included four cases of ETMR (one male and three females). The mean age at diagnosis was 29.5 (range, 15–37) months. Presenting symptoms included seizure, hemiparesis, vomiting, and headache. The mean maximal tumor diameter was 42.5 mm. The tumor locations included frontal lobe, temporal lobe, occipital lobe, cerebellum, and brainstem. Gross total resection was achieved in two cases. Fluorescence in situ hybridization analysis demonstrated amplification of 19q13.42 chromosome region in all cases, and diffuse positive expression was observed in the immunohistochemical staining for LIN28A. Systemic postoperative chemotherapy was administered to all patients. Three patients received intrathecal therapy and three were irradiated. The mean overall survival and progression-free survival were 45.3 and 42 months, respectively. Two patients who underwent gross total resection are alive without recurrence. CONCLUSION Complete surgical resection may be an important prognostic factor in patients with ETMR. Further prospective studies are needed to confirm these results.

NCOG-31. GIANT PITUITARY ADENOMA (GPA) SCORE: A NOVEL SCORING SYSTEM TO PREDICT POSTOPERATIVE OUTCOMES OF GIANT PITUITARY ADENOMAS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi158-vi158
Author(s):  
Syed Ather Enam ◽  
Fauzan Alam Hashmi ◽  
Sanam Mir Ghazi ◽  
Ahsan Ali Khan ◽  
Muhammad Bilal Tariq ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Linear Regression ◽  
Pituitary Adenomas ◽  
Scoring System ◽  
Tumor Resection ◽  
Maximum Diameter ◽  
Giant Pituitary Adenoma ◽  
Giant Pituitary Adenomas ◽  
The Mean ◽  
Suprasellar Extension

Abstract BACKGROUND Giant pituitary adenomas (GPA) are uncommon and highly variable in morphology and extension. There is no scoring system that considers all the dimensions of adenoma invasion. We developed a new Giant Pituitary Adenoma score and report our surgical experience and evaluate outcomes after resection of these tumors in accordance with the preoperative score. METHODS We developed a novel scoring system for classifying giant pituitary adenomas, and 11-year data of GPA surgery at our center was collected retrospectively, based on this scoring system. GPA Score considered tumor’s parasellar extension, encasement of cavernous internal carotid artery (ICA), suprasellar extension &gt; 2 cm, suprasellar extension &gt; 4cm and retrosellar extension. Maximum possible score was 9. The scoring system was applied to 53 patients of GPA who underwent surgical resection between January 1, 2006, and December 2017. The Lundin-Pederson (ABC/2) method was used to calculate the tumor volume both pre- and post-resection and linear regression was used to assess the relationship between extent of tumor resection and GPA score. RESULTS The median age of the study population was 42.08 ± 16.49 years. The mean maximum diameter of the pituitary adenomas was 5.0 cm (range 4.0 cm-8.5cm) while the mean volume of the adenomas was 27.3 cm3 (range 10 cm3-149 cm3). There were 3 cases of score 2, 5 cases of score 3, 13 cases of score 4, 20 cases of score 5, 9 cases of score 6 and 3 cases of score 7. The range of tumor volumes of tumors for scores from 2-7 was 17.3 cm3 to 65.8 cm3 and GPA score was correlated with the percent residual tumor using linear regression that was statistically significant (p= 0.001). CONCLUSION GPA Score is a reliable scoring system to predict the extent and subsequent difficulty in tumor resection in GPA.

scholarly journals Impact of tumor characteristics and pre- and postoperative hormone levels on hormonal remission following endoscopic transsphenoidal surgery in patients with acromegaly

2020 ◽  
Vol 48 (6) ◽  
pp. E10 ◽  
Author(s):  
Tyler Cardinal ◽  
Martin J. Rutkowski ◽  
Alexander Micko ◽  
Mark Shiroishi ◽  
Chia-Shang Jason Liu ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Medical Therapy ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Cranial Nerves ◽  
Elevated Serum ◽  
Tumor Control ◽  
Tumor Diameter ◽  
Endoscopic Endonasal ◽  
Csf Leakage

OBJECTIVEAcromegaly is a disease of acral enlargement and elevated serum levels of insulin-like growth factor–1 (IGF-1) and growth hormone (GH), usually caused by a pituitary adenoma. A lack of consensus on factors that reliably predict outcomes in acromegalic patients following endoscopic endonasal transsphenoidal surgery (EETS) warrants additional investigation.METHODSThe authors identified 52 patients with acromegaly who underwent an endoscopic endonasal approach (EEA) for resection of a GH-secreting pituitary adenoma. Preoperative and postoperative tumor and endocrinological characteristics such as tumor size, invasiveness, and GH/IGF-1 levels were evaluated as potential indicators of postoperative hormonal remission. Endocrinological remission was defined as postoperative IGF-1 levels at or below the age- and sex-normalized values.RESULTSThe 52 patients had a mean age of 50.7 ± 13.4 years and a mean follow-up duration of 24.4 ± 19.1 months. Ten patients (19%) had microadenomas and 42 (81%) had macroadenomas. Five patients (9.6%) had giant adenomas. Forty-four tumors (85%) had extrasellar extension, with 40 (77%) exhibiting infrasellar invasion, 18 (35%) extending above the sella, and 7 (13%) invading the cavernous sinuses. Thirty-six patients (69%) underwent gross-total resection (GTR; mean maximal tumor diameter 1.47 cm), and 16 (31%) underwent subtotal resection (STR; mean maximal tumor diameter 2.74 cm). Invasive tumors were significantly larger, and Knosp scores were negatively correlated with GTR. Thirty-eight patients (73%) achieved hormonal remission after EEA resection alone, which increased to 87% with adjunctive medical therapy. Ninety percent of patients with microadenomas and 86% of patients with macroadenomas achieved hormonal remission. Preoperative IGF-1 and postoperative day 1 (POD1) GH levels were inversely correlated with hormonal remission. Postoperative CSF leakage occurred in 2 patients (4%), and none experienced vision loss, death, or injury to internal carotid arteries or cranial nerves.CONCLUSIONSEndoscopic transsphenoidal resection of GH-secreting pituitary adenomas is a safe and highly effective treatment for achieving hormonal remission and tumor control in up to 87% of patients with acromegaly when combined with postoperative medical therapy. Patients with lower preoperative IGF-1 and POD1 GH levels, with less invasive pituitary adenomas, and who undergo GTR are more likely to achieve postoperative biochemical remission.

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.

scholarly journals SUN-135 Characterization of Transcription Factor Immunostaining and Null Cell Adenoma Status in Hormone Negative Pituitary Adenomas

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Hans C Baertsch ◽  
Dhiraj J Pangal ◽  
Trey Garrett ◽  
Andrew Brunswick ◽  
Martin Rutkowski ◽  
...  
Keyword(s):  
Transcription Factors ◽  
Pituitary Adenomas ◽  
Vision Loss ◽  
World Health ◽  
Tumor Diameter ◽  
Null Cell ◽  
Cell Adenoma ◽  
Cavernous Sinus Invasion ◽  
Endocrine Organs

Abstract Introduction: Since the 2017 W.H.O. classification of pituitary adenomas redefined null cell adenomas (NCAs) as negative for all adenohypophyseal hormones and the transcription factors (TFs) SF-1, PIT-1, and T-PIT, limited data exist characterizing these tumors1. We characterize NCAs in comparison to hormone negative adenomas (HNAs), which demonstrate negative hormone immunostaining in the context of positive TF immunoreactivity. Methods: Retrospective review of 22 patients with HNAs between 2011-2019. Samples were stained for PIT-1 and SF-1. Negative ACTH staining served as a proxy for T-PIT given demonstrated prior concordance of these stains2. Demographics, tumor characteristics, preoperative symptoms, and postoperative outcomes were assessed. Results: Fifteen samples (68%) stained negative for both PIT-1 and SF-1 and were classified as NCAs. Seven were positive for SF-1 (n=3), PIT-1 (n=3), or both (n=1) and were classified as HNAs. NCA patients were predominantly female (80%), while those with HNAs were predominantly male (57%). All tumors were macroadenomas, with mean maximal tumor diameter of 28mm in NCAs vs 23mm in HNAs (p=0.2705). NCAs were more likely to demonstrate suprasellar invasion (100% vs. 71%, p=0.0325), and although not statistically significant, cavernous sinus invasion (53% vs. 43%, p=0.6695), and higher MIB-1 proliferative index (2.271 vs. 1.971, p=0.733). The most common preoperative symptoms were headache (73% NCA, 71% HNA) and vision loss (53%, 40%). Postoperative improvements in headache (60% NCA, 71% HNA) and vision (53%, 50%) were comparable. Sixty-four percent of NCAs underwent gross total resection vs. 43% of HNAs (p=.3712). There were no recurrences or progressions in either group over 24mo. Few comparisons reached significance, potentially due to limited sample size. Conclusion: A majority of HNAs demonstrated negative TF immunostaining and met criteria for NCAs. NCAs may be more common in females and demonstrate more suprasellar invasion than HNAs, but otherwise, do not vary significantly. TF staining may be of limited clinical utility in identifying high-risk pathology, however future studies with larger cohorts are warranted. References: 1. Osamura RY, Lopes MBS, Grossman A, Matsuno A, Korbonits M, Trouillas J, Kovacs K (2017) Pituitary adenoma. In: Lloyd RV, Osamura RY, Klöppel G, Rosai J (eds) World health organization classification of tumours of endocrine organs, 4th edn. IARC, Lyon, pp 14-18. 2. Nishioka H, Inoshita N, Mete O, Asa SL, Hayashi K, Takeshita A, Fukuhara N, Yamaguchi-Okadad M, Takeuchi Y, Yamada S (2015) The Complementary Role of Transcription Factors in the Accurate Diagnosis of Clinically Nonfunctioning Pituitary Adenomas. Endocr Path 26(4):249-55.

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