Intrasellar gangliocytoma and syndromes of pituitary hypersecretion

1983 ◽  
Vol 59 (6) ◽  
pp. 1071-1075 ◽  
Author(s):  
Edwin G. Fischer ◽  
James H. Morris ◽  
William M. Kettyle
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Pituitary Function ◽  
Pituitary Hormone ◽  
Content Type ◽  
Rare Tumors ◽  
Successful Removal ◽  
Fine Print

✓ Syndromes of hypersecretion of pituitary hormone and sellar enlargement may on occasion be caused by a gangliocytoma instead of a pituitary adenoma. At least some of these rare tumors are apparently independent of and separable from the pituitary gland, its stalk, and the hypothalamus, and are therefore surgically removable without incurring further endocrine deficit. The authors report such a case, with successful removal of the tumor via a frontal craniotomy. The associated hypersecretion of pituitary hormone was corrected without disturbing normal pituitary function.

Computerized tomography of a sellar spine

1982 ◽  
Vol 57 (3) ◽  
pp. 407-409 ◽  
Author(s):  
David L. LaMasters ◽  
James E. Boggan ◽  
Charles B. Wilson
Keyword(s):  
Pituitary Adenoma ◽  
High Resolution ◽  
Pituitary Gland ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Radiographic Appearance ◽  
Content Type ◽  
High Resolution Ct ◽  
Developmental Variant ◽  
Fine Print

✓ A presumed developmental variant of the dorsum sellae was found in a patient undergoing evaluation for a suspected pituitary adenoma. An initial computerized tomography (CT) scan suggested a suprasellar mass; however, high-resolution CT with reformations clearly revealed the mass to be the pituitary gland, which was deformed and displaced upward by an osseous spine projecting from the dorsum sellae. The radiographic appearance and etiology of this anomaly are discussed. Neurosurgeons and neuroradiologists should be aware of this anomaly when evaluating a patient for pituitary adenoma.

Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function

2002 ◽  
Vol 97 ◽  
pp. 415-421 ◽  
Author(s):  
Günther Christian Feigl ◽  
Christine Maria Bonelli ◽  
Andrea Berghold ◽  
Michael Mokry
Keyword(s):  
Pituitary Gland ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Pituitary Function ◽  
Pituitary Insufficiency ◽  
Content Type ◽  
The Mean ◽  
Fine Print ◽  
Stimulating Hormone

Object. The authors undertook a retrospective analysis of the incidence and time course of pituitary insufficiency following gamma knife radiosurgery (GKS) for pituitary adenomas. Methods. Pituitary adenomas in 92 patients were analyzed. There were 61 hormonally inactive tumors, 18 prolactinomas, and nine somatotropic and four adrenocorticotropic adenomas. The mean tumor volume was 3.8 cm3 (range 0.2–14.6 cm3). The mean prescription dose was 15 Gy. The mean prescription isodose was 50.7%. The mean follow-up time was 4.6 years (range 1.2–10 years). The following new or deteriorating insufficiencies that did not require treatment were recorded for the different pituitary axes: follicle-stimulating hormone (FSH)/luteinizing hormone (LH) 19 (20.6%), thyroid-stimulating hormone (TSH) 32 (34.8%), adenocorticotropic hormone (ACTH) 10 (10.9%), and growth hormone (GH) 26 (28.3%). For new insufficiencies or deterioration requiring replacement therapy, the figures were as follows: FSH/LH 20 (21.7%), TSH 22 (23.9%), ACTH eight (8.7%), and GH 12 (13%). Spot dosimetry was performed in 59 patients in the hypothalamic region, the pituitary gland, and pituitary stalk. The pituitary stalks in patients with deterioration of pituitary function received a statistically higher dosage of radiation, 7.7 ± 3.7 Gy compared with 5.5 ± 3 Gy (p = 0.03). Conclusions. The function of the residual normal pituitary gland is less affected following GKS of pituitary adenomas than after fractionated radiotherapy. Nonetheless, increased attention needs to be exercised to reduce the dose to the stalk and pituitary gland to minimize the incidence of these complications.

Experimental radiofrequency telethermohypophysectomy

1971 ◽  
Vol 35 (5) ◽  
pp. 564-570
Author(s):  
Charles Burton ◽  
Richard C. Black
Keyword(s):  
Diabetic Retinopathy ◽  
Pituitary Gland ◽  
Pituitary Adenomas ◽  
Therapeutic Approach ◽  
Malignant Disease ◽  
Pituitary Function ◽  
Posterior Pituitary ◽  
Papio Anubis ◽  
Content Type ◽  
Fine Print

✓ A new means of producing well-delineated lesions of the pituitary gland by the heating of implanted electroseeds with electromagnetic radiation has been tested in a series of eight adult baboons (Papio anubis). The technique shows promise as a future simple and safe means of depressing anterior or posterior pituitary function in a controlled fashion over a period of time. In addition, possible fallacies relating to the rationale justifying total sellar hypophysectomy are considered. The authors believe that progressive depression of pituitary function may represent a more logical therapeutic approach to patients requiring hypophysectomy for the palliation of malignant disease, diabetic retinopathy, or eosinophilic pituitary adenomas.

Gamma knife surgery of the pituitary: new treatment for thalamic pain syndrome

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 38-41 ◽  
Author(s):  
Motohiro Hayashi ◽  
Takaomi Taira ◽  
Taku Ochiai ◽  
Mikhail Chernov ◽  
Yuichi Takasu ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Gamma Knife ◽  
Pain Syndrome ◽  
Pain Reduction ◽  
Gamma Knife Surgery ◽  
Content Type ◽  
Thalamic Pain Syndrome ◽  
Thalamic Pain ◽  
Fine Print

Object. Although reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain. Methods. Inclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months. Conclusions. An initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.

Pituitary adenoma producing growth hormone and adrenocorticotropin: a histological, immunocytochemical, electron microscopic, and in situ hybridization study

1998 ◽  
Vol 88 (6) ◽  
pp. 1111-1115 ◽  
Author(s):  
Kalman Kovacs ◽  
Eva Horvath ◽  
Lucia Stefaneanu ◽  
Juan Bilbao ◽  
William Singer ◽  
...  
Keyword(s):  
Growth Hormone ◽  
In Situ Hybridization ◽  
Pituitary Adenoma ◽  
Immunoelectron Microscopy ◽  
Secretory Granules ◽  
Cell Types ◽  
Content Type ◽  
Separate Cell ◽  
Fine Print

✓ The authors report on the morphological features of a pituitary adenoma that produced growth hormone (GH) and adrenocorticotropic hormone (ACTH). This hormone combination produced by a single adenoma is extremely rare; a review of the available literature showed that only one previous case has been published. The tumor, which was removed from a 62-year-old man with acromegaly, was studied by histological and immunocytochemical analyses, transmission electron microscopy, immunoelectron microscopy, and in situ hybridization. When the authors used light microscopy, the tumor appeared to be a bimorphous mixed pituitary adenoma composed of two separate cell types: one cell population synthesized GH and the other ACTH. The cytogenesis of pituitary adenomas that produce more than one hormone is obscure. It may be that two separate cells—one somatotroph and one corticotroph—transformed into neoplastic cells, or that the adenoma arose in a common stem cell that differentiated into two separate cell types. In this case immunoelectron microscopy conclusively demonstrated ACTH in the secretory granules of several somatotrophs. This was associated with a change in the morphological characteristics of secretory granules. Thus it is possible that the tumor was originally a somatotropic adenoma that began to produce ACTH as a result of mutations that occurred during tumor progression.

Intrasellar epidermoid cyst

1983 ◽  
Vol 58 (3) ◽  
pp. 411-415 ◽  
Author(s):  
James E. Boggan ◽  
Richard L. Davis ◽  
Greg Zorman ◽  
Charles B. Wilson
Keyword(s):  
Pituitary Adenoma ◽  
Epidermoid Cyst ◽  
Cystic Lesions ◽  
Sellar Region ◽  
Content Type ◽  
Fine Print

✓ The authors report the uncomplicated removal of an intrasellar epidermoid cyst that on presentation mimicked a pituitary adenoma. Current controversies regarding the differentiation of this cyst from other cystic lesions of the sellar region are reviewed.

Surgical experience with chromophobe adenomas of the pituitary gland

1971 ◽  
Vol 34 (6) ◽  
pp. 726-729 ◽  
Author(s):  
Bronson S. Ray ◽  
Russell H. Patterson
Keyword(s):  
Radiation Therapy ◽  
Pituitary Gland ◽  
Operative Mortality ◽  
Postoperative Radiation ◽  
Surgical Experience ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Chromophobe Adenoma ◽  
First Time ◽  
Fine Print

✓ Between 1950 and 1969, 165 operations were performed on 146 patients for the treatment of chromophobe adenoma of the pituitary gland unassociated with either acromegaly or Cushing's syndrome. The over-all operative mortality was 1.2%, and no deaths occurred in 138 cases operated on for the first time. In 106 of the patients who had not received prior treatment, vision was improved in 80% of cases and returned to normal in 50%. In the group of patients whose initial treatment was surgery, postoperative radiation therapy was administered in one-half of the cases. The rate of recurrence was 8% in those who received radiation and 22% in those who did not. Recurrence of symptoms within less than 1 year often was due to a hemorrhagic cyst which could be treated better by reoperation than by radiation therapy.

On the origin and nature of the pituitary gland capsule

1977 ◽  
Vol 46 (5) ◽  
pp. 596-600 ◽  
Author(s):  
Ivan Ciric
Keyword(s):  
Pituitary Gland ◽  
Anterior Lobe ◽  
Pituitary Stalk ◽  
Operating Microscope ◽  
Pia Mater ◽  
Content Type ◽  
Fine Print

✓ Observations under the operating microscope confirming the presence of a pituitary capsule are reported. This capsule envelops the anterior lobe of the pituitary, the neurohypophysis, and the pituitary stalk. It merges along the stalk with the intracranial pia mater. The origin and nature of this capsule are discussed in light of the known facts of development of the pituitary gland and surrounding structures. It is concluded that the pituitary gland capsule is a derivative of the primitive pia mater.

Acromegaly, diabetes insipidus, and visual loss caused by metastatic growth hormone—releasing hormone-producing malignant pancreatic endocrine tumor in the pituitary gland

1995 ◽  
Vol 83 (4) ◽  
pp. 719-723 ◽  
Author(s):  
Shigeru Genka ◽  
Hitoshi Soeda ◽  
Manabu Takahashi ◽  
Hideki Katakami ◽  
Naoko Sanno ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Metastatic Cancer ◽  
Growth Hormone Releasing Hormone ◽  
Serum Growth Hormone ◽  
Content Type ◽  
Releasing Hormone ◽  
Metastatic Growth ◽  
Fine Print

✓ The case of a 52-year-old woman with acromegaly, diabetes insipidus, and visual impairment caused by a metastatic growth hormone—releasing hormone (GRH)—produced pancreatic tumor is reported. Serum growth hormone (GH) and somatomedin C levels were elevated to 14 ng/ml (normal < 5 ng/ml), and 3.20 U/ml (normal < 1.88 U/ml), respectively. Paradoxical increases were observed in GH levels after glucose tolerance and thyrotropin—releasing hormone-stimulation tests. Biopsy of a pituitary tumor observed on computerized tomography scans and magnetic resonance studies revealed a metastatic cancer. When circulating GRH levels were measured, a marked increase in plasma GRH (1145 pg/ml; normal < 4—1 pg/ml) was observed. The patient died of cachexia due to metastases. Postmortem examination revealed that a primary tumor, a malignant endocrine lesion, was present in the pancreas, with metastatic tumors in the pituitary, lung, liver, and adrenal glands. Synthesis and production of GRH by the tumor was demonstrated by Northern blotting and immunohistochemical analysis. The pituitary gland showed hyperplastic, but not adenomatous changes. The authors stress the importance of both exploration for an ectopic source of GRH and the search for a GH-producing pituitary adenoma when unusual signs and symptoms are seen in patients with acromegaly.

Transsphenoidal surgery in Cushing disease: 10 years of experience in 34 consecutive cases

2004 ◽  
Vol 100 (4) ◽  
pp. 634-638 ◽  
Author(s):  
Charlotte Höybye ◽  
Eva GrenbäcK ◽  
Marja Thorén ◽  
Anna-Lena Hulting ◽  
Lars Lundblad ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Transsphenoidal Surgery ◽  
Cushing Syndrome ◽  
Preoperative Evaluation ◽  
Clinical Signs ◽  
Pituitary Hormone ◽  
Years Of Experience ◽  
Cushing Disease ◽  
Content Type ◽  
Fine Print

Object. Cushing disease is a rare disorder. Because of their small size the adrenocorticotropic hormone (ACTH)—producing tumors are often not detectable on neuroimaging studies. To obtain a cure with transsphenoidal surgery (TSS) may therefore be difficult. In this report the authors present 10 years of experience in the treatment of patients with Cushing disease who were followed up with the same protocol and treated by the same surgeon. Methods. Thirty-four patients, 26 of them female and eight of them male (mean age 40 years, range 13–74 years) were studied. All had obvious clinical signs and symptoms of Cushing syndrome. Magnetic resonance (MR) imaging was performed in all patients, and inferior petrosal sinus (IPS) sampling was done in 14. In 12 patients MR imaging indicated a pituitary tumor; 10 were microadenomas and two were macroadenomas. In six patients with no visible tumor, the results of IPS sampling supported the diagnosis. All patients underwent TSS; the mean follow-up duration was 6 ± 0.5 years. Selective adenomectomy was performed in 32 and hemihypophysectomy in the other two patients. A cure was obtained in 31 patients (91%) after one TSS and in two more patients after further TSS; one patient was not cured despite two TSSs and one underwent bilateral adrenalectomy. Disease recurrence was seen in two patients after 3 years, and they were successfully treated with stereotactic gamma knife surgery. Half of the patients had an ACTH deficiency postoperatively, whereas one third had other pituitary hormone insufficiencies. There were no serious complications attributable to the surgical intervention. Conclusions. Transsphenoidal surgery with selective adenomectomy is an effective and safe treatment for Cushing disease. In the patients presented in this study, the surgical outcome seemed to depend on careful preoperative evaluation and the surgeon's experience. For optimal results in this rare disease the authors therefore suggest that the endocrinological, radiological, and surgical procedures be coordinated in a specialized center.

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