Empty Sella Syndrome as a Window Into the Neuroprotective Effects of Prolactin

Background: The goal of this study was to relate diffusion MR measures of white matter integrity of the retinofugal visual pathway with prolactin levels in a patient with downward herniation of the optic chiasm secondary to medical treatment of a prolactinoma.Methods: A 36-year-old woman with a prolactinoma presented with progressive bilateral visual field defects 9 years after initial diagnosis and medical treatment. She was diagnosed with empty-sella syndrome and instructed to stop cabergoline. Hormone testing was conducted in tandem with routine clinical evaluations over 1 year and the patient was followed with diffusion magnetic resonance imaging (dMRI), optical coherence tomography (OCT), and automated perimetry at three time points. Five healthy controls underwent a complementary battery of clinical and neuroimaging tests at a single time point.Results: Shortly after discontinuing cabergoline, diffusion metrics in the optic tracts were within the range of values observed in healthy controls. However, following a brief period where the patient resumed cabergoline (of her own volition), there was a decrease in serum prolactin with a corresponding decrease in visual ability and increase in radial diffusivity (p < 0.001). Those measures again returned to their baseline ranges after discontinuing cabergoline a second time.Conclusions: These results demonstrate the sensitivity of dMRI to detect rapid and functionally significant microstructural changes in white matter tracts secondary to alterations in serum prolactin levels. The inverse relations between prolactin and measures of white matter integrity and visual function are consistent with the hypothesis that prolactin can play a neuroprotective role in the injured nervous system.

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Empty sella syndrome as a window into the neuroprotective effects of prolactin

10.1101/2020.11.30.403576 ◽

2020 ◽

Author(s):

David A. Paul ◽

Emma Strawderman ◽

Alejandra Rodriguez ◽

Ricky Hoang ◽

Colleen L. Schneider ◽

...

Keyword(s):

White Matter ◽

Medical Treatment ◽

Structural Integrity ◽

Empty Sella ◽

Serum Prolactin ◽

Visual Field Defects ◽

Automated Perimetry ◽

Healthy Controls ◽

White Matter Tracts ◽

Empty Sella Syndrome

ABSTRACTBACKGROUNDTo correlate structural integrity of visual pathway white matter tracts with prolactin levels in a patient who demonstrates downward herniation of the optic chiasm secondary to medical treatment of a prolactinoma.METHODSA 36-year-old woman with a prolactinoma presented with progressive bilateral visual field defects nine years after initial diagnosis and medical treatment. She was diagnosed with empty-sella syndrome and instructed to stop cabergoline. Hormone testing was conducted in tandem with routine clinical evaluations over one year and the patient was followed with diffusion magnetic resonance imaging (dMRI), optical coherence tomography (OCT), and automated perimetry at three time points. Five healthy controls underwent a complementary battery of clinical and neuroimaging tests at a single time point.RESULTSShortly after discontinuing cabergoline, diffusion metrics in the optic tracts were within the range of values observed in healthy controls. However, following a brief period where the patient resumed cabergoline (of her own volition), there was a decrease in serum prolactin with a corresponding decrease in visual ability and increase in radial diffusivity (p<0.001). Those measures again returned to their baseline ranges after discontinuing cabergoline a second time.CONCLUSIONSThese results demonstrate the sensitivity of dMRI to detect rapid and functionally significant microstructural changes in white matter tracts secondary to alterations in serum prolactin levels. The inverse relations between prolactin and measures of diffusion and visual function provide support for a neuroprotective role of prolactin in the injured nervous system.

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Surgical Management of Giant Pituitary Adenomas

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100030055 ◽

1990 ◽

Vol 17 (1) ◽

pp. 62-66 ◽

Cited By ~ 98

Author(s):

Gérard Mohr ◽

Jules Hardy ◽

Ronald Comtois ◽

Hughes Beauregard

Keyword(s):

Pituitary Adenomas ◽

Residual Tumor ◽

Empty Sella ◽

Csf Leak ◽

Visual Field Defects ◽

Pituitary Insufficiency ◽

Empty Sella Syndrome ◽

Type D ◽

Giant Pituitary Adenomas ◽

Type C

ABSTRACT:During the past 25 years, 77 giant pituitary adenomas have been treated surgically, including suprasellar extensions of type C in 66 cases and of type D in 11 cases. Non-secreting adenomas were present in 53 and secreting adenomas in 24 cases. All patients except 3 presented with significant visual field defects; including bitemporal hemianopia, superior quadranopia or unilateral temporal hemianopia, contralateral blindness in 73% of the cases, and one case with sudden bilateral blindness due to acute pituitary apoplexy. A single transsphenoidal procedure was carried out in 74% of the patients while 11 patients (7%) required re-operations for recurrent or residual tumor. Only 3 patients required a subsequent transcranial procedure. Complications included 1 CSF-leak, 1 empty-sella syndrome and 4 fatal post-operative hematomas. We prefer the transsphenoidal route even in very large or giant pituitary adenomas, since it allows rapid and adequate decompression of the optic nerves and chiasm, avoids major pituitary insufficiency in 60% of the cases and is associated with low morbidity-mortality rates.

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EPA-1717 – Effects of exercise therapy on white matter integrity in patients with schizophrenia and healthy controls- a longitudinal DTI study

European Psychiatry ◽

10.1016/s0924-9338(14)78856-x ◽

2014 ◽

Vol 29 ◽

pp. 1

Author(s):

A. Svátková ◽

R.C.W. Mandl ◽

T.W. Scheewe ◽

R.S. Kahn ◽

W. Cahn ◽

...

Keyword(s):

White Matter ◽

Exercise Therapy ◽

White Matter Integrity ◽

Healthy Controls

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Changes in Cerebral Volume and White Matter Integrity in Adults on Hemodialysis and Relationship to Cognitive Function

Nephron ◽

10.1159/000510614 ◽

2020 ◽

Vol 145 (1) ◽

pp. 35-43

Author(s):

Wesley T. Richerson ◽

Laura G. Umfleet ◽

Brian D. Schmit ◽

Dawn F. Wolfgram

Keyword(s):

Cognitive Impairment ◽

White Matter ◽

Cognitive Performance ◽

Gray Matter ◽

Structural Changes ◽

Structural Integrity ◽

Diffusion Tensor ◽

White Matter Integrity ◽

Healthy Controls ◽

Matter Volume

Introduction: Patients on hemodialysis (HD) have a significant burden of cognitive impairment. Characterizing the cerebral structural changes in HD patients compared to healthy controls and evaluating the relationship of cerebral structural integrity with cognitive performance in HD patients can help clarify the pathophysiology of the cognitive impairment in HD patients. Methods: In this cross-sectional study, in-center HD patients ≥50 years of age underwent brain structural and diffusion MRIs and cognitive assessment using the NIH Toolbox cognition battery. The cerebral imaging measures of the HD participants were compared to imaging from age-matched controls. Gray matter volume, white matter volume, and white matter integrity determined by diffusion tensor imaging parameters (including fractional anisotropy [FA]) were measured in both cohorts to determine differences in the cerebral structure between HD participants and healthy controls. The association between cognitive performance on the NIH Toolbox cognition battery and cerebral structural integrity was evaluated using multiple linear regression models. Results: We compared imaging measures form 23 HD participants and 15 age-matched controls. The HD participants had decreased gray matter volumes (526.8 vs. 589.5 cm3, p < 0.01) and worsened white matter integrity overall (FA values of 0.2864 vs. 0.3441, p < 0.01) within major white matter tracts compared to healthy controls. Decreases in white matter integrity in the left superior longitudinal fasciculus was associated with lower executive function scores (r2 = 0.24, p = 0.02) and inferior longitudinal fasciculus with lower memory scores (r = 0.25 and p = 0.03 for left and r2 = 0.21 and p = 0.03 for right). Conclusions: HD patients have a pattern of decreased white matter integrity and gray matter atrophy compared to controls. Decreases in white matter integrity were associated with decreased cognitive performance in the HD population.

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Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation

Journal of the American Society of Nephrology ◽

10.1681/asn.2020050584 ◽

2020 ◽

Vol 32 (1) ◽

pp. 177-187

Author(s):

Rebecca J. Lepping ◽

Robert N. Montgomery ◽

Palash Sharma ◽

Jonathan D. Mahnken ◽

Eric D. Vidoni ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Kidney Transplantation ◽

White Matter ◽

Magnetic Resonance ◽

White Matter Integrity ◽

Healthy Controls ◽

Resonance Imaging ◽

Brain Abnormalities ◽

Post Transplant

BackgroundCKD is associated with abnormalities in cerebral blood flow, cerebral neurochemical concentrations, and white matter integrity. Each of these is associated with adverse clinical consequences in the non-CKD population, which may explain the high prevalence of dementia and stroke in ESKD. Because cognition improves after kidney transplantation, comparing these brain abnormalities before and after kidney transplantation may identify potential reversibility in ESKD-associated brain abnormalities.MethodsIn this study of patients with ESKD and age-matched healthy controls, we used arterial spin labeling to assess the effects of kidney transplantation on cerebral blood flow and magnetic resonance spectroscopic imaging to measure cerebral neurochemical concentrations (N-acetylaspartate, choline, glutamate, glutamine, myo-inositol, and total creatine). We also assessed white matter integrity measured by fractional anisotropy (FA) and mean diffusivity (MD) with diffusion tensor imaging. We used a linear mixed model analysis to compare longitudinal, repeated brain magnetic resonance imaging measurements before, 3 months after, and 12 months after transplantation and compared these findings with those of healthy controls.ResultsStudy participants included 29 patients with ESKD and 19 controls; 22 patients completed post-transplant magnetic resonance imaging. Cerebral blood flow, which was higher in patients pretransplant compared with controls (P=0.003), decreased post-transplant (P<0.001) to values in controls. Concentrations of neurochemicals choline and myo-inositol that were higher pretransplant compared with controls (P=0.001 and P<0.001, respectively) also normalized post-transplant (P<0.001 and P<0.001, respectively). FA increased (P=0.001) and MD decreased (P<0.001) post-transplant.ConclusionsCertain brain abnormalities in CKD are reversible and normalize with kidney transplantation. Further studies are needed to understand the mechanisms underlying these brain abnormalities and to explore interventions to mitigate them even in patients who cannot be transplanted.Clinical Trial registry name and registration number:Cognitive Impairment and Imaging Correlates in End Stage Renal Disease, NCT01883349

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Altered basal ganglia functional connectivity in multiple sclerosis patients with fatigue

Multiple Sclerosis Journal ◽

10.1177/1352458514555784 ◽

2014 ◽

Vol 21 (7) ◽

pp. 925-934 ◽

Cited By ~ 91

Author(s):

C Finke ◽

J Schlichting ◽

S Papazoglou ◽

M Scheel ◽

A Freing ◽

...

Keyword(s):

Multiple Sclerosis ◽

White Matter ◽

Basal Ganglia ◽

Functional Connectivity ◽

Grey Matter ◽

Matter Density ◽

White Matter Integrity ◽

Healthy Controls ◽

Grey Matter Density ◽

Fatigue Severity

Background: Fatigue is one of the most frequent and disabling symptoms in multiple sclerosis, but its pathophysiological mechanisms are poorly understood. It is in particular unclear whether and how fatigue relates to structural and functional brain changes. Objective: We aimed to analyse the association of fatigue severity with basal ganglia functional connectivity, basal ganglia volumes, white matter integrity and grey matter density. Methods: In 44 patients with relapsing–remitting multiple sclerosis and 20 age- and gender-matched healthy controls, resting-state fMRI, diffusion tensor imaging and voxel-based morphometry was performed. Results: In comparison with healthy controls, patients showed alteration of grey matter density, white matter integrity, basal ganglia volumes and basal ganglia functional connectivity. No association of fatigue severity with grey matter density, white matter integrity and basal ganglia volumes was observed within patients. In contrast, fatigue severity was negatively correlated with functional connectivity of basal ganglia nuclei with medial prefrontal cortex, precuneus and posterior cingulate cortex in patients. Furthermore, fatigue severity was positively correlated with functional connectivity between caudate nucleus and motor cortex. Conclusion: Fatigue is associated with distinct alterations of basal ganglia functional connectivity independent of overall disability. The pattern of connectivity changes suggests that disruption of motor and non-motor basal ganglia functions, including motivation and reward processing, contributes to fatigue pathophysiology in multiple sclerosis.

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Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity After Kidney Transplantation

10.1101/2020.05.04.20091199 ◽

2020 ◽

Author(s):

Rebecca J. Lepping ◽

Robert N. Montgomery ◽

Palash Sharma ◽

Jonathan D. Mahnken ◽

Eric D. Vidoni ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Kidney Transplantation ◽

White Matter ◽

Kidney Disease ◽

Brain Mri ◽

White Matter Integrity ◽

Healthy Controls ◽

Brain Abnormalities ◽

Increased Risk

AbstractBackgroundChronic kidney disease (CKD) is associated with abnormalities in cerebral blood flow (CBF), cerebral neurochemical concentrations and white matter integrity, each of which are associated with adverse clinical consequences in the non-CKD population, and may explain the high prevalence of dementia and stroke in end stage kidney disease (ESKD). Since cognition improves after kidney transplantation (KT), we examined these brain abnormalities pre-to post-KT to identify potential reversibility in ESKD-associated brain abnormalities.MethodsWe measured the effects of KT on CBF assessed by arterial spin labeling, cerebral neurochemical concentrations (N-acetylaspartate, choline, glutamate and glutamine, myoinositol and total creatine) measured by magnetic resonance spectroscopic imaging, and white matter integrity measured by fractional anisotropy (FA) and mean diffusivity (MD) with diffusion tensor imaging. We used a linear mixed model analysis to compare longitudinal, repeated brain MRI measurements pre-KT, and 3 months and 12 months post-KT, and also compared findings with healthy controls.Results29 ESKD patients and 19 age-matched healthy controls participated in the study. 22 patients underwent post-KT MRI. CBF, which was higher pre-KT than in controls (p=0.003), decreased post-KT (p<0.0001) to values in controls. KT also normalized concentrations of osmotic neurochemicals choline (p<0.0001) and myo-inositol (p=0.0003) that were higher pre-KT compared to controls. Post-KT, FA increased (p=0.001) and MD decreased (p=0.0001).ConclusionsBrain abnormalities in CKD are reversible and normalize with KT. Further studies are needed to understand the mechanisms underlying these brain abnormalities and to explore interventions to mitigate them even in patients who cannot be transplanted.Significance statementKidney disease is accompanied by brain structural and physiological abnormalities and increased risk of dementia and stroke. Renal replacement therapy with dialysis does not normalize these brain abnormalities. We evaluated these brain abnormalities before and after kidney transplantation and demonstrated that unlike dialysis, kidney transplantation normalizes cerebral blood flow, neurochemical concentrations and white matter integrity. These changes persist beyond initial post-transplantation period and thus cannot be attributed to peri-procedural interventions like steroids. These results indicate reversibility of brain abnormalities in kidney disease. Further studies are needed to understand the mechanisms underlying these abnormalities and explore interventions for prevention and mitigation in patients who cannot be transplanted.

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MRI CLINICAL RATINGS AND COGNITIVE FUNCTION IN A CROSS-SECTIONAL POPULATION STUDY OF DEMENTIA: THE CACHE COUNTY MEMORY STUDY

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2019.1 ◽

2019 ◽

pp. 1-8

Author(s):

Y.H.W. Tsui-Caldwell ◽

T.J. Farrer ◽

Z. McDonnell ◽

Z. Christensen ◽

C. Finuf ◽

...

Keyword(s):

White Matter ◽

Rating Scale ◽

Population Sample ◽

Population Based ◽

White Matter Integrity ◽

Healthy Controls ◽

Cross Sectional ◽

Increased Risk ◽

Scale Scores ◽

Cache County

BACKGROUND: White matter integrity in aging populations is associated with increased risk of cognitive decline, dementia diagnosis, and mortality. Population-based data can elucidate this association. Objectives: To examine the association between white matter integrity, as measured by a clinical rating scale of hyperintensities, and mental status in older adults including advanced aging. Design: Scheltens Ratings Scale was used to qualitatively assess white matter (WM) hyperintensities in participants of the Cache County Memory Study (CCMS), an epidemiological study of Alzheimer’s disease in an exceptionally long-lived population. Further, the relation between Mini-Mental State Exam (MMSE) and WM hyperintensities were explored. Method: Participants consisted of 415 individuals with dementia and 22 healthy controls. Results: CCMS participants, including healthy controls, had high levels of WM pathology as measured by Scheltens Ratings Scale score. While age did not significantly relate to WM pathology, higher Scheltens Ratings Scale scores were associated with lower MMSE findings (correlation between -0.14 & -0.22; p < .05). Conclusions: WM pathology was common in this county-wide population sample of those ranging in age from 65 to 106. Increased WM burden was found to be significantly associated with decreased overall MMSE performance.

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