Reappraising the Role of Trans-Sphenoidal Surgery in Prolactin-Secreting Pituitary Tumors

Background: Prolactinomas represent a unique challenge for endocrinologists and neurosurgeons. Considering recent innovations in surgical practice, the authors aimed to investigate the best management for prolactinomas. Methods: A retrospective, cross-sectional and monocentric study was designed. Consecutive patients affected by prolactinomas were enrolled if treated with a first-line treatment with a dopamine agonist (DA) or trans-sphenoidal surgery (TSS). Patients carried giant prolactinomas, and those with a follow-up <12 months were excluded. Results: Two hundred and fifty-nine patients were enrolled. The first treatment was DA for 140 patients and TS for 119 cases. One hundred and forty-six of 249 patients (58.6%) needed a second therapy. The mean follow-up was 102.2 months (12–438 months). Surgery highly impacted on the cure rate—in particular, in females (p = 0.0021) and in microprolactinomas (p = 0.0020). Considering the multivariate analysis, the female gender and surgical treatment in the course of the clinical history were the only independent positive predictors of a cure at the end of 5 years follow-up (p = 0.0016, p = 0.0005). The evaluation of serum prolactin (24 hours after TSS) revealed that 86.4% of patients with postoperative prolactin (PRL) ≤10 ng/mL were cured at the end of the follow-up (p < 0.0001). Conclusions: According to our experience, surgery allows a high cure rate of prolactinomas, particularly in females with microadenoma, with a good safety profile. TSS for prolactinomas should be considered as a concrete option, during the multidisciplinary evaluation, in centers of reference for pituitary diseases.

Hypothalamic–Pituitary Diseases and Erectile Dysfunction

Several hormones contribute to ensure penile erection, a neurovascular phenomenon in which nitric oxide plays a major role. Erectile dysfunction (ED), which is defined as the persistent inability to obtain or maintain penile erection sufficient for a satisfactory sexual performance, may be due to arteriogenic, neurogenic, iatrogenic, but also endocrinological causes. The hypothalamus–pituitary axis plays a central role in the endocrine system and represents a fundamental link between the brain and peripheral glands, including gonads. Therefore, the hormonal production of the hypothalamic–pituitary axis can control various aspects of sexual function and its dysregulation can compromise erectile function. In addition, excess and deficiency of pituitary hormones or metabolic alterations that are associated with some pituitary diseases (e.g., Cushing’s disease and acromegaly, hypopituitarism) can determine the development of ED with different mechanisms. Thus, the present review aimed to explore the relationship between hypothalamic and pituitary diseases based on the most recent clinical and experimental evidence.

Pituitary Diseases Registry Study in Latvia. Part 1

Background: Our registry study is designed to create a unified database of pituitary disease patients in Latvia. Methods: We collected 3 yrs data from medical records with pituitary diseases from one clinical university hospital and 4 outpatients clinics. Prospective cohort analysis was performed based on demographic data, MRI, laboratory data, data on medications and regimens used to treat pituitary diseases, information on co-morbidities and concomitant medications used in 355 patients with various pituitary diseases: prolactinomas, clinically nonfunctional adenomas (CNFA), acromegalies, empty sella syndrome, Cushing’s disease (CD), Ratke’s pocket cysts, meningiomas, craniopharyngoma, pituitary aplasia and hypoplasia, TSH-omas, germinoma, glioma, chondrosarcoma, pericytoma. Results: From July 2016 to July 2019, 355 people (71.7% women) with pituitary diseases were registered. The mean age in the cohort was 43.4 yrs (range 18–83 yrs). Prolactinomas were the most common adenomas (40.8%), followed by CNFA (28.5%), acromegaly (16.1%) and empty sella syndrome (5.1%), CD (2.3%), Ratchet pocket cysts (2.3%), meningiomas (1.4%), craniopharyngiomas (1.1%), pituitary aplasia and hypoplasia (0.8%), TSH-omas (0.6%), germinoma (0.3%), glioma (0.3%), chondrosarcoma (0.3%), pericitoma (0.3%). Female dominance was observed in patients with prolactinoma and CNFA, ​​empty sella syndrome, Ratke’s pocket cysts, CD, meningiomas, TSH-omas. Patients in the cohort most often received drug therapy with any type of medication alone (octreotide LAR, lanreotide, bromocriptine, cabergoline, pegvisomant) in 50.5% of cases; various types of combination therapy in 13% of cases. The majority of patients (81.7%) were treated with 1or more medication for co-morbidity. Thyroid disease was slightly more common than cardiovascular disease: 86.1% vs. 81.3%. In 10.1% of the cohort, cancer of various localities was detected. Both types of diabetes or other disorders of carbohydrate metabolism were found in 36.3% of cases. Conclusion: Based on the study of the pituitary disease register in Latvia, a unified database of pituitary disease patients has been created, which allows analyzing the population characteristics of the pituitary diseases, the applied treatment schemes for the treatment of pituitary diseases; types of neurosurgery, medication and radiation therapy. A state register may be set up in the future.

Reappraising the Role of Trans-Sphenoidal Surgery in Prolactin-Secreting Pituitary Tumors.

Backgrounds: Prolactinomas represent a unique challenge for endocrinologists and neurosurgeons. Considering recent innovations in surgical practice, the authors aimed to investigate the best management for prolactinomas.Methods: A retrospective, cross-sectional and monocentric study was designed. Consecutive patients affected for prolactinomas were enrolled if treated with first line treatment with dopamine-agonist (DA) or trans-sphenoidal surgery (TS). Patients carried giant prolactinomas and those with a follow-up < 12 months were excluded. Results: 259 patients were enrolled. The first treatment was DA for 140 patients and TS for 119 cases. 146 of 249 patients (58.6%) needed a second therapy. Mean follow up was 102.2 months (12-438 months). Surgery highly impacted on the cure rate, in particular in females (p=0.0021) and in microprolactinomas (p=0.0020). Considering multivariate analysis, female gender and surgical treatment in the course of clinical history were the only independent positive predictors of cure at the end of 5 years follow-up (p=0.0016, p=0.0005). The evaluation of serum prolactin (24 hours after TS) revealed that 86.4% of patients with post-operative PRL≤10 ng/ml resulted cured at the end of follow-up (p< 0.0001).Conclusion: According to our experience, surgery allows a high cure rate of prolactinomas, particularly in females with microadenoma, with a good safety profile. TS for prolactinomas should be considered as concrete option, during the multidisciplinary evaluation, in centers of reference for pituitary diseases.

Evaluation of an individualized education program in pituitary diseases: a pilot study

Introduction The low prevalence of pituitary diseases makes patient autonomy crucial, and self-management programs should be more common. Objectives To assess the efficacy of an education program for patients with pituitary diseases in terms of patients’ quality of life, satisfaction and goal attainment. Design and methods Adult patients with pituitary disorders were recruited in a tertiary referral center and chose at least three of eight possible sessions on various topics, from disease management to psychosocial issues. Patients were included if they attended at least three sessions between 2012 and 2016 and completed the initial, final, and follow-up questionnaires. Data on quality of life (SF36), satisfaction and goal attainment were analyzed. Results Fifty-three patients were included (33 women; mean age, 53.5 years). There were a significant quality of life improvements in terms of physical and psychic limitation scores at the final assessment that persisted at follow-up evaluation. Most patients reached their objectives, especially those on sharing experiences and improving autonomy and self-confidence. More than half set new objectives at the end of the program, the most popular one being to reinforce their knowledge of their pituitary disease, its evolution and treatment (17.1% of patients). The mean overall satisfaction score was 3.75/4. At follow-up evaluation, patients reported improved self-management of pituitary disease (3.6/5) and improved self-efficacy (3.8/5). Conclusion Individualizing the educational objectives of patients with pituitary disease improves the way they live with their disease. If confirmed in other cohorts, this approach could become the gold standard for education programs in rare endocrine diseases.