Table of Contents
1
UI - 21426231
AU - Boronat M; Marrero D; Carrillo A; Larroche F; Ojeda A; Novoa FJ
TI -
[Central diabetes insipidus as clinical presentation of a bronchogenic
adenocarcinoma]
SO - An Med Interna 2001 Jul;18(7):376-8
AD - Seccion de Endocrinologia y Nutricion, Hospital Insular, Las Palmas de
Gran Canaria.
Metastatic tumors of the pituitary gland are uncommon. The majority of
them are silent lesions incidentally discovered at autopsy. In contrast,
the occurrence of symptomatic metastases is exceptional. Here we report
the clinical and radiological findings of a 45 year-old woman with a
metastatic lung adenocarcinoma who presented with diabetes insipidus and
hypernatremic dehydration. There was no previous history of malignancy,
and the pituitary metastases were responsible for the first
manifestation of the disease. Clinical presentation, diagnosis and
therapeutic management of patients with pituitary metastases are
reviewed.
2
UI - 21439313
AU - Porta-Etessam J; Ramos-Carrasco A; Berbel-Garcia A; Martinez-Salio A;
TI -
Benito-Leon J
Clusterlike headache as first manifestation of a prolactinoma.
SO - Headache 2001 Jul-Aug;41(7):723-5
AD - Department of Neurology, Hospital Universitario 12 de Octubre, Madrid,
Spain.
We report a case of cluster headache in a patient with a
macroprolactinoma. Symptomatic cluster headache was suspected because of
an unsatisfactory response to medications that are usually effective in
idiopathic cluster headache. The neurological examination was normal.
However, magnetic resonance imaging demonstrated a large pituitary
tumor. One year after starting treatment with cabergoline, the patient
remains asymptomatic. Symptomatic cluster headache should be suspected
when the clinical features of the headache are atypical. By inducing
vascular mechanisms, the parasellar lesion may have played a role in
initiating the cluster headache.
3
UI - 21435203
AU - Chen YD; Shu SG; Chi CS; Hsieh PP; Ho WL
TI -
Precocious puberty associated with growth hormone deficiency in a
patient with craniopharyngioma: report of one case.
SO - Acta Paediatr Taiwan 2001 Jul-Aug;42(4):243-7
AD - Department of Pediatrics, Taichung Veterans General Hospital, 160, Chung
Kang Road, Sec. 3, Taichung, Taiwan.
Isosexual precocious puberty in girls is not uncommon, but its
association with craniopharyngioma and growth hormone deficiency is
rarely reported. We present a patient with this combination. An
8-year-old girl developed breasts and then had menarche at 7 9/12 years
old. Growth hormone deficiency was suspected due to inappropriate height
and growth velocity in association with idiopathic precocity and a poor
predicted adult height of 138.8 cm. Growth hormone deficiency was
confirmed by clonidine and insulin stimulation tests. Intracranial
lesion was suspected due to precocity associated with GH deficiency. MRI
of the sella's region revealed a 1 cm mass in the hypothalamus. After
surgical resection, pathology of the tumor disclosed a craniopharyngioma
which has rarely been reported to cause precocious puberty. The
precocious puberty regressed after surgery. Growth hormone deficiency
persisted and GH therapy was given to improve growth. The growth rate of
patients with both growth hormone deficiency and precocious puberty may
be maintained within the normal prepubertal range by the effect of sex
steroid. We suggest that in patients with central type precocity in
association with an inappropriate growth status, physicians should
investigate the underlying intracranial lesion, and the possibility of
growth hormone deficiency.
4
UI - 21440186
AU - Sunthornthepvarakul T; Prachasilchai P; Komindr A; Ngowngarmratana S;
TI -
Dansirikul R
A case of thyrotropin-secreting pituitary macroadenoma.
SO - J Med Assoc Thai 2001 Jun;84(6):897-906
AD - Department of Medicine, Rajavithi Hospital, Ministry of Public Health,
Bangkok, Thailand.
We present a 49 year old male patient with thyroid stimulating hormone
(TSH) producing pituitary macroadenoma. He had been mistakenly diagnosed
and treated as Graves' disease for 1 year. Serum TSH level was
inappropriately elevated in the presence of high serum total and free
thyroid hormone concentrations. Thyrotropin releasing hormone
stimulation showed blunt response of TSH but good response for
prolactin. The alpha-subunit level and alpha-subunit to TSH molar ratio
were measured and found to be high before surgery. The sex
hormone-binding globulin level was also high. MRI demonstrated a
pituitary macroadenoma. Insulin tolerance test and GnRH revealed normal
response. The patient was given a high dose of PTU combined with lugol's
solution for controlling hyperthyroidism preoperatively. Transfrontal
surgery was performed and the tumor was partially removed. The diagnosis
was confirmed by tissue pathology and immunohistochemistry staining of
the tumor. The immunohistochemistry staining was performed and found
that tumor cells were strongly reactive to TSH with a relatively mild
degree for follicular stimulating hormone and leutinizing hormone. The
tumor cells were not stained for prolactin, growth hormone and ACTH.
Supervoltage irradiation by 60Co was delivered to the pituitary area
because of persistence of hyperthyroidism. While waiting for the remote
effect of radiotherapy, the patient was given an antithyroid drug to
control hyperthyroidism.
5
UI - 21449368
AU - Loubani M; Galinanes M
TI -
Pituitary gland macroadenoma: a cause of transient blindness after
cardiac surgery.
SO - Ann Thorac Surg 2001 Sep;72(3):929-31
AD - Department of Surgery, Glenfield Hospital, Leicester, England.
Pituitary gland macroadenoma complicating cardiac surgery is an uncommon
condition of spectacular clinical presentation that is generally treated
by surgery. We report here on an unusual presentation of this condition
that was successfully managed by medical treatment.
6
UI - 21449535
AU - Fahlbusch R; Ganslandt O; Buchfelder M; Schott W; Nimsky C
TI -
Intraoperative magnetic resonance imaging during transsphenoidal
surgery.
SO - J Neurosurg 2001 Sep;95(3):381-90
AD - Department of Neurosurgery, University Erlangen-Nurnberg, Erlangen,
Germany.
OBJECT: The aim of this study was to evaluate whether intraoperative
magnetic resonance (MR) imaging can increase the efficacy of
transsphenoidal microsurgery, primarily in non-hormone-secreting intra-
and suprasellar pituitary macroadenomas. METHODS: Intraoperative imaging
was performed using a 0.2-tesla MR imager, which was located in a
specially designed operating room. The patient was placed supine on the
sliding table of the MR imager, with the head placed near the 5-gauss
line. A standard flexible coil was placed around the patient's forehead.
Microsurgery was performed using MR-compatible instruments. Image
acquisition was started after the sliding table had been moved into the
center of the magnet. Coronal and sagittal T1-weighted images each
required over 8 minutes to acquire, and T2-weighted images were obtained
optionally. To assess the reliability of intraoperative evaluation of
tumor resection, the intraoperative findings were compared with those on
conventional postoperative 1.5-tesla MR images, which were obtained 2 to
3 months after surgery. Among 44 patients with large intra- and
suprasellar pituitary adenomas that were mainly hormonally inactive,
intraoperative MR imaging allowed an ultra-early evaluation of tumor
resection in 73% of cases; such an evaluation is normally only possible
2 to 3 months after surgery. A second intraoperative examination of 24
patients for suspected tumor remnants led to additional resection in 15
patients (34%). CONCLUSIONS: Intraoperative MR imaging undoubtedly
offers the option of a second look within the same surgical procedure,
if incomplete tumor resection is suspected. Thus, the rate of procedures
during which complete tumor removal is achieved can be improved.
Furthermore, additional treatments for those patients in whom tumor
removal was incomplete can be planned at an early stage, namely just
after surgery.
7
UI - 21268026
AU - Pawlikowski M
TI -
Immunocytochemical prognostic markers in pituitary tumors.
SO - Folia Histochem Cytobiol 2001;39(2):105-6
AD - Department of Experimental Endocrinology and Hormone Diagnostics,
Institute of Endocrinology, Medical University, Lodz, Poland.
The value of different immunocytochemical markers in the evaluation of
the pituitary tumor aggressiveness is discussed on the basis of the data
from the literature and the author's personal experience. The usefulness
of the proliferation markers (PCNA, Ki-67), prothymosin-alpha, the
endothelial markers revealing the intratumoral vascularization and of
the expression or co-expression of glycoprotein hormones in predicting
the aggressive behaviour of the tumor is likely, but still needs further
studies.
8
UI - 21277044
AU - Jane JA Jr; Thapar K; Alden TD; Laws ER Jr
TI -
Fluoroscopic frameless stereotaxy for transsphenoidal surgery.
SO - Neurosurgery 2001 Jun;48(6):1302-7; discussion 1307-8
AD - Department of Neurosurgery, University of Virginia, Charlottesville
22908, USA.
OBJECTIVE: To assess the value of frameless fluoroscopy-guided
stereotactic transsphenoidal surgery using the FluoroNav Virtual
Fluoroscopy System (Medtronic Sofamor Danek, Inc., Memphis, TN).
METHODS: Twenty consecutive patients undergoing transsphenoidal surgery
for sellar lesions were assigned to transsphenoidal surgery with or
without computer-assisted fluoroscopic image guidance using the
FluoroNav system. Prospective data regarding patient age, sex, lesion
characteristics, operative time, and treatment cost were obtained.
RESULTS: Although patients in the FluoroNav group were, on average, 17
years younger than the patients in the control group, more patients with
recurrent adenomas were treated in the image guidance group. No other
significant differences between the groups were found. FluoroNav
provided accurate, continuous information regarding the anatomic midline
trajectory to the sella turcica as well as anatomic structures (e.g.,
sella, sphenoid sinus) in the lateral view. No patient required
reversion to intraoperative videofluoroscopy. No statistically
significant differences were found with regard to preincision setup
time, operative time, or cost. FluoroNav allowed procedures to be
performed with significantly fewer x-rays being taken. CONCLUSION:
Fluoroscopic computer-assisted frameless stereotaxy furnishes accurate
real-time information with regard to midline structures and operative
trajectory. Although it is useful in first-time transseptal
transsphenoidal surgery, its primary benefit is realized in recurrent
surgery.
9
UI - 21277967
AU - Uccella S; La Rosa S; Genasetti A; Capella C
TI -
Localization of inhibin/activin subunits in normal pituitary and in
pituitary adenomas.
SO - Pituitary 2000 Nov;3(3):131-9
AD - Department of Clinical and Biological Sciences, University of Insubria,
Varese, Italy.
The localization of inhibin/activin (I/A) subunits was investigated in
human normal adenohypophysial cells and in 87 pituitary adenomas of
different types, using immunohistochemistry. Monoclonal antibodies
directed against alpha, beta A and beta B subunits of I/A were employed.
In normal pituitary, alpha subunit of inhibin was detected only in
FSH-positive gonadotrophs, while beta A subunit of I/A was expressed in
FSH-positive gonadotrophs, GH-cells and in a few PRL-cells. beta B
subunit was found in FSH-positive gonadotrophs, TSH-cells and a few
LH-positive gonadotrophs. The three subunits of I/A were detected in the
majority of nonfunctioning tumors, while functioning adenomas showed a
significantly lower expression. This study shows that alpha, beta A and
beta B subunits of I/A are expressed by specific adenohypophysial cell
types and that they are characteristically present in nonfunctioning
adenomas. These results suggest that inhibins and activins may play a
role in the local regulation of pituitary hormonal secretion both in
normal adenohypophysial cells and in pituitary adenomas.
10
UI - 21277970
AU - Meij BP; Lopes MB; Vance ML; Thorner MO; Laws ER Jr
TI -
Double pituitary lesions in three patients with Cushing's disease.
SO - Pituitary 2000 Nov;3(3):159-68
AD - Department of Neurosurgery, Health Sciences Center, University of
Virginia, Charlottesville, Virginia 22908-0214, USA.
Double pituitary adenomas are rare in surgical specimens and the most
common clinical feature in reported patients has been acromegaly. We
report 3 cases of double pituitary lesions in patients who presented
with Cushing's disease. In a 22-year-old man (case 1) with delayed
puberty and low testosterone levels, mild hyperprolactinemia was
diagnosed and treated with dopamine agonist therapy that reduced the
prolactin (PRL) levels to normal. Over a 1-year period Cushing's disease
developed gradually and was confirmed with classical endocrine testing.
In a 27-year-old woman (case 2) who initially presented with severe
depression and morbid obesity there was a gradual onset of Cushing's
disease; initially she had minimally elevated serum PRL. In a
33-year-old woman (case 3) there was a 2-year history of Cushing's
disease characterized by hirsutism, hypertension and weight gain; serum
PRL was normal. Magnetic resonance imaging in all 3 patients revealed a
microadenoma that was successfully removed by transsphenoidal pituitary
surgery. Histology and immunocytochemistry in case 1 and case 3 revealed
a corticotroph cell adenoma and a PRL cell adenoma in separate areas of
the pituitary. In case 3 the PRL cell adenoma was "silent" but in case 1
the PRL cell adenoma may have been the cause of the mild
hyperprolactinemia. In case 2 nodular corticotroph hyperplasia was the
cause of Cushing's disease and a "silent" PRL cell adenoma was also
identified. We conclude from these cases and a literature review that
double pituitary lesions may occur in patients with Cushing's disease.
The corticotroph part of the double lesion may consist of a corticotroph
cell adenoma or, as reported in this study, of corticotroph nodular
hyperplasia. The counterpart of the double lesion may consist either of
a "silent" PRL cell adenoma or a functional PRL cell adenoma causing
hyperprolactinemia.
11
UI - 21277974
AU - Boulis NM; Noordmans AJ; Barkan A; Hassing J; Chandler WF
TI -
Somatotropinoma infarction during octreotide therapy leading to
bilateral cavernous sinus syndrome.
SO - Pituitary 2000 Nov;3(3):185-8
AD - Section of Neurosurgery, University of Michigan Medical Center, Ann
Arbor, MI, USA. nboulis@umich.edu
The cyclic somatostatin analog, octreotide, forms the mainstay of
medical treatment for acromegaly. In addition to lowering circulating
growth hormone levels and shrinking tumor size, octreotide may provide
symptomatic relief of headaches associated with growth hormone secreting
tumors. The majority of reported complications of octreotide therapy are
gastrointestinal and metabolic. The present case illustrates the
development of acute bilateral cavernous sinus syndrome with loss of eye
movement bilaterally during octreotide therapy. Serial MRI examination
suggest tumor infarction as the etiology. The symptoms resolved over 2
months as the tumor shrunk in size and growth hormone was dramatically
reduced.
12
UI - 21277975
AU - Orrego JJ; Chandler WF; Barkan AL
TI -
Rapid re-expansion of a macroprolactinoma after early discontinuation of
bromocriptine.
SO - Pituitary 2000 Nov;3(3):189-92
AD - Pituitary and Neuroendocrine Center, Section of Neurosurgery, Department
of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan,
USA.
Prolactin (PRL)-secreting pituitary adenomas are the most common
functioning pituitary tumors. Medical treatment with dopamine agonists
is the therapy of choice for macroprolactinomas (> or = 10 mm).
Withdrawal of bromocriptine after weeks or months of uninterrupted
therapy has been associated with rapid tumor re-expansion as evidenced
by x-ray and CT scanning of the pituitary region. We report a patient
with a giant macroprolactinoma who had a dramatic response to
bromocriptine (tumor volume shrinkage of 53% within a month) but rapid
re-expansion to its original dimensions one week after discontinuation
of bromocriptine. To our knowledge, this is the first time that the
rapid shrinkage/re-expansion of a macroprolactinoma has been documented
with serial MRI scans.
13
UI - 21284765
AU - Zumkeller W; Jassoy A; Lebek S; Nagel M
TI -
Clinical, endocrinological and radiography features in a child with
McCune-Albright syndrome and pituitary adenoma.
SO - J Pediatr Endocrinol Metab 2001 May;14(5):553-9
AD - Department of Pediatrics, Martin-Luther-University Halle-Wittenberg,
Halle, Germany. walter.zumkeller@medizin.uni-halle.de
McCune-Albright syndrome is a rare syndrome presenting with polyostotic
dysplasia, cafe-au-lait spots and multiple endocrinopathies that is very
often combined with precocious puberty. We examined the clinical,
endocrinological and radiological features in a boy with McCune-Albright
syndrome and pituitary adenoma. X-rays, magnetic resonance (MRI) scan,
whole body scintigraphy, single photon emission computer tomography
(SPECT) and 3D-reconstruction from bone SPECT was performed to evaluate
clinical improvement after treatment with sandostatin and pamidronic
acid. After a six-month period of treatment with sandostatin and
pamidronate, bone scintigraphy revealed significantly reduced activity.
Treatment with bromocriptine and methimazole led to normalization of
prolactin and thyroid hormone levels. Mobility of the patient improved.
A significant improvement as a result of treatment with sandostatin and
pamidronic acid was found in this patient with generalized fibrous
dysplasia. So far, this condition has been treated with pamidronate only
in adults, but severely affected children also benefit from this
treatment regimen.
14
UI - 21284599
AU - Ito I; Ishida T; Hashimoto T; Arita M; Osawa M; Yokota T; Ishimori T
TI -
Hypopituitarism due to pituitary metastasis of lung cancer: case of a
21-year-old man.
SO - Intern Med 2001 May;40(5):414-7
AD - Department of Internal Medicine, Kurashiki Central Hospital.
A 21-year-old man presented persistent dry cough, general malaise, loss
of appetite, decreased sexual desire and double vision. Chest radiograph
revealed a mass shadow in the left upper lobe. Histopathological
diagnosis of the tumor was squamous cell carcinoma. Brain computed
tomography and magnetic resonance imaging revealed a metastasis to the
pituitary gland. Hypopituitarism was diagnosed by pituitary function
tests. Diabetes insipidus was absent and the function of the posterior
lobe of the pituitary gland was preserved. Hypopituitarism due to
pituitary metastasis is a rare complication of lung cancer, and has
never been reported in a patient as young as 21 years old.
15
UI - 21290414
AU - Erel CT; Oral E; Senturk LM; Aksu MF
TI -
Craniopharyngioma and Bardet-Biedl syndrome. A case report.
SO - J Reprod Med 2001 May;46(5):501-3
AD - Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine,
Istanbul University, Istanbul, Turkey. tamererel@superonline.com
BACKGROUND: Bardet-Biedl syndrome is a rare disorder and associated with
a variety of anomalies. CASE: An 18-year-old woman was referred with
primary amenorrhea. Following physical, ophthalmologic, psychiatric,
hormonal and radiologic examinations, the diagnosis of both
craniopharyngioma and Bardet-Biedl syndrome was established. CONCLUSION:
Although the pathogenesis of hypogonadism in a woman with Bardet-Biedl
syndrome remains unclear, cranial structures, especially the
hypothalamus and pituitary gland, should be investigated to reveal any
possible abnormalities.
16
UI - 21285996
AU - Sener RN
TI -
Proton MR spectroscopy of craniopharyngiomas.
SO - Comput Med Imaging Graph 2001 Sep-Oct;25(5):417-22
AD - Department of Radiology, Ege University Hospital, Bornova, Izmir,
TR-35100, Turkey. rnsener@hotmail.com
To date, only a few cases of craniopharyngiomas have been studied by
magnetic resonance (MR) spectroscopy. We report our spectroscopy
experiences with five patients having surgically proven
craniopharyngiomas. Proton MR spectroscopy images were obtained using
the single-voxel mode with spin-echo point resolved spectroscopy. Very
prominent peaks centered at 1-1.5ppm were noted in spectroscopic
analysis, which probably corresponded to lipid/cholesterol peaks,
correlating with the histological findings revealing high amounts of
cholesterol in the cyst fluids.
17
UI - 21390921
AU - Yang Z; Guo Y; Chen K
TI -
[Diagnosis and surgical treatment of pituitary microadenoma]
SO - Zhonghua Er Bi Yan Hou Ke Za Zhi 1998 Feb;33(1):42-3
AD - Third Clinical College, Bethune University of Medical Sciences,
Changchun 130031.
OBJECTIVE: Through the experiences of clinic picture and the radiologic
characteristics of eleven cases of micropituitary adenomas, the early
diagnosis and surgical indications were discussed. METHODS: Intensified
CT and MRI were used to compare their significances in the diagnosis of
micropituitary adenomas. Kaltai incision of the nares and
transsphenoidal approach were adopted in these cases. RESULTS: The
bulging of the upper border of the pituitary gland and the shifting
position of the pituitary stalk observed in the intensified MRI are the
pathognomonic signs for the diagnosis of micropituitary adenoma. The
operation was stopped due to hemorrhage in one case. The average
following up was 3.2 years past operative death in the second month in
one case, operative failure in one case and loss of following up in one
case. CONCLUSION: Strict selection of surgical indications must be done
necessary after careful study of MRI.
18
UI - 21411344
AU - Fuller CE; Smith M; Miller DC; Schelper R
TI -
Pigmented papillary epithelial neoplasm of the pituitary fossa: a
distinct lesion of uncertain histogenesis.
SO - Arch Pathol Lab Med 2001 Sep;125(9):1242-5
AD - Department of Anatomic Pathology, State University of New York Upstate
Medical University, Syracuse, NY, USA. fullercny@hotmail.com
Primary pigmented intracranial neoplasms are strikingly uncommon. The
differential diagnosis is limited and includes both epithelial and
nonepithelial tumors, most of which arise within or near the ventricular
system. The authors describe a 42-year-old man who presented with a
pigmented papillary epithelial lesion that arose within the sella and
exhibited suprasellar extension and bony erosion. Following external
beam radiotherapy and multiple surgical resections, tumor growth became
rapid, necessitating additional debulking procedures. Pathologic
evaluation of subsequent lesional tissue samples revealed an anaplastic
lesion with malignant epithelial and spindle cell components. Occasional
epithelial cells showed features reminiscent of the original papillary
lesion, whereas others exhibited oncocytic morphologic features. This
case represents the only report, to our knowledge, of a pigmented
papillary epithelial neoplasm arising within the pituitary fossa.
Although the histogenesis of this tumor is enigmatic, this appears to be
a distinct lesion characterized by aggressive growth and the capacity
for anaplastic progression.
19
UI - 21434010
AU - Kreutzer J; Vance ML; Lopes MB; Laws ER Jr
TI -
Surgical management of GH-secreting pituitary adenomas: an outcome study
using modern remission criteria.
SO - J Clin Endocrinol Metab 2001 Sep;86(9):4072-7
AD - Department of Neurological Surgery, University of Virginia Health
System, Charlottesville, Virginia 22908, USA.
The results of transsphenoidal surgery as initial therapy for
GH-secreting pituitary adenomas in 57 acromegalic patients were analyzed
retrospectively. Patients with prior surgery or radiation therapy were
excluded from the study. Three different criteria were used to define
remission: glucose-suppressed (nadir) GH less than 1.0 microg/liter, a
normal sex- and age-adjusted IGF-I level, and postoperative random GH
levels of 2.5 microg/liter or less. Additionally, we analyzed the
neuropathological data, including immunohistochemistry and
ultrastructural categorization, and the surgical complications. The
short-term remission rate (6-wk postoperative follow-up visit), as
determined by a random GH measurement of 2.5 microg/liter or less, was
48.8%; the remission rate, as determined by nadir GH, was 51.4%. For 57
patients followed for 12 months or more after surgery (mean, 37.7
months), surgical remission was achieved in 70.2%, 66.7%, and 61.1%,
respectively, for patients assessed by normal IGF-I, random GH, and
nadir GH. One patient (1.1%) developed recurrence of active acromegaly
81 months after initially successful surgical therapy. Extrasellar
growth of the tumor (P = 0.04) and dural invasion by the adenoma (P =
0.008) were significant univariate predictors of a poor outcome. Tumor
size was significantly greater in patients with persistent or recurrent
acromegaly (P = 0.02). Patients with tumors of the ultrastructural
categories of mixed GH/PRL cell and mammosomatotroph adenomas had the
lowest remission rates (50% and 42.9%, respectively). There were no
perioperative deaths, and there was no serious morbidity. The permanent
complication rate was 3.3% (1 permanent DI and 2 nasal septal
perforations). Surgical management of acromegaly currently provides
prompt, effective, and satisfactory initial treatment for the majority
of patients. Using stringent criteria for remission, primary
transsphenoidal surgery for GH-secreting pituitary adenomas is effective
and often definitive therapy for acromegaly. These results provide a
benchmark for the contemporary results of surgical management as
assessed by modern outcome criteria.
20
UI - 21453613
AU - Dort JC; Sutherland GR
TI -
Intraoperative magnetic resonance imaging for skull base surgery.
SO - Laryngoscope 2001 Sep;111(9):1570-5
AD - Department of Surgery, Division of Otolaryngology, The University of
Calgary, Calgary, Alberta, Canada. jdort@ucalgary.ca
OBJECTIVES/HYPOTHESIS: Skull base surgery has evolved over the past
several decades. Major improvements in the imaging of skull base
pathology led to better target localization and better surgical
planning. The objectives of this study were to assess the use of
intraoperative magnetic resonance (MR) imaging in the management of a
series of patients with skull base pathology. We hypothesized that
high-quality intraoperative MR imaging would have an impact on surgery
in this patient group. STUDY DESIGN: Prospective, non-randomized, cohort
study. METHODS: Thirty-one patients with skull base lesions underwent
surgery in a 1.5-Tesla intraoperative MR suite. The concepts of a moving
magnet, high magnetic field strength, and radiofrequency coil design are
presented. RESULTS: Eleven of 31 patients had the course of surgery
significantly altered by the information acquired from the images
obtained during surgery. CONCLUSIONS: Intraoperative MR imaging is a
valuable adjunct to skull base surgery. One third of patients had
altered surgery as a result of this adjunct. Intraoperative MR imaging
is of particular value in the treatment of pituitary adenomas and benign
skull base tumors.
21
UI - 21441840
AU - Oyama K; Sanno N; Teramoto A; Osamura RY
TI -
Expression of neuro D1 in human normal pituitaries and pituitary
adenomas.
SO - Mod Pathol 2001 Sep;14(9):892-9
AD - Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
Neuro D1 is a basic helix-loop-helix transcription factor expressed in
the endocrine cells of pancreas and in a subset of neurons as they
undergo terminal differentiation. In the adult pituitary gland, Neuro D1
is expressed in corticotroph cells and contributes to the
corticotroph-specific pro-opiomelanocortin (POMC) transcription by
interacting with Pituitary homeobox 1 (Ptx 1) transcription factor. In
the present study, we investigated the expression of Neuro D1 in human
normal pituitaries and different types of human pituitary adenomas using
the RT-PCR and immunohistochemical techniques. Using RT-PCR, Neuro D1
mRNA was found to be expressed in ACTH-secreting adenomas (n = 3) and 6
of 8 non-functioning adenomas. On the other hand, GH-secreting adenomas
(n = 5) and PRL-secreting adenomas (n = 3) were completely negative for
Neuro D1 mRNA. Immunohistochemically, Neuro D1 was expressed in all
ACTH-secreting adenomas (n = 10), and in 14 of 20 nonfunctioning
adenomas. In contrast, 3 of 10 PRL-secreting adenomas and 2 of 10
GH-secreting adenomas showed positive Neuro D1 staining in the nuclei.
The above results suggest that Neuro D1 contribute to the functional
expression and the differentiation of ACTH-secreting adenomas. It also
appears from our study that Neuro D1 might play a role in the
differentiation of non-functioning adenomas, the mechanism of which
remains to be further investigated. This is the first study on Neuro D1
in case of human pituitary adenomas.
22
UI - 21250450
AU - Grigsby PW
TI -
Pituitary adenoma.
SO - Front Radiat Ther Oncol 2001;35():48-56
AD - Mallinckrodt Institute of Radiology, Washington University Medical
School, St. Louis, Mo., USA. grigsbyp@netscape.net
23
UI - 21277311
AU - Kumar K; Macaulay RJ; Kelly M; Pirlot T
TI -
Absent p53 immunohistochemical staining in a pituitary carcinoma.
SO - Can J Neurol Sci 2001 May;28(2):174-8
AD - Department of Surgery, Regina General Hospital, University of
Saskatchewan, Canada.
BACKGROUND: Carcinomatous transformation of pituitary adenomas is
uncommon, and is generally accompanied by nuclear accumulation of p53
protein. Pituitary carcinoma lacking accumulation of p53 protein is very
rare, only two such cases being previously reported. METHODS: A patient
presented with visual disturbance and cranial nerve palsies and was
found to have a suprasellar mass. He underwent both transphenoidal and
transfrontal excision of a nonfunctioning pituitary adenoma which
recurred several times. The third recurrence was accompanied by multiple
dural-based metastases. Despite aggressive surgical management, he
continued to develop additional intracranial lesions and died two years
after the discovery of metastatic disease. Specimens from 1984, 1995,
1997 and 1998 were available for histological and immunocytochemical
analysis. Antibodies recognizing the pituitary hormones (ACTH, PRL, GH,
FSH, LH and TSH), as well as cytokeratin, epithelial membrane antigen
(EMA), glial fibrillary acidic protein (GFAP) and chromogranin A were
applied to investigate the lineage of the neoplasm. Antisera specific
for Ki-67 (MIB-1) and p53 protein were also applied to further delineate
the biology of the tumour. RESULTS: Although cytokeratin and
chromogranin A were detected in neoplastic cells. no expression of
pituitary hormones was demonstrable, indicative of a nonfunctioning,
null-cell pituitary adenoma. Nuclear pleomorphism and mitotic activity
increased with subsequent resections. Abnormal accumulation of p53
protein was not observed, neither in early resections nor in the
metastatic deposits. CONCLUSIONS: Failure to demonstrate p53 protein
accumulation does not ensure a favourable outcome for pituitary adenoma.
Accordingly, pituitary carcinoma may occur in the absence of p53
accumulation. The factors which underlie aggressive behaviour of
pituitary neoplasms are uncertain but are under investigation.
24
UI - 21277270
AU - Attanasio R; Barausse M; Cozzi R
TI -
GH/IGF-I normalization and tumor shrinkage during long-term treatment of
acromegaly by lanreotide.
SO - J Endocrinol Invest 2001 Apr;24(4):209-16
AD - Division of Endocrinology, Niguarda Hospital, Milan, Italy.
New depot somatostatin analogs such as lanreotide-slow release (LAN)
represent a significant improvement in the medical treatment of
acromegaly. Seventy-three consecutive acromegalic patients, treated by
LAN, were evaluated in a retrospective monocentric study. Sixteen were
excluded from further evaluation due to combined treatment with dopamine
agonist drugs, early LAN withdrawal for persistence of headache, or
gastrointestinal side-effects. Fifty-seven patients (aged 20-82 years,
16 males) were thus evaluated. Thirty-two patients had been previously
treated by neurosurgery (Tx) and/or radiotherapy (Rx). After washout,
LAN (30 mg) was administered im at 10-14-day intervals. Time intervals
between injections were then individually tailored to normalize IGF-I
levels. LAN was administered for 12 (6-36) [median (range)] months. GH
and IGF-I levels decreased from 13 (7-20) [median (interquartile)]
microg/l to 3.2 (1.7-6.2) microg/l (p<0.0001) and from 780 (596-1000)
microg/l to 264 (180-530) microg/l (p<0.000001), respectively. Seven
patients were resistant to treatment. Among the 50 sensitive patients,
GH levels fell below 2.5 microg/l in 52% (and below 1 microg/l in 18%),
IGF-I levels normalized in 72% and both results were obtained in 46%.
IGF-I values normalized in 87% of patients treated every 14 days, in
100% every 21-28 days, in 69% every 10 days and in 22% every 7 days. No
different control of GH/IGF-I hypersecretion was evidenced between
patients previously treated or not by Tx and/or Rx. Patients with the
lowest basal hormonal levels and those over 55 years showed greater
responsiveness (both p<0.05). The maintenance of LAN schedule up to 18
months determined a further suppression (p=0.04 for IGF-I). A reduction
of tumor size was shown in 60% of evaluated patients (6/10). HbA1c
slightly increased in 42% of patients and gallstones were observed in
16%. LAN is a very effective tool in the treatment of acromegaly: its
chronic administration normalizes GH/IGF-I levels in most patients,
shrinks the tumor in a high percentage of patients and seems to control
hormonal hypersecretion as primary treatment as well as neurosurgery.
25
UI - 21297818
AU - Jouanneau E; Ducluzeau PH; Tilikete C; Borson-Chazot F; Trouillas J;
TI -
Perrin G
[Should silent corticotroph-cell adenoma be classified as a
non-functional pituitary adenoma?]
SO - Neurochirurgie 2001 May;47(2-3 Pt 1):128-32
AD - Service de Neurochirurgie A, Universite Claude-Bernard-Lyon 1, Lyon,
France.
A 45-year-old man underwent surgery for a silent corticotroph-cell
pituitary adenoma which developed in 9 months. The tumor was termed
silent because it exhibited increased corticotropic secretion without
clinical signs of hypercorticism. This classes it as a non-functional
adenoma. The non-functional group includes different types of adenomas
such as gonadotroph and other silent thyreotroph and somatotroph
adenomas with variable proliferative potential. Silent corticotroph-cell
adenoma is considered as an aggressive tumor. In contrast, gonadotroph
adenomas usually grow slowly and postoperative tumor remnants can remain
stable for years. Because of this variability in tumor growth, the
therapeutic decision is difficult if there is a postoperative remnant.
No precise guidelines can be established. We suggest that non-functional
pituitary adenomas should be considered separately, according to the
histological type. This classification is essential for improving
knowledge and specifying indications for radiotherapy.
26
UI - 21469267
AU - Huang MC; Lee LS; Ho DM; Cheng H; Chung WY; Huang CI; Hsiao CY; Pan DH
TI -
A metastatic pituitary carcinoid tumor successfully treated with gamma
knife radiosurgery.
SO - Zhonghua Yi Xue Za Zhi (Taipei) 2001 Jul;64(7):414-8
AD - Department of Neurosurgery, Neurological Institute, Taipei Veterans
General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan.
muhuang@vghtpe.gov.tw
Intracranial metastasis occurs in a certain number of patients with
carcinoid tumor. However, carcinoid tumor with metastasis to the
pituitary gland is extremely rare. Up to the present, no effective
treatment for either a metastatic intracranial carcinoid tumor or a
metastatic pituitary lesion of any origin has been documented. We have
treated a case of metastatic carcinoid tumor of the pituitary gland with
transsphenoidal tumor resection followed by gamma knife radiosurgery. A
59-year-old man presented with headache and left oculomotor palsy. He
was treated at the same hospital for bronchial atypical carcinoid tumor
one and a half years ago. Magnetic resonance image of the brain showed a
pituitary tumor. There were no signs of recurrent or metastatic lesion
elsewhere despite thorough investigation. Transsphenoidal approach for
removal of tumor was done and the pathology turned out to be a
metastatic carcinoid tumor. Subsequent gamma knife radiosurgery was
given for residual tumor. The oculomotor palsy improved after
radiosurgery. No neurological deficit occurred. Follow-up CT scan of the
brain showed complete resolution of the tumor. We concluded that gamma
knife radiosurgery could be used to treat a metastatic intracranial
carcinoid tumor. It can also be used to treat a metastatic lesion of the
pituitary gland without causing neurological deficit.
27
UI - 21475017
AU - Yoon JW; Jo SK; Cha DR; Cho WY; Kim HK
TI -
A case of Rathke's Cleft Cyst inflammation presenting with diabetes
insipidus.
SO - Korean J Intern Med 2001 Jun;16(2):132-5
AD - Division of Nephrology, Department of Internal Medicine, College of
Medicine, Hallym University, Chunchon, Korea.
Rathke's Cleft Cyst (RCC), which is located at the intrasellar region,
is considered to be the distended remnants of Rathke's pouch, an
invagination of the stomodeum. Lined with columnar or cuboidal
epithelium of ectodermal origin, RCC usually contains mucoid material
and it is found in 13-22% of normal pituitary glands. The cyst rarely
leads to the development of symptoms but, when it does, the most common
presenting symptoms are headache, visual impairment, hypopituitarism and
hypothalamic dysfunction. However, in some cases it presents symptoms of
diabetes insipidus, decreased libido and impotence. Recently we
experienced a case of RCC inflammation presenting with diabetes
insipidus and treated with transsphenoidal surgery. To our knowledge,
this is the first report of RCC presenting with symptoms of diabetes
insipidus in Korea.
28
UI - 21295724
AU - Imaki T; Tsushima T; Hizuka N; Odagiri E; Murata Y; Suda T; Takano K
TI -
Postoperative plasma cortisol levels predict long-term outcome in
patients with Cushing's disease and determine which patients should be
treated with pituitary irradiation after surgery.
SO - Endocr J 2001 Feb;48(1):53-62
AD - Department of Medicine, Institute of Clinical Endocrinology, Tokyo
Women's Medical University, Japan.
Transsphenoidal surgery is the treatment of choice for ACTH-producing
pituitary adenoma (Cushing's disease) and pituitary irradiation is
widely considered the most appropriate treatment for patients with
Cushing's disease for whom transsphenoidal surgery has been
unsuccessful. We studied 49 consecutive patients who underwent
transsphenoidal surgery for the treatment of Cushing's disease at Tokyo
Women's Medical University from 1977-1997 with a mean follow-up duration
of 87.6 months (range, 24-253 months). We examined the relationship
between postoperative endocrinological data, assessed between 3 and 8
weeks after surgery, and long-term outcome and efficacy of pituitary
irradiation after surgery. Long-term remission was defined as the
regression of the symptom and signs of Cushing's syndrome, and
restoration of normal levels of plasma ACTH, cortisol and urinary free
cortisol, together with adequate suppression of morning plasma cortisol
levels following the administration of low dose (1 mg) of dexamethasone.
Thirty patients had no additional treatment after pituitary surgery.
Only 1 of 25 patients (4%) whose postoperative plasma cortisol level was
less than 2 microg/dl developed recurrent disease whereas 3 out of 5
patients with postoperative plasma cortisol levels higher than 2
microg/dl relapsed. Postoperative external pituitary radiation was used
to treat the remaining 19 patients. Four patients who received radiation
therapy had a low or undetectable postoperative plasma cortisol level
(<2 microg/dl, 56 nmol/L) and all of these patients developed
hypopituitarism whereas 5 patients with subnormal plasma cortisol levels
(2.0-10.0 microg/dl) remained in remission. Among 10 patients with
persistent disease after surgery, 6 entered remission 6-47 months after
irradiation but one of them subsequently relapsed after 108 months.
These results suggest that 1) additional therapy should be avoided in
patients with a postoperative plasma cortisol less than 2 microg/dl
because relapse is very rare and radiotherapy will frequently induce
hypopituitarism, 2) patients with a subnormal cortisol level following
surgery should be treated with pituitary irradiation, because the
relapse rate is reportedly high and radiotherapy is effective in
preventing relapse, 3) radiotherapy in patients with persistent disease
after surgery is effective only in 50% (5/10) of the patients.
29
UI - 21300174
AU - Vidal S; Horvath E; Kovacs K; Scheithauer BW; Lloyd RV; Kontogeorgos G
TI -
Ultrastructural features of apoptosis in human pituitary adenomas.
SO - Ultrastruct Pathol 2001 Mar-Apr;25(2):85-92
AD - Department of Laboratory Medicine, St. Michael's Hospital, University of
Toronto, Canada.
Although several recent studies deal with various molecular aspects of
apoptosis, or programmed cell death, very little information is
available on the ultrastructural changes associated with apoptosis in
the adenohypophysis and its role in the regulation of pituitary adenoma
growth and progression. This paper describes the distinct
ultrastructural sequences that develop during the various phases of the
apoptotic process. The study is based on the ultrastructural
investigation of more than 8,000 surgically removed pituitary biopsies,
which were examined by histology and immunocytochemistry for diagnostic
purposes. No apoptosis was found in normal adenohypophysis and it is
also a rare event in pituitary adenomas. When present, adenomatous
adenohypophysial cells exhibit common and characteristic apoptotic
changes. The ultrastructural alterations of membraneous organelles
associated with apoptosis are similar to those previously reported in
other tissues. It is noteworthy that apoptosis is clearly
distinguishable from the ubiquitous dark cells denoting the common way
of cell death. The findings suggest that apoptosis in pituitary adenomas
is not a random event. Practically every specimen containing multiple
apoptotic cells represents corticotroph adenoma. Occasional examples
occur in lactotroph or gonadotroph adenomas. Although electron
microscopic specimens are admittedly small, the large number of
investigated cases gives credence to the observations.
30
UI - 21423771
AU - Ho DM; Hsu CY; Ting LT; Chiang H
TI -
Plurihormonal pituitary adenomas: immunostaining of all pituitary
hormones is mandatory for correct classification.
SO - Histopathology 2001 Sep;39(3):310-9
AD - Department of Pathology and Laboratory Medicine, Veterans General
Hospital-Taipei, Taiwan, Republic of China. mtho@vghtpe.gov.tw
AIMS: We studied the clinicopathological characteristics of
plurihormonal pituitary adenomas. METHODS AND RESULTS: The study
material included 167 plurihormonal adenomas, which consisted of 31% of
the surgically removed pituitary adenomas that we collected during a
12-year period. The mean age of patients with plurihormonal adenoma was
45.7 years (range 13-75 years). There were 86 men and 81 women. All
tumours were fully classified by immunohistochemical staining for seven
pituitary hormones or subunits. Thirty immunohistochemical subtypes of
plurihormonal adenomas were recognized. Hormonal symptoms were present
in 70% of patients, while serum hormonal levels were increased in 89% of
patients. Most patients had symptoms related to only one of the hormones
and only 7% of patients had symptoms related to two hormones. The most
common hormonal symptom was acromegaly (50%); symptoms related to
hyperprolactinaemia ranked second (20%). Double immunostaining of all
the possible combinations of the hormones was performed in 30 selected
tumours, and they all showed mixtures of hormones in individual adenoma
cells in any hormonal combinations studied. The latter finding supported
the view that plurihormonal adenomas are monomorphous adenomas.
CONCLUSIONS: Plurihormonal adenomas are common pituitary adenomas.
Immunohistochemical staining of all pituitary hormones is mandatory for
correct classification.
31
UI - 21450638
AU - Gao R; Isoda H; Tanaka T; Inagawa S; Takeda H; Takehara Y; Isogai S;
TI -
Sakahara H
Dynamic gadolinium-enhanced MR imaging of pituitary adenomas: usefulness
of sequential sagittal and coronal plane images.
SO - Eur J Radiol 2001 Sep;39(3):139-46
AD - Department of Radiology, Hamamatsu University School of Medicine, 1-20-1
Handayama, Hamamatsu 431-3192, Japan.
Dynamic magnetic resonance (MR) imaging for pituitary adenomas is
usually performed in a coronal direction; however, small lesions between
slices, or lesions located at the anterior or posterior aspect of the
pituitary gland might be overlooked on MR images in only the coronal
direction. The purpose of our study was to evaluate whether consecutive
dynamic MR images in the coronal and sagittal planes improve detection
of pituitary adenomas. Eighteen patients with pituitary microadenomas
and nine with healthy pituitary glands were included in this study. MR
images were performed with 1.5 T superconductive units and
commercially-available head coils. After a 5 ml gadolinium contrast
injection, eight serial dynamic sagittal images were obtained. Within 3
or 6 min, this was followed by a 10-15 ml gadolinium injection and
acquisition of eight serial dynamic coronal images. Dynamic MR images
and conventional noncontrast- and contrast-enhanced sagittal and coronal
T1-weighted images were evaluated independently in a blind fashion by
two neuroradiologists regarding the depiction of pituitary
microadenomas. The sensitivities of dynamic enhanced MR imaging in the
detection of microadenomas were 61.1% in sagittal direction, 72.2% in
coronal direction respectively, and were superior to those of
conventional noncontrast- and contrast-enhanced T1-weighted imaging
(22.2-50%). The sensitivity of a combination of sagittal and coronal
dynamic enhance
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