Prognostic factors of biochemical remission after transsphenoidal surgery for acromegaly: a structured review
ConclusionSurgical outcome prognostication systems could be further generated by machine learning algorithms in order to support development and implementation of personalized care in patients with acromegaly. (Source: Pituitary)
Source: Pituitary - June 29, 2020 Category: Endocrinology Source Type: research

Correction to: Quality of care evaluation in non-functioning pituitary adenoma with chiasm compression: visual outcomes and timing of intervention clinical recommendations based on a systematic literature review and cohort study
The original version of the article unfortunately contained an error in Figure 2. The term ‘Refer within 3 days’ should read ‘Refer as soon as possible’. Corrected version of Figure 2 is given below. (Source: Pituitary)
Source: Pituitary - June 21, 2020 Category: Endocrinology Source Type: research

The suprasellar volume of nonfunctioning pituitary adenomas: a useful tool for predicting visual field deficits
ConclusionThe SSV may represent an accurate method in routinely clinical practice for predicting VF deficit in patients affected by NFPA. (Source: Pituitary)
Source: Pituitary - June 19, 2020 Category: Endocrinology Source Type: research

Pituitary society guidance: pituitary disease management and patient care recommendations during the COVID-19 pandemic —an international perspective
AbstractSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the viral strain that has caused the coronavirus disease 2019 (COVID-19) pandemic, has presented healthcare systems around the world with an unprecedented challenge. In locations with significant rates of viral transmission, social distancing measures and enforced ‘lockdowns’ are the new ‘norm’ as governments try to prevent healthcare services from being overwhelmed. However, with these measures have come important challenges for the delivery of existing services for other diseases and conditions. The clinical care of patients wit...
Source: Pituitary - June 18, 2020 Category: Endocrinology Source Type: research

Is pasireotide-induced diabetes mellitus predictable? A pilot study on the effect of a single dose of pasireotide on glucose homeostasis
AbstractIntroductionPasireotide (PAS) is an effective treatment for Cushing ’s disease (CD) but its use is burdened by an associated high incidence of diabetes mellitus (DM). The aim of this study was to examine the effect of a single subcutaneous injection of PAS on glucose metabolism in CD, and to identify predictors of DM onset.MethodsFifteen patients with CD (13 females, 2 males; median age 43 years [IQR 34 –50]) were submitted to an acute PAS test (600 µg s.c.), measuring glucose, insulin, C-peptide, GIP, glucagon, GLP-1, ACTH, and cortisol at the baseline and every 30 min for 2 h. Then they were tre...
Source: Pituitary - June 10, 2020 Category: Endocrinology Source Type: research

Ectopic GH-secreting pituitary adenoma of the clivus: systematic literature review of a challenging tumour
ConclusionAlthough primary clival GHEPA are exceedingly rare, even if likely under-reported in literature, they should be considered in the differential diagnosis of clival tumours because of their specific management. Surgery represents the first-line treatment option, while medical and radiation therapies can be adopted as neo-adjuvant, adjuvant or primary treatments according to tumour and patient characteristics. (Source: Pituitary)
Source: Pituitary - June 5, 2020 Category: Endocrinology Source Type: research

Feasibility of machine learning based predictive modelling of postoperative hyponatremia after pituitary surgery
ConclusionOur trained ML-model was able to learn the complex risk factor interactions and showed a high discriminative capability on unseen patient data. In conclusion, ML-methods can predict postoperative hyponatremia and thus potentially reduce morbidity and improve patient safety. (Source: Pituitary)
Source: Pituitary - June 3, 2020 Category: Endocrinology Source Type: research

GH deficiency in cancer survivors in the transition age: diagnosis and therapy
ConclusionsEndocrine dysfunction among CCSs has a high prevalence in the transition age and increase with time. Many endocrine disorders, including GHD, are often not diagnosed or under-diagnosed, probably due to the lack of specialized centers for the long-term follow-up. Therefore, it is crucial that transition specialized clinics should be increased in terms of number and specific skills in order to manage endocrine disorders in adolescence, a delicate and complex period of life. A multidisciplinary approach, also including psychological counseling, is essential in the follow-up and management of these patients in order...
Source: Pituitary - June 3, 2020 Category: Endocrinology Source Type: research

The implication of giant tumor size on surgical resection, oncological, and functional outcomes in craniopharyngioma
ConclusionTumor size should be considered as an important predictor of the  postoperative functional outcome. Although the rate of GTR is less than that of small tumors, the recurrence rate, progression-free survival, and overall survival of the patients with giant tumor are comparable to non-giant tumors. (Source: Pituitary)
Source: Pituitary - May 25, 2020 Category: Endocrinology Source Type: research

High accuracy of bilateral and simultaneous petrosal sinus sampling with desmopressin for the differential diagnosis of pediatric ACTH-dependent Cushing ’s syndrome
ConclusionIn a series of children and adolescents with ADCS, BIPSS was safe and highly accurate in defining the central to peripheral ACTH gradient using desmopressin as secretagogue. Nevertheless, there was a limited value of the ACTH-gradient between the petrosal sinuses for the tumor location. (Source: Pituitary)
Source: Pituitary - May 25, 2020 Category: Endocrinology Source Type: research

Preconception use of pegvisomant alone or as combination therapy for acromegaly: a case series and review of the literature
ConclusionPreconception therapy with PEG resulted in successful fertility outcomes. Although few cases have been reported, these four pregnancies with PEG use prior to or at the time of conception were not associated with significant maternal or fetal complications. More studies are needed to establish the safety of PEG preconception. (Source: Pituitary)
Source: Pituitary - May 25, 2020 Category: Endocrinology Source Type: research

ACTH increment post total bilateral adrenalectomy for Cushing ’s disease: a consistent biosignature for predicting Nelson’s syndrome
ConclusionPatients who developed NS had higher rebound rise of ACTH following TBA and a more severe disease phenotype at baseline. Consistent ACTH increment can be used as a marker for predicting the development of NS. (Source: Pituitary)
Source: Pituitary - May 25, 2020 Category: Endocrinology Source Type: research

Motivation for and adherence to growth hormone replacement therapy in adults with hypopituitarism: the patients ‘ perspective
ConclusionsAdherence to GH-Rx was high for those patients on therapy. Instead of focusing on improving adherence in those adults already on GH-Rx, efforts should be undertaken to ally fear of side effects and provide education on positive treatment effects for those eligible but not receiving therapy. (Source: Pituitary)
Source: Pituitary - May 21, 2020 Category: Endocrinology Source Type: research

Trends in endoscopic and microscopic transsphenoidal surgery: a survey of the international society of pituitary surgeons between 2010 and 2020
ConclusionEndoscopic TSS is now the clearly preferred method for surgery amongst a cohort of higher-volume academic neurosurgeons. This trend is likely to continue, and this provides guidelines for future training. (Source: Pituitary)
Source: Pituitary - May 21, 2020 Category: Endocrinology Source Type: research

Quality of care evaluation in non-functioning pituitary adenoma with chiasm compression: visual outcomes and timing of intervention clinical recommendations based on a systematic literature review and cohort study
AbstractPurposeSurgery in patients with non-functioning pituitary macroadenomas (NFMA) is effective in ameliorating visual function. The urgency for decompression, and preferred timing of surgery related to the preoperative severity of dysfunction is unknown.MethodsSystematic review for evidence to provide clinical guidance for timing of surgical decompression of the optic chiasm, and a cohort study of 30 NFMA patients, in whom mean deviation (MD), and severity of visual dysfunction was assessed.ResultsSystematic review 44 studies were included with a total of 4789 patients. Postoperatively, visual field defects improved i...
Source: Pituitary - May 18, 2020 Category: Endocrinology Source Type: research

Metabolic syndrome and its components in adult hypopituitary patients
AbstractPurposeTo evaluate the prevalence of metabolic syndrome (MetS) and its components in adult hypopituitary patients.Patients and methodsRetrospective, cross-sectional analysis of a cohort of hypopituitary adult patients followed in a single reference center for pituitary diseases. MetS was defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Patients with 18 years or older, presenting two or more anterior pituitary deficiencies associated or not with diabetes insipidus (DI), were included, while patients with hypopituitarism due to Acromegaly or Cushing ’s dis...
Source: Pituitary - May 16, 2020 Category: Endocrinology Source Type: research

Hypopituitarism in five PROP1 mutation siblings: long-lasting natural course and the effects of growth hormone replacement introduction in middle adulthood
This report provides important experience regarding hormonal replacement, particularly rhGH treatment, in adults with long-term untreated CH. Beneficial effect of such therapy are widely acknowledged, yet these subjects could be susceptible to certa in risks of hormonal treatment initiated in adulthood. Careful and continual clinical follow-up is thus strongly advised. (Source: Pituitary)
Source: Pituitary - May 15, 2020 Category: Endocrinology Source Type: research

Axis-specific analysis and predictors of endocrine recovery and deficits for non-functioning pituitary adenomas undergoing endoscopic transsphenoidal surgery
ConclusionsDynamic alterations in pituitary hormones were observed in a proportion of patients following ETSS in NFPA patients. Postoperative endocrine vulnerability, recovery, and factors that predicted recovery or loss of endocrine function depended on the hormonal system, necessitating an axis-specific surveillance strategy postoperatively. (Source: Pituitary)
Source: Pituitary - May 9, 2020 Category: Endocrinology Source Type: research

Pituitary germinomas: a multi-institutional study analyzing patient demographics and management patterns
ConclusionsThere exist significant differences in the management of pediatric and adult populations with pituitary germinomas. The low incidence of these tumors makes them challenging to study, but also highlights the importance of national cancer registries in amassing sufficient patient data from which to draw evidence-based conclusions. (Source: Pituitary)
Source: Pituitary - May 9, 2020 Category: Endocrinology Source Type: research

Suprasellar pituitary adenomas: a 10-year experience in a single tertiary medical center and a literature review
ConclusionsSPAs could be defined as pituitary adenomas completely or partially located in the suprasellar region. There were both similarities and differences among the different anatomic subtypes of SPA. For patients who were suspected of having SPAs, visual field tests, pituitary hormone evaluation and MRI were necessary. Because imaging examination is not a reliable method, surgery is the only way to confirm the tumor origin. Extended endoscopic TSS might be a safe and efficient approach to remove these tumors, but more studies are needed to verify this conclusion. For type II SPA, the pituitary stalk should be carefull...
Source: Pituitary - May 6, 2020 Category: Endocrinology Source Type: research

Do nothing but observe microprolactinomas: when and how to replace sex hormones?
AbstractHyperprolactinemia is associated with suppression of the hypothalamic- pituitary –gonadal axis and consequent hypogonadism, manifesting loss of libido, infertility and osteoporosis long-term in both male and female patients, with associated menstrual irregularities, amenorrhea and galactorrhea in women and erectile dysfunction in men. The primary goals of therapy in patients h arboring prolactinoma are control of tumor size and normalization of serum PRL, with restoration of gonadal and sexual function and fertility. Clinical manifestations of hypogonadism have variable consequences depending on the age and s...
Source: Pituitary - April 9, 2020 Category: Endocrinology Source Type: research

Long-course temozolomide in aggressive pituitary adenoma: real-life experience in two tertiary care centers and review of the literature
ConclusionsTMZ may be useful and well-tolerated in APAs and PCs as a long-term therapy. PR appears within the first cycles with no escape throughout the treatment; most patients achieve SD. We suggest extended protocols particularly in responsive ACTH+   PAs and PCs, when further therapies may be unsuccessful. (Source: Pituitary)
Source: Pituitary - March 30, 2020 Category: Endocrinology Source Type: research

An evaluation of the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ) in adult patients with acromegaly, including correlations with other patient-reported outcome measures: data from two large multicenter international studies
ConclusionsThe Acro-TSQ is a brief, yet comprehensive tool to monitor important outcomes associated with injectable acromegaly SSA treatments. Its content reflects both disease and treatment burden as well as patient satisfaction, and its relevant for use in clinical studies. (Source: Pituitary)
Source: Pituitary - March 27, 2020 Category: Endocrinology Source Type: research

Hyperprolactinemia and bone
AbstractProlactin (PRL) has direct and indirect effects on bone metabolism. Experimental studies showed that in the presence of high PRL levels bone resorption was increased as well as bone formation was suppressed. Increased PRL levels in humans caused a reduction in sex hormone levels which turn may have detrimental effects on bone. Patients with hyperprolactinemia did have often decreased bone mineral density as well as an increased risk of fractures. Since PRL control may be relevant to bone health it is a clinical open issue the inclusion of skeletal health in future guidelines as indication to proactive screening, pr...
Source: Pituitary - March 26, 2020 Category: Endocrinology Source Type: research

The evaluation of the tendon and muscle changes of lower extremity in patients with acromegaly
AbstractPurposeAlthough it is well known that acromegaly causes enlargement in the extremities, studies investigating the effects of acromegaly on tendons, muscles and soft tissue are limited. The aims of our study were to investigate tendons, the presence of enthesitis, soft tissue, muscle groups in terms of thickness and pennation angle (PA) which is an indicator of microstructure and strength of the muscle, of the lower extremities.MethodsThirty-nine patients with acromegaly and thirty-nine healthy control subjects similar for age, sex and body mass index were enrolled. Lower extremity tendons, skin, muscle groups were ...
Source: Pituitary - March 21, 2020 Category: Endocrinology Source Type: research

Pituitary metastases: presentation and outcomes from a pituitary center over the last decade
ConclusionsIn our contemporary series, clinical presentation of PM has evolved; we found increased prevalence of anterior hypopituitarism, decreased rates of DI and longer survival compared with older literature. Increased availability of diagnostic imaging, improvements in screening and recognition of pituitary disease and longer survival of patients with metastatic cancer may be contributing factors. (Source: Pituitary)
Source: Pituitary - March 18, 2020 Category: Endocrinology Source Type: research

Optimizing MR imaging for intraoperative image guidance in sellar pathologies
ConclusionOur data showed that VIBE sequences obtain the highest degree of consensus with intraoperative findings of invasiveness and position of the normal pituitary gland. VIBE sequences, due to their high spatial resolution and at the same time fast image acquisition could provide improved imaging for neuronavigation. (Source: Pituitary)
Source: Pituitary - March 13, 2020 Category: Endocrinology Source Type: research

Cardiovascular effects of growth hormone (GH) treatment on GH-deficient adults: a meta-analysis update
ConclusionsAs assessed by echocardiography, GH administration may improve the general vital signs and life quality of AGHD patients, based on the positive effect on BHR and negative effects on DBP and VE/VCO2 slope. Also, GH treatment would influence the structure of heart with positive effects on LVIS, LVPW and negative effect on LVEDV, which together with the increase of EF and decrease of NT-BNP, then resulting in improving the systolic function of AGHD patients. (Source: Pituitary)
Source: Pituitary - March 12, 2020 Category: Endocrinology Source Type: research

Multi-syphilitic gummas in pituitary and cerebellopontine angle in a patient
ConclusionsSyphilitic gummas in pituitary and CPA are similar to benign or malignant brain tumors, easily leading to misdiagnosis. Gumma should be considered in differential diagnosis when a patient has unexplained nervous system symptoms or signs and imaging findings suggest intracranial mass in syphilis seropositive patients. (Source: Pituitary)
Source: Pituitary - March 10, 2020 Category: Endocrinology Source Type: research

Shall we be less aggressive in pituitary surgery in the elderly?
(Source: Pituitary)
Source: Pituitary - February 18, 2020 Category: Endocrinology Source Type: research

A novel diagnostic method for pituitary adenoma based on magnetic resonance imaging using a convolutional neural network
ConclusionThe CAD system could accurately diagnose patients with pituitary tumors based on MR images. Further, we will improve this CAD system by augmenting the amount of dataset and evaluate its performance by external dataset. (Source: Pituitary)
Source: Pituitary - February 15, 2020 Category: Endocrinology Source Type: research

Growth hormone therapy in adults with growth hormone deficiency: a critical assessment of the literature
ConclusionsIn the setting of inconsistent data on the benefits of GH therapy, treatment of AO-GHD remains an individualized decision. There is a need for more randomized, placebo-controlled studies to evaluate the long-term outcomes of GH therapy in adults with hypopituitarism. (Source: Pituitary)
Source: Pituitary - February 14, 2020 Category: Endocrinology Source Type: research

Expression patterns of ER α66 and its novel variant isoform ERα36 in lactotroph pituitary adenomas and associations with clinicopathological characteristics
ConclusionThe decreasing trends of ER α36 and ERα66 expression from normal pituitaries to tumors are associated with aggressive clinical behavior. (Source: Pituitary)
Source: Pituitary - February 5, 2020 Category: Endocrinology Source Type: research

Effects of octreotide on autophagy markers and cell viability markers related to metabolic activity in rat pituitary tumor cells
ConclusionsWe provided evidence that octreotide can affect autophagy in pituitary tumor cells. The observed effects of octreotide were not related to a decrease of cellular metabolic activity. Finally, the induction of autophagy was either short-lived or overshadowed by other factors in the long term and this limit does not help clarifying their real impact on the pharmacological activity of somatostatin analogs. (Source: Pituitary)
Source: Pituitary - January 29, 2020 Category: Endocrinology Source Type: research

The tale in evolution: clarity, consistency and consultation, not contradiction and confusion
(Source: Pituitary)
Source: Pituitary - January 7, 2020 Category: Endocrinology Source Type: research

Machine learning applications in imaging analysis for patients with pituitary tumors: a review of the current literature and future directions
ConclusionThrough our concise evaluation and comparison of the studies using the concepts presented, we highlight future directions so that potential ML applications using different imaging modalities can be developed to benefit the clinical care of pituitary tumor patients. (Source: Pituitary)
Source: Pituitary - January 6, 2020 Category: Endocrinology Source Type: research

Diagnosis and management of prolactinomas: current challenges
(Source: Pituitary)
Source: Pituitary - January 3, 2020 Category: Endocrinology Source Type: research

MRI texture analysis in acromegaly and its role in predicting response to somatostatin receptor ligands
ConclusionOur data suggest that MRI texture analysis can distinguish NFPAs from somatotroph macroadenomas with good diagnostic accuracy and can predict normalization of IGF-I with SRL therapy. (Source: Pituitary)
Source: Pituitary - January 2, 2020 Category: Endocrinology Source Type: research

Dysregulation of the pituitary gland axes: an acute marker for a chronic process?
(Source: Pituitary)
Source: Pituitary - January 1, 2020 Category: Endocrinology Source Type: research

Predictive factors for responses to primary medical treatment with lanreotide autogel 120  mg in acromegaly: post hoc analyses from the PRIMARYS study
AbstractPurposePRIMARYS (NCT00690898) was a 48-week, open-label, phase 3b study, evaluating treatment with the somatostatin receptor ligand lanreotide autogel (stable dose: 120  mg/28 days) in treatment-naïve patients with growth hormone (GH)-secreting pituitary macroadenoma. This post hoc analysis aimed to evaluate factors predictive of long-term responses.MethodsPotential predictive factors evaluated were: sex, age, and body mass index at baseline; and GH, insulin-like growth factor-1 (IGF-1), and tumor volume (TV) at baseline and week 12, using univariate regression analyses. Treatment responses were defi...
Source: Pituitary - December 26, 2019 Category: Endocrinology Source Type: research

Pasireotide treatment significantly reduces tumor volume in patients with Cushing ’s disease: results from a Phase 3 study
ConclusionsMeasurable decreases in pituitary tumor volume were observed in a large proportion of patients with CD and measurable tumor volume who were enrolled in the trial and treated with subcutaneous pasireotide; this decrease was not correlated with UFC control.ClinicalTrials.gov identifierNCT00434148. (Source: Pituitary)
Source: Pituitary - December 24, 2019 Category: Endocrinology Source Type: research

Biochemical diagnosis in prolactinomas: some caveats
AbstractProlactinomas are the most frequently seen pituitary adenomas in clinical practice. A correct biochemical diagnosis of hyperprolactinemia is a prerequisite for further investigation but may be hampered by analytical difficulties as well as a large number of potentially overlapping conditions associated with increased prolactin levels. Suspicion should rise in patients whose symptoms and biochemical results do not match. Assay problems, macroprolactinemia, and high-dose hook effect are discussed as possible reasons for false positive or false negative prolactin levels. Physiological and pathological causes of hyperp...
Source: Pituitary - December 23, 2019 Category: Endocrinology Source Type: research

Acromegaly in the setting of Tatton-Brown-Rahman Syndrome
ConclusionOur case suggests that TBRS might be associated with pituitary adenoma and a broader spectrum of tumors than previously thought, making long-term follow up of these patients crucial to identify tumors early, and to elucidate the clinical spectrum of the disorder for optimization of management. (Source: Pituitary)
Source: Pituitary - December 19, 2019 Category: Endocrinology Source Type: research

Surgery for prolactinomas: a better choice?
ConclusionGiven excellent results of TSS and concerns about medical treatment, the scale of indications for TSS as an alternative to DAs has increased. The patient ’s wishes concerning a chance at a cure with TSS instead of a long-term treatment with DAs has become an important and accepted indication. With DA medication and TSS, two effective treatment modalities for prolactinomas are available that can be used in a complementary fashion. (Source: Pituitary)
Source: Pituitary - December 18, 2019 Category: Endocrinology Source Type: research

Long-term follow-up for ectopic ACTH-secreting pituitary adenoma in a single tertiary medical center and a literature review
Conclusions In patients with negative intrasellar findings, the uncommon disease of EAPA should be considered. Due to the endocrine similarity between intrasellar pituitary corticotrophin adenoma and EAPA, the preoperative identification of EAPA depends on a careful review of the imaging examinations. Locations such as the cavernous sinus, sphenoid sinus and suprasellar region should be considered first. Tumor resection is recommended when the diagnosis is confirmed. (Source: Pituitary)
Source: Pituitary - December 14, 2019 Category: Endocrinology Source Type: research

Semen quality in hypogonadal acromegalic patients
ConclusionsDespite severe hypoandrogenism acromegalic patients had semen quality similar to healthy controls based on determination of the number of progressively motile spermatozoa. By contrast non-acromegalic pituitary patients had reduced sperm motility. Our data do not support reduced semen quality in acromegaly. (Source: Pituitary)
Source: Pituitary - December 13, 2019 Category: Endocrinology Source Type: research

Pituitary neuroendocrine tumors (PitNETs): nomenclature evolution, not clinical revolution
(Source: Pituitary)
Source: Pituitary - December 13, 2019 Category: Endocrinology Source Type: research

Diagnosis, treatment and follow-up of patients with acromegaly in a clinical practice setting in Spain: the ACROPRAXIS program Delphi survey
AbstractAimThe ACROPRAXIS program aims to describe the management of acromegaly in Spain and provide guidance.MethodsNinety-three endocrinologists were organized into 13 panels to discuss the practical issues in managing acromegaly. Based on the key learnings, an online Delphi survey with 62 statements was performed, so those statements achieving consensus could be used as guidance. Statements were rated on a 9-point scale (9, full agreement; consensus  >  66.6% of response in the same tertile).ResultsNinety-two endocrinologists (98.8%) answered two rounds of the survey (mean age 47.6  years; 59.8% wo...
Source: Pituitary - December 10, 2019 Category: Endocrinology Source Type: research

Observed discordance between outcomes reported by acromegaly patients and their treating endocrinology medical provider
ConclusionsMedical providers were aware that their patients who were receiving a stable dose of SRL regularly experienced acromegaly symptoms. Addressing discordance in patient- and medical provider-reported frequency and severity of acromegaly symptoms and injection site reactions by facilitating better communication may improve care of acromegaly patients. (Source: Pituitary)
Source: Pituitary - December 5, 2019 Category: Endocrinology Source Type: research

Prolactinomas in males: any differences?
ConclusionsCompared to other pituitary adenomas, secreting and non-secreting, where pituitary surgery is the recommended first-line treatment, men with prolactinomas will usually respond to medical treatment with no need for any additional treatment. (Source: Pituitary)
Source: Pituitary - December 5, 2019 Category: Endocrinology Source Type: research