Intraoperative indocyanine green videoangiography for identification of pituitary adenomas using a microscopic transsphenoidal approach
Conclusion Our data show that intraoperative ICG VA can be a useful and easily applicable additional diagnostic tool for visualization of pituitary lesions using the microscopic approach. (Source: Pituitary)
Source: Pituitary - December 9, 2014 Category: Endocrinology Source Type: research

New oral anticoagulants and pituitary apoplexy
(Source: Pituitary)
Source: Pituitary - November 23, 2014 Category: Endocrinology Source Type: research

Clinical and biochemical characteristic features of metastatic cancer to the sella turcica: an analytical review
Conclusions Sellar metastasis should be suspected in patients presenting with sellar masses, abnormal eye motility and/or diabetes insipidus even those without known malignancy since pituitary metastasis can often be the first manifestation of cancer. (Source: Pituitary)
Source: Pituitary - November 6, 2014 Category: Endocrinology Source Type: research

Pasireotide monotherapy in Cushing’s disease: a single-centre experience with 5-year extension of phase III Trial
Conclusions Pasireotide therapy can provide normalization of UFC and of clinical symptoms and signs of CD during up to 5 years of follow-up. This study demonstrates the possible recuperation of normoglycemia after continued use of pasireotide and control of underlying hypercortisolemia. Longer-term monitoring for potential adverse events related to continued use of pasireotide is indicated. (Source: Pituitary)
Source: Pituitary - November 6, 2014 Category: Endocrinology Source Type: research

Prolactin levels in manganese-exposed male welders
Abstract Purpose Early studies on manganese (Mn) exposure have demonstrated that this transition metal affects dopamine neurotransmission. Dopamine serves as a tonic inhibitor of prolactin release in the anterior hypophysis. Our aim was to determine the relation between serum prolactin levels and manganese-exposure. Methods Whole blood was collected from 95 non-exposed control subjects and 179 manganese-exposed male welders. Whole blood manganese was analyzed by Inductively Coupled Plasma—Mass Spectrometer on Agilent 7700 (Agilent Technologi...
Source: Pituitary - November 6, 2014 Category: Endocrinology Source Type: research

Feasibility and outcome of re-irradiation in the treatment of multiply recurrent pituitary adenomas
Conclusions Re-irradiation is a feasible treatment option for local control in patients with recalcitrant pituitary adenomas, with acceptable rates of RION and TLN given the lack of options that may be available otherwise. Re-irradiation, however, did not control hormonal hypersecretion. (Source: Pituitary)
Source: Pituitary - November 6, 2014 Category: Endocrinology Source Type: research

Downregulation of Insulin-like growth factor binding protein 6 is associated with ACTH-secreting pituitary adenoma growth
Abstract Background Adrenocorticotrophic hormone (ACTH)-dependent Cushing’s syndrome, called Cushing disease, is caused by a corticotroph tumor of the pituitary gland. Insulin-like growth factor binding protein 6 (IGFBP6), which regulates insulin-like growth factor (IGF) activity and inhibits several IGF2-dependent cancer growths, plays a pivotal role in the tumorigenesis of malignancy, but its roles in ACTH-secreting pituitary adenomas remain unclear. Objective To investigate IGFBP6 expression in ACTH-secreting pituitary adenomas, and i...
Source: Pituitary - November 6, 2014 Category: Endocrinology Source Type: research

Impact of treatment satisfaction on quality of life of patients with acromegaly
Abstract Purpose To evaluate satisfaction of acromegalic subjects with their medical treatment and its contribution to their quality of life. Methods This cross-sectional study included a total of 159 medications used in 133 subjects with acromegaly (controlled n = 84 and uncontrolled n = 49, female/male: 81/52). Subjects were asked to complete questionnaires on symptoms of depression (BDI) and satisfaction with the medical therapy they received for acromegaly (TSQM). Acromegaly cases also completed Acromegaly Quality...
Source: Pituitary - November 6, 2014 Category: Endocrinology Source Type: research

Pituitary carcinoma with fourth ventricle metastasis: treatment by excision and Gamma-knife radiosurgery
In this report, the authors describe the case of a 23-year-old male who had undergone trans-sphenoidal surgery and radiotherapy for an invasive prolactinoma. Seven years later, he presented with a new 4th ventricle metastasis from the pituitary lesion, and it was diagnosed with a pituitary carcinoma. He underwent resection and Gamma-knife radiosurgery (GKRS). The tumor has been well controlled for over 3 years. To our knowledge, there have been no reports of the effects of GKRS in patients with pituitary carcinomas. GKRS might have considerable effects in the treatment of pituitary carcinomas. (Source: Pituitary)
Source: Pituitary - November 6, 2014 Category: Endocrinology Source Type: research

Peptide receptor radionuclide therapy for aggressive atypical pituitary adenoma/carcinoma: variable clinical response in preliminary evaluation
Conclusion We have found mixed results in our first 3 patients with stable disease achieved only in the patient with the more slowly progressive tumour. As only a limited number of centres offer Peptide receptor radionuclide therapy, a formal study with prospective data collection may be feasible and if carried out should include dosimetric evaluation of absorbed dose. (Source: Pituitary)
Source: Pituitary - November 6, 2014 Category: Endocrinology Source Type: research

Biochemical and quality of life responses to octreotide-LAR in acromegaly
This study was designed to determine AcroQoL score changes and concentrations of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), before and after treatment with octreotide-LAR (oct-LAR) in acromegaly. Methods Retrospective observational study of 28 acromegalic patients with a mean age of 45 years (range 28–64), evaluated over a 4-year period, before and during treatment with oct-LAR in clinical practice conditions. Results Baseline AcroQoL score (53 ± 15) improved after oct-LAR treatment (70&nbs...
Source: Pituitary - November 6, 2014 Category: Endocrinology Source Type: research

Tamoxifen as a therapeutic agent in acromegaly
Conclusion Tamoxifen might be useful in the treatment of patients with biochemically-mild active acromegaly, but longer term studies are warranted. (Source: Pituitary)
Source: Pituitary - November 6, 2014 Category: Endocrinology Source Type: research

A novel mutation in SOX3 polyalanine tract: a case of kabuki syndrome with combined pituitary hormone deficiency harboring double mutations in MLL2 and SOX3
Conclusion Our study provides additional evidence that deletion in PA tracts of SOX3 is associated with hypopituitarism. Female carriers of SOX3 PA tract deletions will show a broad phenotypic spectrum, ranging from clinically normal to CPHD. (Source: Pituitary)
Source: Pituitary - November 6, 2014 Category: Endocrinology Source Type: research

Adamantinomatous craniopharyngiomas express tumor stem cell markers in cells with activated Wnt signaling: further evidence for the existence of a tumor stem cell niche?
Conclusions Our results indicate tumor stem cell-like characteristics of β-catenin accumulating cell clusters in adaCP, which may represent a tumor stem cell niche and might contribute to tumor recurrence. The potential impact of these special cell groups in regard to future CP management, including postoperative follow-up and additional treatment remains to be explored. (Source: Pituitary)
Source: Pituitary - November 6, 2014 Category: Endocrinology Source Type: research

Update on radiation therapy in patients with Cushing’s disease
Conclusions Radiation therapy is an effective second line therapy in patients with Cushing’s disease. Ongoing refinements in delivery of radiation therapy are anticipated to lead to improved patient outcomes, but long-term follow-up data, including adequate control groups, are needed to fully investigate this possibility. (Source: Pituitary)
Source: Pituitary - October 31, 2014 Category: Endocrinology Source Type: research

Acknowledgement of reviewers 2013
(Source: Pituitary)
Source: Pituitary - October 28, 2014 Category: Endocrinology Source Type: research

Comparison of multifocal visual evoked potential, static automated perimetry, and optical coherence tomography findings for assessing visual pathways in patients with pituitary adenomas
Conclusions mfVEP, SAP, and OCT provided complementary information for detecting visual pathway abnormalities in patients with PAs. Good agreement was demonstrated between SAP and mfVEP and quantitative analysis of structure–function measurements revealed a moderate correlation. (Source: Pituitary)
Source: Pituitary - October 28, 2014 Category: Endocrinology Source Type: research

Clinical outcome and evidence of high rate post-surgical anterior hypopituitarism in a cohort of TSH-secreting adenoma patients: Might somatostatin analogs have a role as first-line therapy?
Conclusions Neurosurgery ultimately led to complete disease remission or to biochemical control in majority of patients, whereas resulting in a considerable percentage of post-operative complications (mainly hypopituitarism, 50 %). In the light of the optimal results unanimously reported for medical treatment with SSA, our experience suggests that a careful evaluation of risk/benefit ratio should be taken into consideration when directing the treatment approach in patients with TSHoma. (Source: Pituitary)
Source: Pituitary - October 19, 2014 Category: Endocrinology Source Type: research

Frequent development of combined pituitary hormone deficiency in patients initially diagnosed as isolated growth hormone deficiency: a long term follow-up of patients from a single center
Conclusion Our study indicated a high frequency of development of CPHD in patients initially diagnosed as IGHD at childhood. Half of our patients with IGHD developed the second hormone deficiency after 5 years of diagnosis, reinforcing the need for lifelong monitoring of pituitary function in these patients. (Source: Pituitary)
Source: Pituitary - October 15, 2014 Category: Endocrinology Source Type: research

Pituitary image: pituicytoma
Conclusions Pituicytomas are often difficult to distinguish from other hypothalamic or pituitary lesions. However, their identification would be preferable in a pre-operative setting in order to optimize the work-up and to initiate a proactive management of the expected complications. (Source: Pituitary)
Source: Pituitary - October 14, 2014 Category: Endocrinology Source Type: research

Sella turcica: an anatomical, endocrinological, and historical perspective
Abstract Introduction The sphenoid bone has a superior depression called the sella turcica, Latin for “Turkish saddle,” where the pituitary gland is found. The availability of modern radiological imaging techniques has replaced plain radiography of the sella turcica in the investigation of hypothalamo–pituitary abnormalities. However, the size of the sella turcica, and smaller sella turcica size in particular, may cause pituitary dysfunction because of the changes in the structure of pituitary gland or may be associated with some genetic or acquired endocrine disorders. The n...
Source: Pituitary - October 12, 2014 Category: Endocrinology Source Type: research

Discontinuation of somatostatin analogs while acromegaly is in long-term remission
Abstract Purpose We aimed to evaluate the disease activity of medically controlled patients with acromegaly after withdrawal of somatostatin receptor ligands (SRL). Methods Sixteen patients who were on a stable dose of SRL for more than 2 years and had at least 1 year of remission were included in the study. Five patients were on 10 mg, four were on 20 mg and three were on 30 mg of octreotide; whereas for lanreotide, one was on 60 mg, two were on 90 mg, and one was on 120 mg. All patients had received SRL with 28-d...
Source: Pituitary - October 10, 2014 Category: Endocrinology Source Type: research

Inhibition of heat shock protein 90 decreases ACTH production and cell proliferation in AtT-20 cells
Conclusions CCT018159 inhibits ACTH production and corticotroph tumor cell proliferation in vitro and in vivo. (Source: Pituitary)
Source: Pituitary - October 4, 2014 Category: Endocrinology Source Type: research

Growth hormone deficiency after mild combat-related traumatic brain injury
Abstract Objective Traumatic brain injury (TBI) has been recognized as a cause of growth hormone deficiency (GHD) in civilians. However, comparable data are sparse in veterans who incurred TBI during combat. Our objective was to determine the prevalence of GHD in veterans with a history of combat-related TBI, and its association with cognitive and psychosocial dysfunction. Design Single center prospective study. Patients Twenty male veterans with mild TBI incurred during combat 8–72 months prior to enrol...
Source: Pituitary - September 30, 2014 Category: Endocrinology Source Type: research

Preoperative somatostatin analogues versus direct transsphenoidal surgery for newly-diagnosed acromegaly patients: a systematic review and meta-analysis using the GRADE system
Abstract Whether the preoperative use of somatostatin analogues (SA) improves surgical outcomes in acromegaly is still a matter of debate. Objective We conducted a systematic review of randomized, controlled trials that compared the short-term outcomes of preoperative use of SA (Pre-SA) with direct TSS (No-SA) for the treatment of newly diagnosed acromegaly. Methods Embase, Pubmed, Lilacs, and Central Cochrane were used as our data sources. The primary outcomes were no need for any adjuvant treatment 3 months after surgery, based...
Source: Pituitary - September 27, 2014 Category: Endocrinology Source Type: research

Heart rate variability is reduced in acromegaly patients and improved by treatment with somatostatin analogues
Conclusion Cardiac autonomic functions and sympathovagal balance are altered in patients affected by acromegaly and could be ameliorated by SSAs therapy. HRV analysis allows an estimation of the autonomic sympathovagal balance and may be a useful clinical tool for the cardiac risk stratification in acromegalic patients. (Source: Pituitary)
Source: Pituitary - September 27, 2014 Category: Endocrinology Source Type: research

Endoscopic endonasal transsellar approach for laterally extended pituitary adenomas: volumetric analysis of cavernous sinus invasion
Conclusions The transsellar approach is adequate for removal of lateral tumor compartment in the majority of cases with laterally extended pituitary adenomas. The tumor compartments dorsal and ventral to the horizontal portion of the intracavernous carotid artery are amenable to the removal. But for removal of the tumor compartment lateral to the carotid siphon requires additional use of the parasellar approach. (Source: Pituitary)
Source: Pituitary - September 27, 2014 Category: Endocrinology Source Type: research

Effective time window in reducing pituitary adenoma size by gamma knife radiosurgery
Abstract Objectives Although the effectiveness of gamma knife radiosurgery (GKRS) in controlling the size of pituitary adenomas has been well demonstrated in many studies, the time period in which significant changes in tumor size occurs has been investigated in a limited fashion. It is important to determine the therapeutic window of GKRS in treating pituitary adenomas, i.e., the effective timeframe during which significant size reduction of these tumors occurs, so that alternative treatments such as further GKRS or microsurgery might be prescribed in a timely manner if clinically indicat...
Source: Pituitary - September 26, 2014 Category: Endocrinology Source Type: research

Adult mortality or morbidity is not increased in childhood-onset growth hormone deficient patients who received pediatric GH treatment: an analysis of the Hypopituitary Control and Complications Study (HypoCCS)
Conclusions The results indicate no increased risk of mortality or incidence of cancer, stroke, or MI in adult GH-deficient patients who had previously received pediatric GH treatment. (Source: Pituitary)
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

Surgical management of pituicytomas: case series and comprehensive literature review
Conclusions EETS-TP surgery is the preferred strategy for surgical removal of pituicytoma. EETS-TP and transsphenoidal approaches are associated with higher rates of gross total removal and lower rates of neurological complications than craniotomy. Gross total removal should be the intended goal of surgery. (Source: Pituitary)
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

Intracranial internal carotid artery changes in acromegaly: a quantitative magnetic resonance angiography study
Abstract Purpose Although cerebrovascular mortality is increased up to eightfold in acromegaly, intracranial internal carotid artery (ICA) changes have not been well investigated. This is a magnetic resonance angiography (MRA) quantitative cross-sectional study of ICA tortuosity, ectasia and intercarotid distance in acromegalic patients with subsequent analysis of concomitant clinical, laboratory and neuroimaging findings. Methods One hundred seventy six acromegalic patients (mean-age 55 ± 14 years, age range 21–88, 92 ...
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

Second attempt to withdraw cabergoline in prolactinomas: a pilot study
Conclusions Second attempt of CAB withdrawal after 2 additional years of therapy may be successful in some patients. A second withdrawal can be attempted with close monitoring of prolactin level. In this study, we could not identify any predictor of recurrence. Most of the recurrences occurred within the first 12 months after withdrawal. (Source: Pituitary)
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

Characterization of pituitary cells targeted by antipituitary antibodies in patients with isolated autoimmune diseases without pituitary insufficiency may help to foresee the kind of future hypopituitarism
Conclusions The characterization of pituitary cells targeted by APA in patients with isolated autoimmune diseases, when the pituitary function is still normal, may help to foresee the kind of subsequent hypopituitarism, especially when APA immunostained selectively only one type of pituitary cells. A careful follow-up of pituitary function in these patients is advisable to allow an early diagnosis of hypopituitarism, even in subclinical phase and a consequent timely replacement therapy. (Source: Pituitary)
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

Nasally located ectopic ACTH-secreting pituitary adenoma (EAPA) causing Nelson’s syndrome: diagnostic challenges
Conclusion Ectopic ACTH-secreting pituitary adenomas can occur not only along the developmental route of Rathke’s pouch, but other aberrant locations giving a clinical and biochemical picture identical to Cushing’s disease or Nelson’s syndrome. Clinicians should suspect an EAPA, when a central ACTH source seems to be apparent with no obvious pituitary adenoma. A detailed MRI involving possible EAPA sites aids in locating these unusual lesions. (Source: Pituitary)
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

GH secretion reserve in subclinical hypercortisolism
Abstract Purpose In overt hypercortisolism, growth hormone (GH) secretion is decreased and normalizes after surgery. In subclinical hypercortisolism (SH), GH secretion has been scarcely investigated. We assessed GH reserve in patients with and without SH and, in the former, also after recovery. Methods We enrolled 24 patients with adrenal adenomas, 12 with SH (SH+, 8 females, 58.3 ± 6.5 years) and 12 without SH (SH−; 11 females, 61.8 ± 10.6 years). SH was diagnosed in the presence of ≥2 out...
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

Elevated white blood cell counts in Cushing’s disease: association with hypercortisolism
Abstract Background Glucocorticoid receptors are expressed in white blood cells (WBC’s) and are known to play a role in cell adhesion and WBC’s recruitment from bone marrow. In Cushing’s disease leukocytosis is frequently mentioned as laboratory finding. However, there is no data on the prevalence of this finding among patients, or correlation with disease severity. Purpose To investigate the prevalence of leukocytosis in patients with Cushing’s disease, alterations in other blood count parameters and correlation with degre...
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

Prevalence of obstructive sleep apnea in patients with prolactinoma before and after treatment with dopamine agonists
Abstract Objectives Obesity is the main risk factor for the development of obstructive sleep apnea (OSA). Hyperprolactinemia has also been related to obesity. To determine the OSA prevalence in patients with prolactinoma before and after dopamine agonist (DA) and to evaluate the correlation between the apnea-hypopnea index (AHI) and prolactin levels, body mass index (BMI), waist circumference (WC), visceral fat volume (VFV), subcutaneous fat volume, and other metabolic parameters. Methods Thirty-five patients with prolactinoma at baseline ...
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

Pituitary incidentalomas
Conclusions Current experience from a multidisciplinary pituitary center is presented, with indications for treatment and longitudinal care of these challenging patients. (Source: Pituitary)
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

AZA-Deoxycytidine stimulates proopiomelanocortin gene expression and ACTH secretion in human pituitary ACTH-secreting tumors
Conclusions The present study shows that AZA increases POMC gene expression and ACTH secretion in human pituitary ACTH-secreting tumors. This can be taken to indicate that mechanisms set into motion by AZA play a role in the regulation of ACTH secretion/POMC expression in tumoral corticotropes and paves the way to further studies in Cushing’s disease. (Source: Pituitary)
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

Cerebrovascular complications and utilization of endovascular techniques following transsphenoidal resection of pituitary adenomas: a study of the Nationwide Inpatient Sample 2001–2010
Abstract Purpose Cerebrovascular complications following transsphenoidal resection of pituitary tumors are rare and often evaluated and treated with endovascular techniques. We determined the utilization rate and outcomes of endovascular procedures in transsphenoidal pituitary resection patients using an administrative database. Methods Using the Nationwide Inpatient Sample 2001–2010, patients receiving transsphenoidal resection of benign pituitary tumors were identified. The rate of cerebrovascular complications and utilization of endovascu...
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

Reversible pituitary insufficiency due to bexarotene therapy in a patient with mycosis fungoides
(Source: Pituitary)
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

Erratum to: Prevalence of obstructive sleep apnea in patients with prolactinoma before and after treatment with dopamine agonists
(Source: Pituitary)
Source: Pituitary - September 25, 2014 Category: Endocrinology Source Type: research

Treatment patterns in Cushing’s disease patients in two large United States nationwide databases: application of a novel, graphical methodology
Conclusions This study addresses a need for US data on real-world treatment patterns for CD patients. The majority of CD patients undergo surgery as initial therapy. Patients using pharmacotherapy had limited persistence with treatment. Neither reasons for discontinuation of therapy nor the impact of a recent FDA warning on potentially fatal liver toxicity from ketoconazole could be assessed. (Source: Pituitary)
Source: Pituitary - September 23, 2014 Category: Endocrinology Source Type: research

Pituitary imaging findings in male patients with hypogonadotrophic hypogonadism
Abstract Context Data on pituitary imaging in adult male patients presenting with hypogonadotrophic hypogonadism (HH) and no known pituitary disease are scarce. Objective To assess the usefulness of pituitary imaging in the evaluation of men presenting with HH after excluding known pituitary disorders and hyperprolactinemia. Design A historical prospective cohort of males with HH. Patients Men who presented for endocrine evaluation from 2011 to 2014 with testosterone levels
Source: Pituitary - September 23, 2014 Category: Endocrinology Source Type: research

Perioperative thromboprophylaxis in Cushing’s disease: What we did and what we are doing?
Conclusions Provoked thrombotic events pose a major problem in the management of CD patients after surgery, regardless of the procedure’s outcome. The prophylactic regimen proposed in this paper afforded an efficacy prophylaxis against postoperative VTE in patients with CD. Due to the rarity of CD, a multicenter study on a larger sample of cases would be warranted in order to collect more thrombotic events. (Source: Pituitary)
Source: Pituitary - September 20, 2014 Category: Endocrinology Source Type: research

Expression pattern of neuronal intermediate filament α-internexin in anterior pituitary gland and related tumors
Conclusion Go, NC as well as TSHomas exhibit high levels of intracellular INA protein indicating neuronal transdifferentiation. A possible impact on pathogenesis and endocrine activity needs further investigation. (Source: Pituitary)
Source: Pituitary - September 19, 2014 Category: Endocrinology Source Type: research

Effective performance of contrast enhanced SPACE imaging in clearly depicting the margin of pituitary adenoma
Abstract Purpose The aim of this study is to determine if contrast enhanced (CE) sampling perfection with application-optimized contrasts using different flip-angle evolutions (SPACE) images can provide clearer pituitary adenoma margin than conventional CE T1-weighted spin echo (T1-SE) sequence for cavernous sinus (CS) invasion evaluation. Methods 21 healthy volunteers were preformed with SPACE scans before and after administration of gadopentetate dimeglumine at different time points (1, 7 and 13 min). Signal intensity (SI) of regions of interest w...
Source: Pituitary - September 19, 2014 Category: Endocrinology Source Type: research

Autoimmune lymphocytic hypophysitis in association with autoimmune eye disease and sequential treatment with infliximab and rituximab
Conclusion This is the first report of hypophysitis occurring with the triad of scleritis, uveitis, and optic neuritis, as well as the first immunotherapy based on the sequential use of infliximab and rituximab. (Source: Pituitary)
Source: Pituitary - September 16, 2014 Category: Endocrinology Source Type: research