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    Resection of pituitary macroadenomas via the pseudocapsule along the posterior tumor margin: a cohort study and technical note.
    J Neurosurg 2017 Aug 18:1-7. Epub 2017 Aug 18.
    Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
    OBJECTIVE Extracapsular resection of pituitary microadenomas improves remission rates, but the application of pseudocapsular techniques for macroadenomas has not been well described. In larger tumors, the extremely thin, compressed normal gland or its complete absence along the tumor's anterior surface limits the application of the traditional pseudocapsular technique that can be used for microadenomas. However, in the authors' experience, the interface between the pseudocapsule at the posterior margin of the adenoma and the compressed normal gland behind it is universally present, providing a surgical dissection plane. Read More

    Risk factors and the prognosis of sexual dysfunction in male patients with pituitary adenomas: a multivariate analysis.
    Asian J Androl 2017 Aug 11. Epub 2017 Aug 11.
    Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
    The impact of sexual dysfunction (SD) is distressing to many male patients with pituitary adenomas which affect both physical and psychological health. The research explored to identify risk factors affecting sexual function and the prognosis of male patients with pituitary adenomas. Two hundred and fifty-four male patients, who aged between 18 and 60 (mean ± s. Read More

    Clinically non-functioning pituitary adenomas: Pathogenic, diagnostic and therapeutic aspects.
    Endocrinol Diabetes Nutr 2017 Aug - Sep;64(7):384-395. Epub 2017 Jul 4.
    Department of Medicine, American British Cowdray Medical Center, Mexico City, Mexico.
    Clinically non-functioning pituitary adenomas (NFPAs) are among the most common tumors in the sellar region. These lesions do not cause a hormonal hypersecretion syndrome, and are therefore found incidentally (particularly microadenomas) or diagnosed based on compressive symptoms such as headache and visual field defects, as well as clinical signs of pituitary hormone deficiencies. Immunohistochemically, more than 45% of these adenomas stain for gonadotropins or their subunits and are therefore called gonadotropinomas, while 30% of them show no immunostaining for any hormone and are known as null cell adenomas. Read More

    Prevalence, Clinical Features, and Natural History of Incidental Clinically Non-Functioning Pituitary Adenomas.
    Horm Metab Res 2017 Jul 31. Epub 2017 Jul 31.
    Department of Endocrinology, Hospital Universitario A Coruña, A Coruña, Spain.
    The objective of the study was to assess the prevalence and clinical features of incidentally discovered clinically non-functioning pituitary adenoma (CNFPA) and to analyze its natural history. A multicenter retrospective study in patients diagnosed with incidental CNFPA periodically followed-up in 3 specialized neuroendocrinology units from 1992 to 2015 was performed. Out of a total of 189 CNFPA patients, 57 cases (30. Read More

    The Outcomes of Primary Transsphenoidal Surgery in Cushing's Disease: Experience of a Tertiary Center.
    World Neurosurg 2017 Jul 12. Epub 2017 Jul 12.
    Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey; Pituitary Center, Istanbul University, Istanbul, Turkey. Electronic address:
    Background: To report the initial and long-term remission rates and related factors, secondary treatments, and outcomes of a series of patients with Cushing's disease (CD).

    Methods: One hundred forty-seven consecutive adult patients with CD who underwent primary trans-sphenoidal surgery between 1998 and 2014 were included in this study. Eighty-two were followed up in Cerrahpasa Medical Faculty Endocrinology and Metabolism outpatient clinic. Read More

    [Tumors of the sellar region].
    Radiologe 2017 Jun 30. Epub 2017 Jun 30.
    Abteilung für Neuroradiologie, Kantonsspital Baden, Baden, Schweiz.
    Methodical Issue: The anatomy of the sellar region is complex and tumors of the sellar region are very variable because they arise from the many different tissue types in the sellar region, ranging from benign to life-threatening. Despite this variety, approximately 80% of sellar region tumors are due to the 5 most common lesions: adenomas, meningiomas, aneurysms, astrocytomas and craniopharyngiomas.

    Standard Radiological Methods: In addition to clinical and laboratory results, the magnetic resonance imaging (MRI) and computed tomography (CT) results including the exact anatomical position and the proliferation pattern of the lesion are decisive for the diagnosis. Read More

    Prolactinomas diagnosed in the postmenopausal period: Clinical phenotype and outcomes.
    Clin Endocrinol (Oxf) 2017 Jun 19. Epub 2017 Jun 19.
    Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
    Objective: Most prolactinomas in females are diagnosed during the reproductive age, and the majority are microadenomas. Prolactinomas detected in the postmenopausal period are less common with limited published data on their presentation and prognosis. Our objective was to assess the presenting clinical, biochemical and imaging findings, as well as the outcomes of women diagnosed with a prolactinoma in the postmenopausal period. Read More

    Optimized multi-stable stochastic resonance for the enhancement of pituitary micoadenoma in MRI.
    IEEE J Biomed Health Inform 2017 Jun 13. Epub 2017 Jun 13.
    Magnetic resonance imaging (MRI) is the modality of choice as far as imaging diagnosis of pathologies in the pituitary gland is concerned. Further, the advent of dynamic contrast enhanced (DCE) has enhanced the capability of this modality in detecting minute benign but endocrinologically significant tumors called microadenoma. These lesions are visible with difficulty and a low confidence level in routine MRI sequences, even after administration of intravenous gadolinium. Read More

    Acromegaly: surgical results in 548 patients.
    Pituitary 2017 Jun 6. Epub 2017 Jun 6.
    Neurosurgery Department, Puerta de Hierro Hospital, Madrid, Spain.
    Purpose: The goal of this study was to quantified the results of microsurgery, in all the patients with acromegaly treated by the same endocrinologist and the same surgeon between 1975 and 2015.

    Methods: A series of 548 patients with acromegaly were operated and followed-up from 6 months to 40 years. Patients were selected according to five criteria: (1) Operated by the same surgeon. Read More

    Prolactinoma management: predictors of remission and recurrence after dopamine agonists withdrawal.
    Pituitary 2017 Aug;20(4):464-470
    Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
    Objective: Prolactinomas are the most common functional pituitary tumour. Dopamine agonists (DA) are its principal treatment. The criteria that should guide therapy withdrawal and the factors that influence disease remission or relapse are not yet fully established. Read More

    Preliminary experience with 4K ultra-high definition endoscope: analysis of pros and cons in skull base surgery.
    Acta Otorhinolaryngol Ital 2017 Jun;37(3):237-241
    Institute of Otorhinolaryngology, Catholic University School of Medicine, Rome, Italy.
    During the last two decades endoscopic skull base surgery observed a continuous technical and technological development 3D endoscopy and ultra High Definition (HD) endoscopy have provided great advances in terms of visualisation and spatial resolution. Ultra-high definition (UHD) 4K systems, recently introduced in the clinical practice, will shape next steps forward especially in skull base surgery field. Patients were operated on through transnasal transsphenoidal endoscopic approaches performed using Olympus NBI 4K UHD endoscope with a 4 mm 0° Ultra Telescope, 300 W xenon lamp (CLV-S400) predisposed for narrow band imaging (NBI) technology connected through a camera head to a high-quality control unit (OTV-S400 - VISERA 4K UHD) (Olympus Corporation, Tokyo, Japan). Read More

    Different patterns of gelatinolytic activity in pituitary macro- and microadenomas.
    Clin Neurol Neurosurg 2017 Jul 4;158:90-92. Epub 2017 May 4.
    Department of Medical Chemistry, Medical University of Lublin, Chodźki 4, 20-093 Lublin, PL, Poland. Electronic address:
    Objective: Gelatinases, Matrix MetalloProteinase(MMP)-2 and MMP-9, belong to zinc-dependent endopeptidases involved in several physiological and pathological processes including inflammation and tumor development. Because the information about the involvement of gelatinases in pituitary adenoma (PA) development are scant, our objective was the analysis of MMP-2 and MMP-9 activity in serum and tumor tissue of PA patients.

    Patients And Methods: Twenty one patients with PA (macroadenoma n=18, microadenoma n=3), qualified to the endoscopic resection of tumors were enrolled. Read More

    Outcome of Endoscopic Transsphenoidal Surgery for Acromegaly.
    World Neurosurg 2017 Aug 29;104:272-278. Epub 2017 Apr 29.
    Pituitary Center, Seoul National University College of Medicine, Seoul, Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. Electronic address:
    Objective: Endoscopic transsphenoidal surgery has recently been introduced in pituitary surgery. We investigated outcomes and complications of endoscopic surgery in 2 referral centers in Korea.

    Methods: We enrolled 134 patients with acromegaly (microadenomas, n = 15; macroadenomas, n = 119) who underwent endoscopic transsphenoidal surgery at Seoul National University Hospital (n = 74) and Samsung Medical Center (n = 60) between January 2009 and March 2016. Read More

    Metabolic In Vivo Visualization of Pituitary Adenomas: a Systematic Review of Imaging Modalities.
    World Neurosurg 2017 Aug 28;104:489-498. Epub 2017 Apr 28.
    Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA. Electronic address:
    Objective: Pituitary adenomas (PAs) are the most common intrasellar mass. Functional PAs constitute most of pituitary tumors and can produce symptoms related to hormonal overproduction. Timely and accurate detection is therefore of vital importance to prevent potentially irreversible sequelae. Read More

    Comparison of MRI techniques for detecting microadenomas in Cushing's disease.
    J Neurosurg 2017 Apr 28:1-7. Epub 2017 Apr 28.
    Department of Neurological Surgery and.
    OBJECTIVE Many centers use conventional and dynamic contrast-enhanced MRI (DMRI) sequences in patients with Cushing's disease. The authors assessed the utility of the 3D volumetric interpolated breath-hold examination, a spoiled-gradient echo 3D T1 sequence (SGE) characterized by superior soft tissue contrast and improved resolution, compared with DMRI and conventional MRI (CMRI) for detecting microadenomas in patients with Cushing's disease. METHODS This study was a blinded assessment of pituitary MRI in patients with proven Cushing's disease. Read More

    Transcriptome Analysis Showed a Differential Signature between Invasive and Non-invasive Corticotrophinomas.
    Front Endocrinol (Lausanne) 2017 22;8:55. Epub 2017 Mar 22.
    Laboratory of Hormones and Molecular Genetics LIM-42, University of São Paulo Medical School, São Paulo, Brazil; Endocrinology Service, AC Cancer Center, São Paulo, Brazil.
    ACTH-dependent hypercortisolism caused by a pituitary adenoma [Cushing's disease (CD)] is the most common cause of endogenous Cushing's syndrome. CD is often associated with several morbidities, including hypertension, diabetes, osteoporosis/bone fractures, secondary infections, and increased cardiovascular mortality. While the majority (≈80%) of the corticotrophinomas visible on pituitary magnetic resonance imaging are microadenomas (MICs, <10 mm of diameter), some tumors are macroadenomas (MACs, ≥10 mm) with increased growth potential and invasiveness, exceptionally exhibiting malignant demeanor. Read More

    Long-Term Endocrine Outcomes Following Endoscopic Endonasal Transsphenoidal Surgery for Acromegaly and Associated Prognostic Factors.
    Neurosurgery 2017 Mar 29. Epub 2017 Mar 29.
    Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.
    Background: Long-term remission rates from endoscopic transsphenoidal surgery for acromegaly and their relationship to prognostic indicators of disease aggressiveness are not well documented.

    Objective: To investigate long-term remission rates in patients with acromegaly after endoscopic transsphenoidal surgery, and correlate this with molecular and radiographic markers of disease aggressiveness.

    Methods: We identified all patients undergoing endoscopic transsphenoidal surgery for acromegaly from 2005 to 2013 at Cedars-Sinai Pituitary Center. Read More

    Efficacy of transsphenoidal surgery in achieving biochemical cure of growth hormone-secreting pituitary adenomas among patients with cavernous sinus invasion: a systematic review and meta-analysis.
    Neurol Res 2017 May 16;39(5):387-398. Epub 2017 Mar 16.
    a Department of Pharmaceutical Business and Administrative Sciences , MCPHS University , Boston , MA , USA.
    Objectives: Growth hormone-secreting pituitary adenomas in adults can result in severe craniofacial disfigurement and potentially fatal medical complications. Surgical resection leading to remission of the disease is dependent on complete surgical resection of the tumor. Lesions that invade the cavernous sinus may not be safely accessible via an endonasal transsphenoidal surgery (TSS), and the rates of biochemical remission of patients with residual disease vary widely in the literature. Read More

    Surgical outcomes in patients with Cushing's disease: the Cleveland clinic experience.
    Pituitary 2017 Aug;20(4):430-440
    Department of Neurosurgery, the Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
    Context: Transsphenoidal surgery (TSS) to resect a pituitary adenoma is considered first-line treatment for patients with Cushing's disease (CD). Early, post-operative remission rates >80% are expected for patients with a microadenoma (≤ 10 mm) visible on magnetic resonance (MR) imaging.

    Objective: To report surgical outcomes and predictors of remission in a specialist center for patients with CD. Read More

    A rare case of ectopic ACTH syndrome originating from malignant renal paraganglioma.
    Arch Endocrinol Metab 2017 May-Jun;61(3):291-295. Epub 2017 Feb 13.
    Department of Endocrinology and Metabolism, Diskapi Teaching and Research Hospital, Irfan Bastug Caddesi, Ankara, Turkey.
    Ectopic adrenocorticotropic hormone (ACTH) syndrome is characterized by hypercortisolism due to the hypersecretion of a non-pituitary ACTH-secreting tumor leading to Cushing's syndrome. Only a few cases have been reported previously as causing ectopic ACTH related to paraganglioma. Herein, we present a case of Cushing's syndrome, in who was proved to be attributable to an ACTH-secreting renal malignant paraganglioma. Read More

    Diagnosis and Treatment of Pituitary Adenomas: A Review.
    JAMA 2017 Feb;317(5):516-524
    Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
    Importance: Pituitary adenomas may hypersecrete hormones or cause mass effects. Therefore, early diagnosis and treatment are important.

    Observations: Prevalence of pituitary adenomas ranges from 1 in 865 adults to 1 in 2688 adults. Read More

    Efficacy of Microsurgical Sublabial Approach (MSA) Versus Endoscopic Endonasal Approach (EEA) for the Treatment of Pituitary Adenomas Based on Radiological and Hormonal Outcome.
    Acta Neurochir Suppl 2017 ;124:101-106
    Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
    Background: The purpose of this study was to compare the surgical efficacy of the microsurgical sublabial approach (MSA) versus the endoscopic endonasal approach (EEA) for the treatment of pituitary adenomas, based on short-term (12 months) radiological and endocrinological follow-up.

    Methods: One hundred and fourteen patients affected by pituitary adenoma were enrolled at our Unit between January 2007 and February 2012; 72 were treated with MSA, and 42 with EEA. The preoperative parameters considered were: type of lesion (secreting or nonsecreting), lesion size, presence of intralesional hemorrhage, lesion perimeter (nodular vs. Read More

    [The surgery of thyrotropin-secreting pituitary adenomas and the significance of thyroid stimulating hormone level in follow-up].
    Zhonghua Yi Xue Za Zhi 2016 Dec;96(47):3825-3828
    Department of Neurosurgery, Peking Union Medical College (PUMC) Hospital, China Academy of Medical Sciences & PUMC, Beijing 100730, China.
    Objective: To explore the clinical characteristics of thyrotropin-secreting pituitary adenomas and the effect of the transsphenoidal approach of procedure with/without drug treatment for thyrotropin-secreting pituitary adenomas, and to investigate the correlation between the prognosis of thyrotropin-secreting pituitary adenomas and the postoperative level of thyroid stimulating hormone (TSH). Methods: A total of 45 patients with thyrotropin-secreting pituitary adenoma who hospitalized in Peking Union Medical College Hospital from 2000 to 2015 were enrolled in the study.We collected the clinical features, hormone levels, imaging findings, treatment and follow-up data of these patients. Read More

    Endoscopic Endonasal Surgery for Remission of Cushing Disease Caused by Ectopic Intracavernous Macroadenoma: Case Report and Literature Review.
    World Neurosurg 2017 Feb 18;98:870.e5-870.e10. Epub 2016 Dec 18.
    Department of Otolaryngology, University of Louisville, Louisville, Kentucky, USA.
    Background: Complete surgical resection of an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma is the gold standard of treatment of Cushing disease. Ectopic location of these adenomas is an extremely rare condition that may compromise the diagnosis and surgical success. We present the first case of an ectopic intracavernous ACTH-secreting macroadenoma totally resected with endoscopic endonasal surgery (EES). Read More

    Incidence and prevalence of clinically relevant pituitary adenomas: retrospective cohort study in a Health Management Organization in Buenos Aires, Argentina.
    Arch Endocrinol Metab 2016 Nov-Dec;60(6):554-561. Epub 2016 Aug 25.
    Research in Internal Medicine Unit, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
    Objectives: The main purpose of this study was to estimate the incidence rate and prevalence of clinically relevant pituitary adenomas (PAs) within the Hospital Italiano Medical Care Program (HIMCP), a well-defined population of 150,000 members living in the urban and suburban area of the city of Buenos Aires. We defined clinically relevant PAs as those associated with endocrine dysfunction and/or mass effect.

    Subjects And Methods: A retrospective open cohort study was conducted, including all members of the HIMCP over 18 years old, with active memberships during the period of the study, from January 1st 2003, to January 1, 2014. Read More

    Prevalence and Predictors of Overweight and Obesity in Patients with Pituitary Dysfunctions.
    Endocr Metab Immune Disord Drug Targets 2016 ;16(4):249-253
    University of Luebeck, Department of Medicine I, Ratzeburger Allee 160, 23538 Luebeck, Germany.
    Background: Patients with hypothalamic-pituitary disorders (HPD) may be of increased risk to develop overweight and obesity, thereby fostering cardiovascular events. However, it remains unclear if patients with pituitary dysfunctions per se have an increased risk of becoming obese.

    Objective: The objective of this study was to evaluate prevalence and to identify possible predictors of overweight and obesity in patients with pituitary dysfunctions. Read More

    Cushing syndrome in a child due to pro-opiomelanocortin (POMC) secretion from a yolk sac tumor.
    Eur J Endocrinol 2017 Feb 22;176(2):K1-K7. Epub 2016 Nov 22.
    Department of EndocrinologyGreat Ormond Street Hospital for Children, London, UK
    Context: Pituitary microadenomas and adrenal tumours are the most common causes for endogenous Cushing syndrome (CS) in children.

    Case Description: We describe a two-year old girl with Cushing syndrome due to ectopic pro-opiomelanocortin (POMC) production from an abdominal yolk sac tumor. Cortisol concentrations were elevated but adrenocorticotropic hormone (ACTH) concentrations were equivocal. Read More

    Parasellar Extension Grades and Surgical Extent in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas : A Single Surgeon's Consecutive Series with the Aspects of Reliability and Clinical Validity.
    J Korean Neurosurg Soc 2016 Nov 24;59(6):577-583. Epub 2016 Oct 24.
    Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
    Objective: The inter-rater reliability of the modified Knosp's classification was measured before the analysis. The clinical validity of the parasellar extension grading system was evaluated by investigating the extents of resection and complication rates among the grades in the endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenomas.

    Methods: From November 2008 to August 2015, of the 286 patients who underwent EETS by the senior author, 208 were pituitary adenoma cases (146 non-functioning pituitary adenomas, 10 adrenocorticotropic hormone-secreting adenomas, 31 growth hormone-secreting adenomas, 17 prolactin-secreting adenomas, and 4 thyroid-stimulating hormone-secreting adenomas; 23 microadenomas, 174 macroadenomas, and 11 giant adenomas). Read More

    Paradoxical and atypical responses to pasireotide in aggressive ACTH-secreting pituitary tumors.
    Pituitary 2016 Dec;19(6):605-611
    Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel.
    Purpose: Pasireotide is the only pituitary targeted medication registered for the treatment of Cushing's disease. Drug efficacy data are largely based on a major prospective study in which the vast majority of patients had microadenomas. The purpose of this study was to summarize results of pasireotide treatment of ACTH secreting macroadenomas from our center. Read More

    Pituitary tumors in MEN1: do not be misled by borderline elevated prolactin levels.
    Pituitary 2016 Dec;19(6):601-604
    Division of Endocrinology Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, 645 N. Michigan Avenue, Suite 530, Chicago, IL, 60611, USA.
    Purpose: The objective of this case report is to demonstrate that the simple expedient of measuring periodic prolactin levels in patients with MEN1 who have modest hyperprolactinemia and normal pituitary MRI scans is insufficient to monitor for the development of pituitary adenomas.

    Methods: Review of relevant literature and chart review.

    Results: A 25 year old man with known MEN1 manifested by hyperparathyroidism and a gastrin-producing neuroendocrine tumor was found to have a prolactin [PRL] level of 20. Read More

    "Micromegaly": an update on the prevalence of acromegaly with apparently normal GH secretion in the modern era.
    Pituitary 2016 Dec;19(6):547-551
    Division of Metabolism, Endocrinology, and Diabetes, Internal Medicine Department, University of Michigan, 24 Frank Lloyd Wright Drive, G-1500, P.O. Box 482, Ann Arbor, MI, 48106, USA.
    Purpose: Approximately 25 % of cases of clinically active acromegaly cases treated in our academic center between 1996 and 2000, were diagnosed in patients who had elevated plasma IGF-1 levels, but apparently "normal" 24-h mean plasma GH levels. The current study served to update the data for patients with acromegaly referred to our facility, after increasing awareness of this "normal" GH subpopulation throughout the medical community.

    Methods: A retrospective chart review was conducted on 157 patients with acromegaly who underwent resection of a confirmed somatotroph pituitary adenoma at the University of Michigan Health System between the dates of 1 Jan 2001 to 23 Sept 2015. Read More

    The epidemiology of pituitary adenomas in a community-based hospital: a retrospective single center study in Saudi Arabia.
    Ann Saudi Med 2016 Sep-Oct;36(5):341-345
    Khalid S. Aljabri, MD, FRCPC, Department of Endocrinology,, King Fahad Armed Forces Hospital,, PO Box 6572, Jeddah 24361,, Saudi Arabia, T: 966555544919, F: 966-22-576-0665, ORCID:
    Background: Data on pituitary adenoma (PA) prevalence in Saudi Arabia are scarce.

    Objective: To estimate the epidemiology of PA in a well-defined population.

    Design: Retrospective analysis. Read More

    Turk Neurosurg 2016 Feb 5. Epub 2016 Feb 5.
    Bulent Ecevit University, Faculty of Medicine.
    Pituitary apoplexy is a medical condition that needs urgent diagnosis and treatment. It may occur spontaneously or may be precipitated by a variety of reasons including dynamic endocrine tests. Although pituitary apoplexy is usually seen in non-functional pituitary adenoma, it can also be seen in ACTH secreting macroadenomas. Read More

    Free middle turbinate mucosal graft reconstruction after primary endoscopic endonasal pituitary surgery.
    Eur Arch Otorhinolaryngol 2017 Feb 1;274(2):837-844. Epub 2016 Sep 1.
    Department of Neurosurgery, University Hospital of Wales, Cardiff, UK.
    The objective is to assess whether free middle turbinate (FMT) graft reconstruction, after endoscopic endonasal pituitary surgery, combines an acceptably low post-operative cerebrospinal fluid (CSF) leak rate with acceptable rhinological morbidity. This study identified 50 patients who underwent endoscopic endonasal pituitary surgery by the senior author in our teaching hospital between May 2011 and June 2012. FMT graft reconstruction was used in 32 cases. Read More

    Surgical treatment of acromegaly according to the 2010 remission criteria: systematic review and meta-analysis.
    Acta Neurochir (Wien) 2016 Nov 2;158(11):2109-2121. Epub 2016 Sep 2.
    Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (Unil), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
    Background: In 2010, the Acromegaly Consensus Group revised the criteria for cure of acromegaly and thus rates of surgical remission need to be revised in light of these new thresholds. Two subgroups consisted of patients with discordant GH and IGF-1 levels and patients in remission according to the 2000 criteria, but not to the 2010 criteria, have been reported after adenomectomy and for these subgroups the precise incidence and management has not been established. The objective of the study was to update rates of surgical remission and complications and to evaluate the incidence, management, and long-term outcome of the two previously described subgroups of patients. Read More

    [Use early morning serum cortisollevel to evaluate the effect of Cushing's disease after transsphenoidal surgery].
    Zhonghua Yi Xue Za Zhi 2016 Aug;96(31):2458-61
    Peking Union Medical College Hospital, CAMS& PUMC, Beijing 100730, China.
    Objective: To predict the therapeutic effect of Cushing's disease after transsphenoidal surgery by using morning serum cortisol level.

    Methods: The clinical data of 275 cases that had transsphenoidal surgery in Peking Union Medical College Hospital from 2010 to 2014 were analyzed retrospectively.Early morning serum cortisol level less than 140 nmol/L 3 days postoperation was usedto predict endocrinological remission. Read More

    Suction Filter in Endoscopic Endonasal Surgery: A Technical Note.
    World Neurosurg 2016 Nov 18;95:464-468. Epub 2016 Aug 18.
    Center of Surgery for Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
    Background: The collection of the greatest possible amount of pathologic tissue is of paramount importance in neurosurgery to achieve the most accurate histopathologic diagnosis, to perform all of the necessary biomolecular tests on the pathologic specimen, and to collect biological material for basic or translational science studies. This problem is particularly relevant in pituitary surgery because of the possible small size and soft consistency of tumors, which make them suitable for removal through suction, reducing the amount of available pathologic tissue. To solve this issue, we adopted a filter connected to the suction tube, which allows the surgeon to collect all of the tissue aspirated during surgery. Read More

    The multimodal management of GH-secreting pituitary adenomas: predictive factors, strategies and outcomes.
    J Med Life 2016 Apr-Jun;9(2):187-92
    "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania.
    Object. The aim of this study was to analyze a series of 28 patients with acromegaly who underwent a multimodal surgical, medical and radiosurgical therapy, with a special attention to the advantages, complications, and predictive factors of a successful outcome. Methods. Read More

    Pituitary magnetic resonance imaging in Cushing's disease.
    Endocrine 2017 Mar 19;55(3):691-696. Epub 2016 Jul 19.
    Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
    Adrenocorticotropin-secreting pituitary tumor represents about 10 % of pituitary adenomas and at the time of diagnosis most of them are microadenomas. Transsphenoidal surgery is the first-line treatment of Cushing's disease and accurate localization of the tumor within the gland is essential for selectively removing the lesion and preserving normal pituitary function. Magnetic resonance imaging is the best imaging modality for the detection of pituitary tumors, but adrenocorticotropin-secreting pituitary microadenomas are not correctly identified in 30-50 % of cases, because of their size, location, and enhancing characteristics. Read More

    Negative correlation between tumour size and cortisol/ACTH ratios in patients with Cushing's disease harbouring microadenomas or macroadenomas.
    J Endocrinol Invest 2016 Dec 30;39(12):1401-1409. Epub 2016 Jun 30.
    Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of Sao Paulo Medical School, São Paulo, SP, Brazil.
    Purpose: Pituitary macroadenomas (MACs) represent 10-30 % of Cushing's disease (CD) cases. The aim of this study was to report the clinical, laboratorial and imaging features and postsurgical outcomes of microadenoma (MIC) and MAC patients.

    Methods: Retrospective study with 317 CD patients (median 32 years old, range 9-71 years) admitted between 1990 and 2014, 74 (23. Read More

    Proopiomelanocortin, glucocorticoid, and CRH receptor expression in human ACTH-secreting pituitary adenomas.
    Endocrine 2017 Mar 24;55(3):853-860. Epub 2016 May 24.
    Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Milan, Italy.
    ACTH-secreting pituitary tumors are by definition partially autonomous, i.e., secrete ACTH independent of physiological control. Read More

    Intraoperative Magnetic Resonance Imaging During Endoscopic Transsphenoidal Surgery of Growth Hormone-Secreting Pituitary Adenomas.
    World Neurosurg 2016 Jul 3;91:490-6. Epub 2016 May 3.
    Department of Neurosurgery, 1st Faculty of Medicine, Charles University, Central Military Hospital, Prague, Czech Republic.
    Background: The effect of intraoperative magnetic resonance imaging (iMRI) on the extent of sellar region tumors treated endonasally has been described in previous research. However, the effects of iMRI on endocrinologic outcome of growth hormone-secreting adenomas have been studied in only a few small cohort studies.

    Methods: Inclusion criteria were primary transsphenoidal surgery for growth hormone-secreting adenoma from January 2009 to December 2014, a minimum follow-up of 1 year, complete endocrinologic data, at least 1 iMRI, and at least 2 postoperative magnetic resonance images. Read More

    MANAGEMENT OF ENDOCRINE DISEASE: Pituitary 'incidentaloma': neuroradiological assessment and differential diagnosis.
    Eur J Endocrinol 2016 Oct 11;175(4):R171-84. Epub 2016 Apr 11.
    Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Belgium
    Pituitary incidentalomas are a by-product of modern imaging technology. The term 'incidentaloma' is neither a distinct diagnosis nor a pathological entity. Rather, it is a collective designation for different entities that are discovered fortuitously, requiring a working diagnosis based on the input of the radiologist, endocrinologist and often a neurosurgeon. Read More

    Magnetic Resonance Imaging of Pituitary Tumors.
    Front Horm Res 2016 15;45:97-120. Epub 2016 Mar 15.
    Service d'Endocrinologie, Centre Hospitalier Universitaire de Liège, Liège, Belgium.
    Magnetic Resonance Imaging (MRI) is currently considered a major keystone of the diagnosis of diseases of the hypothalamic-hypophyseal region. However, the relatively small size of the pituitary gland, its location deep at the skull base and the numerous physiological variants present in this area impede the precise assessment of the anatomical structures and, particularly, of the pituitary gland itself. The diagnosis of the often tiny lesions of this region--such as pituitary microadenomas--is then difficult if the MRI technology is not optimized and if potential artifacts and traps are not recognized. Read More

    Endosphenoidal coil for intraoperative magnetic resonance imaging of the pituitary gland during transsphenoidal surgery.
    J Neurosurg 2016 12 18;125(6):1451-1459. Epub 2016 Mar 18.
    Radiology and Imaging Sciences, the National Institutes of Health, Bethesda, Maryland.
    OBJECTIVE Pituitary MR imaging fails to detect over 50% of microadenomas in Cushing's disease and nearly 80% of cases of dural microinvasion. Surface coils can generate exceptionally high-resolution images of the immediately adjacent tissues. To improve imaging of the pituitary gland, a receive-only surface coil that can be placed within the sphenoid sinus (the endosphenoidal coil [ESC]) during transsphenoidal surgery (TSS) was developed and assessed. Read More

    Prolactinomas: evolution after menopause.
    Arch Endocrinol Metab 2016 02;60(1):42-6
    Departamento de Neuroendocrinología (Neuroendocrinology Department), Sociedad Argentina de Endocrinología y Metabolismo, Ciudad Autónoma de Buenos Aires, Argentina.
    Objetive: The aim was to assess the evolution of tumor size and prolactin (PRL) levels in patients with micro and macroprolactinomas diagnosed and treated with dopamine agonists during fertile age, and the effects of suspension of drugs after menopause.

    Subjects And Methods: Retrospective study, 29 patients with prolactinomas, 22 microadenomas and 7 macroadenomas, diagnosed during their fertile age were studied in their menopause; treatment was stopped in this period. Age at menopause was 49 ± 3. Read More

    [Diagnosis and surgical management in patients with Cushing disease with negative magnetic resonance imaging].
    Zhonghua Yi Xue Za Zhi 2015 Oct;95(39):3213-6
    Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; Email:
    Objective: To analyze the outcome in patients who underwent transsphenoidal surgery (TSS) with Cushing's disease (CD) with no visible adenoma on magnetic resonance imaging (MRI).

    Methods: Between 2012 and 2014, 118 patients with CD underwent TSS at PUMCH. We retrospectively analyzed data in 43 patients without visible adenomas on MRI and compared them with 75 patients with MRI-visible microadenomas. Read More

    Clinicopathological predictive factors in the early remission of corticotroph pituitary macroadenomas in a tertiary referral centre.
    Eur J Endocrinol 2016 Apr 25;174(4):539-49. Epub 2016 Jan 25.
    Departments of Endocrinology and Isotope TherapyNeurosurgeryMilitary Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, PolandDepartment of Epidemiology and BiostatisticsInstitute of Mother and Child, ul. Kasprzaka 17a, 01-211 Warsaw, PolandDepartment of PathologyM. Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, ul. Roentgena 5, 02-781 Warsaw, Poland.
    Objective: Corticotroph macroadenomas are a rare cause of Cushing's disease (CD), but their properties are not well-recognised. The aim of this study was to evaluate the clinical and pathological aspects of corticotroph macroadenomas with particular emphasis on proliferation markers and their associations with the efficacy of surgical treatment.

    Design: A prospective cohort study was conducted in a tertiary referral centre in Poland. Read More

    Multidisciplinary Approach for Acromegaly: A Single Tertiary Center's Experience.
    World Neurosurg 2016 Apr 12;88:270-6. Epub 2016 Jan 12.
    Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. Electronic address:
    Background: Acromegaly is a multisystemic disease that requires a multidisciplinary approach. The aim of this study was to determine early and late remissions of patients who underwent surgery at our center and to evaluate relations between pathologic and radiologic properties of adenoma and medical and radiosurgical treatments with remissions.

    Methods: The medical records of 103 patients with acromegaly who underwent endoscopic endonasal transsphenoidal surgery in Cerrahpasa Medical Faculty, Istanbul University, between 2007 and 2014 were reviewed. Read More

    Endocr Pract 2016 04 20;22(4):466-75. Epub 2016 Jan 20.
    Objective: We conducted a systematic review and meta-analysis to synthesize the evidence about predictors that may affect biochemical remission and recurrence after transsphenoidal surgery (TSS), radiosurgery (RS), and radiotherapy (RT) in Cushing disease.

    Methods: We searched multiple databases through December 2014 including original controlled and uncontrolled studies that enrolled patients with Cushing disease who received TSS (first-line), RS, or RT. We extracted data independently, in duplicates. Read More

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