Adenoma Diameter Research Articles

Correlation of Intraoperative Parathyroid Hormone Levels of Primary Hyperparathyroidism with Single Adenoma Volume and Weight: Can Optimal Criteria be Created to End The Surgery?

Objective: To study the relationship of intraoperative parathormone (PTH) decrease levels with solitary parathyroid adenoma (SPA) weight, diameter, and volume of the adenoma in patients with primary hyperparathyroidism (PHPT). Method: Prospectively evaluation of consecutive patients undergoing parathyroidectomy (PTx) with the diagnosis of PHPT related to SPA. Perioperative biochemical parameters of patients; volume, weight and diameters of adenoma were recorded. Intraoperative PTH drop percentages were calculated. Adenoma diameter and volume were measured and calculated using preoperativ ultrasound. Adenoma was weighed intraoperatively by the surgeon. Results: Forty-five consecutive patients underwent PTx for a SPA between October 2018 and October 2019. There were 9 men and 36 women, with a mean age of 51 ± 14.94 years. A positive correlation was identified between the volume with the weight and maximum diameter of resected parathyroid glands (r = 0.613, p< 0.001; r = 0.871, p< 0.001, respectively). There was a positive correlation between volume and preoperative PTH levels, albeit a weak one (r = 0.334, p = 0.025). No significant relationship was found between adenoma volume and ioPTH drop rate (r = 0.088, p = 0.565). Conclusions: We have not been able to establish criteria based on correlation between PA volume and weight and the ioPTH drop rate that would allow us to make decisions on ending the parathyroidectomy and reducing persistent PHPT cases.

Гігантські аденоми гіпофіза: поширеність, особливості діагностики і клінічного перебігу

На підставі огляду літератури встановлено, що в діагностичному комплексі при гігантських аденомах гіпофіза, крім клінічного обстеження, необхідне застосування комплексу методів нейровізуалізації із визначенням розташування хіазми, ступеня поширення пухлини на основу черепа і деструкції останнього. Хірургічне лікування розглядається методом вибору при встановленні діагнозу гігантської аденоми гіпофіза, виняток становлять поодинокі випадки соматотропін- і пролактинсекретуючих пухлин, при яких можливе лікування агоністами дофаміну. При цьому при гігантських аденомах гіпофіза (діаметр понад 4 см) відсутній єдиний алгоритм оптимальної хірургічної стратегії.

Is there a role for growth status in distinguishing gallbladder adenomas from cholesterol polyps? – A retrospective study based on 520 cholecystectomy patients

Introduction Gallbladder adenomas have cancerous potential and occur in 4–8.9% of gallbladder polyps. The growth status (size progression and growth rate during follow-up) of polyps and their effectiveness for predicting adenomas are poorly defined. Herein, we compared adenomas and cholesterol polyps based on the growth status and evaluated the reported risk factors in predicting neoplasm. Methods We enrolled 520 patients who underwent preoperative ultrasonic follow-up more than 6 months with post-cholecystectomy pathologically confirmed gallbladder polyps. The patients were classified into adenoma and cholesterol polyp groups. Growth status, clinical characteristics, laboratory data, ultrasonic findings were reviewed and compared between the groups. Results Seventy-nine adenomas and 441 cholesterol polyps were analyzed. The mean diameter of adenomas (cholesterol polyps) was 7.24 ± 4.36 mm (6.23 ± 2.88 mm) in the initial and 12.06 ± 4.61 mm (10.05 ± 2.95 mm) in the preoperative examination. The median size progression (range) of polyps in the cholesterol polyps [3 (0, 22)] mm was smaller than that in adenomas [4 (0, 21)] mm (p = .075). The mean growth rate of adenomas (1.07 ± 1.33 mm/6 months) was slightly faster than in cholesterol polyps (0.83 ± 1.04 mm/6 months) (p = .338). The indicators significantly associated with adenomas were age >49.5 years, lack of gallbladder polyps/cholelithiasis family history, polyp size >11.5 mm and solitary polyp (p = .005, p = .027, p = .001, and p = .021, respectively). Conclusion Growth status was not a valuable modality to distinguishing gallbladder adenomas from cholesterol polyps. Risk factors such as age, polyp size, and solitary polyp were effective in predicting adenomas.

Long-term response to cabergoline and multi-modal treatment in men with macroprolactinoma: Does size really matter?

To study the outcome of men with macroprolactinoma following cabergoline treatment based on tumour size. Retrospective cohort study. The study included 94 men, divided into three groups according to adenoma diameter: 10-19 mm (Group A, n = 36); 20-39 mm (Group B, n = 41); or ≥40 mm (Group C, giant prolactinomas, n = 17). Patients were followed for a mean of 7.5 years with sellar magnetic resonance imaging, visual fieldsand hormone measurements. Mean baseline prolactin was 767, 2090 and 24,806 ng/ml in Groups A, Band C, respectively (p < .01). Prolactin suppression below three times the upper limit of normal(ULN) was achieved in 34 (94%; mean weekly cabergoline dose of 1.2 mg), 37 (90%; cabergoline dose, 2.1 mg)and 15 (88%; cabergoline dose, 2.8 mg) men (p = .31) in each group. After excluding patients who underwent surgery and radiotherapy, cabergoline suppressed prolactinbelow three times ULN in 32/35 (91%), 29/37 (78%)and 11/14 (79%) men in Groups A, Band C, respectively (p = .27). Visual deficits were observed in 5 (14%), 12 (29%)and 10 (59%) patients (p < .01); improvement was achieved in 5/5 (100%), 11/12 (92%)and 10/10 (100%) of men in Groups A, Band C. Low baseline testosterone was measured in 26 (72%), 39 (95%)and 17 (100%) patients in the three groups (p < .01). Following multi-modal treatment, hypogonadism persisted in 3 (8%), 5 (12%)and 2 (12%) men, respectively (p = .85). Macroprolactinomas in men were controlled with cabergoline in 84% of cases, independent of tumour size. Pituitary surgery and adjuvant radiotherapy further improved long-term response to 91%.

Can Surgeons Use Parathyroid Hormone Levels as Predictive Value in Parathyroid Adenomas?

Aim: Previous studies using different methods for PTH measurement have found a mild to moderate correlation between iPTH and gland weight. The aim of this study was to describe the relationship between parathyroid hormone and parathyroid adenoma volume, in patients with parathyroid adenomas as predictive value. Material and Methods: The multicenteric study was prepared by retrospectively collecting data from 244 patients with parathyroid adenoma who underwent parathyroidectomy and followed up between 2010 and 2020. Results: Two hundred forty and four (female/male = 203/41) patients with a mean age of 51.41 [min-max: 17 to 88] years. The mean iPTH concentrations preoperatively were 584.27 ng/L [min-max: 18.9 to 5011ng/L]. The mean diameter of adenoma of patients was 2,865 mm3 [min-max: 0.119 to 42.3 mm3]. After parathyroidectomy, PTH values were reevaluated and found as 47.2 ng/L [min-max: 0.2 to 903 ng/L]. In the patients with large parathyroid adenoma volume, preoperative PTH hormone values were statistically significantly higher (p=0.001). Conclusion: Our current study found a positive association between baseline iPTH levels and adenoma weight. These results suggest that serum iPTH level may be useful in predicting parathyroid adenoma volume.

GENES MEDIATING CELL GROWTH IN ALDOSTERONE-PRODUCING ADENOMAS

Objective: Aldosterone-producing adenomas (APA) are a major cause of primary aldosteronism. Somatic mutations explain the excess aldosterone production in the majority of patients with APA with mutations in KCNJ5 encoding a potassium channel the most prevalent in most reported populations. Mechanisms driving cell proliferation are largely undefined. Design and method: Quantitative transcriptome analysis using RNA-seq was used to identify differentially expressed genes between macro-APAs (n = 9, diameter &gt;= 30 mm) and micro-APAs (n = 12, diameter &lt;= 10 mm). Validation of RNA-seq data by TaqMan real-time PCR was performed for 14 genes in a broader cohort of APAs (NMD, no mutation detected, n = 28; KCNJ5-mutated, n = 43). Results: Hierarchical cluster analysis of the 500 genes with largest coefficient of variation indicated sample clustering based on genotype (KCNJ5 or NMD) and APA diameter. Differential expression of 155 and 348 genes was found between micro- and macro-APAs with KCNJ5 mutations and NMD, respectively. Among the top 5 overrepresented Gene Ontology terms (biological process), cell death was exclusively enriched in NMD micro- vs NMD macro-APAs. The expression levels of 10 genes were validated with a potential function related to cell growth. Expression of BEX1 (a reported tumour suppressor) was 2.8-fold down regulated in macro-APAs relative to micro-APAs (P &lt; 0.001), and a linear negative correlation of BEX1 expression with APA diameter was observed in NMD APAs (r = -0.501, P = 0.007). Genes involved in beta-catenin signalling, SFRP2, DKK1 and TSPAN12 were 5.9-fold (P &lt; 0.001), 1.8-fold (P = 0.007) and 8.3-fold (P &lt; 0.0001) down regulated, respectively, in macro-APAs compared with micro-APAs. BAI1 and CCL21 were also down regulated in macro-APAs relative to micro-APAs (3.3-fold, P = 0.026; 2.6-fold, P = 0.145, respectively). Additionally, the expression of TMPRSS3 (r = 0.727, P &lt; 0.001), BMP4 (r = 0.389, P = 0.041) and FBXL21 (r = 0.761, P &lt; 0.001) showed a linear positive correlation with adenoma diameter in NMD subgroup. Conclusions: APA display distinct transcriptome profiles according to adenoma diameter which may help identify genes involved in APA tumour cell growth.

BEX1 Is Differentially Expressed in Aldosterone-Producing Adenomas and Protects Human Adrenocortical Cells From Ferroptosis.

[Figure: see text].

Maximum adenoma diameter, regardless of uni- or bilaterality, is a risk factor for autonomous cortisol secretion in adrenal incidentalomas.

To evaluate differences between patients with unilateral andbilateral adrenal incidentalomas (AIs) in the prevalence of autonomous cortisol secretion (ACS) and related comorbidities. In this multicentre retrospective study, AIs ≥ 1cm without overt hormonal excess were included in the study. ACS was defined by a post-dexamethasone suppression test (DST) serum cortisol ≥ 5.0µg/dl, in the absence of signs of hypercortisolism. For the association of ACS with the prevalence of comorbidities, post-DST serum cortisol was also analysed as a continuous variable. Inclusion criteria were met by 823 patients, 66.3% had unilateral and 33.7% bilateral AIs. ACS was demonstrated in 5.7% of patients. No differences in the prevalence of ACS and related comorbidities were found between bilateral and unilateral AIs (P > 0.05). However, we found that tumour size was a good predictor of ACS (OR = 1.1 for each mm, P < 0.001), and the cut-off of 25mm presented a good diagnostic accuracy to predict ACS (sensitivity of 69.4%, specificity of 74.1%). During a median follow-up time of 31.2 (IQR = 14.4-56.5) months, the risk of developing dyslipidaemia was increased in bilateral compared with unilateral AIs (HR = 1.8, 95% CI = 1.1-3.0 but, this association depended on the tumour size observed at the end of follow-up (HR adjusted by last visit-tumour size = 0.9, 95% CI = 0.1-16.2). Tumour size, not bilaterality, is associated with a higher prevalence of ACS. During follow-up, neither tumour size nor bilaterality were associated with the development of new comorbidities, yet a larger tumour size after follow-up explained the association of bilateral AIs with the risk of dyslipidaemia.

Gonadotroph Pituitary Adenoma Causing Treatable Infertility and Ovarian Hyperstimulation Syndrome in Female Patients: Neurosurgical, Endocrinologic, Gynecologic, and Reproductive Outcomes

Gonadotroph pituitary adenoma (Gn-PA) may rarely cause ovarian hyperstimulation syndrome (OHSS) leading to infertility in women, though this remains poorly described. We present a quantitative systematic review including 2 institutional and 48 literature cases with Gn-PA causing OHSS to thoroughly describe the clinical features and therapeutic outcomes from multidisciplinary aspects. The patients demonstrated a mean age of 31.5 years and a mean FSH of 14.4 IU/L. Estradiol was high at > 350 pg/mL in 82%. The mean maximal adenoma diameter was 22 mm with Knosp grade being ≥ 3 in 10 cases. Abdominal surgery preceded adenoma resection in 24 (48%). Among 25 for whom extent of resection was recorded, total adenoma resection was achieved in 12. Through a mean follow-up of 25 months, adenoma recurrence was observed in 5, which were treated with re-resection (2), radiation (2), and medical therapy followed by bilateral oophorectomy (1). Medical therapies were partially effective or ineffective, and adenoma shrinkage did not follow; gonadotropin-releasing hormone (GnRH) agonists/antagonists were partially effective in 20% (2/10), dopamine agonists in 44% (8/18), and somatostatin analogues in 50% (1/2). Four experienced swelling of tumor/ovaries after GnRH agonists/antagonists administration. Overall, chemical remission was obtained in 26 of 28, normalization of ovaries in 25 of 27, and successful pregnancy in 12 of 14. Adenoma resection is the main treatment, leading to reduction in ovarian size and biochemical remission, with a high likelihood of subsequent spontaneous pregnancy. Increased awareness of this rare condition may help avoid unnecessary abdominal procedures.

Magnetic resonance imaging characteristics of residual pituitary tissues following transsphenoidal resection of pituitary macroadenomas.

The present study is to investigate the pre- and post-operative magnetic resonance imaging of pituitary tissues following transsphenoidal resection of pituitary macroadenomas, as well as its clinical significance. The medical records of 108 consecutive pituitary macroadenoma patients admitted at Fuzhou 900th Hospital between September 2012 and September 2014 were retrospectively reviewed. Siemens 3. 0T magnetic resonance scanner was used to perform pre- and postoperative MRI scanning, including plain scan and contrast-enhanced scan of SE sequential T1WI and T2WI in sagittal, coronal and axial views. PACS medical imaging system was used to measure the diameter of pituitary adenoma, as well as the volumes of the adenoma and pituitary tissue. Hematoxylin-eosin staining and immunohistochemical staining were also performed. Higher height of pituitary adenoma results in lower rate of posterior pituitary bright spot (PPBS) on MR T1-weighted imaging. Preoperative MR signal intensity of PPBS was negatively related to diabetes insipidus (DI). Normal pituitary tissues were likely to be above the pituitary adenomas in growth hormone-secreting adenoma patients, while mostly located aside in gonadotropin-secreting adenoma patients. Morphological restitution of postoperative pituitary tissues was better in lateral displacement than that in superior or superolateral patterns on pre-operative MR images. Positive rate of PPBS on preoperative MRI is negatively related to adenoma height, and the signal intensity of PPBS is inversely related to postoperative DI. The relative locations of pituitary tissues and adenoma tissues may be associated with the adenoma type and may affect the postoperative remodeling of residual pituitary tissues.

Correlation of perioperative biochemical variables with single adenoma weight in patients with primary hyperparathyroidism

BackgroundSingle parathyroid adenoma is the main cause of primary hyperparathyroidism (PHPT), with surgery remaining the gold standard for its treatment. The ability to preoperatively predict the parathyroid adenoma size and could facilitate the decision about the extent of surgical exploration. It is reasonable to hypothesize that the perioperative levels of PHPT-related variables (i.e. calcium, parathormone, phosphate) may predict the adenoma weight or/and demonstrate whether the adenoma is successfully removed or not. Aim of this study is to explore the relationship between perioperative biochemical values and adenoma weight. Secondarily, we investigated the relationship between adenoma weight and uni-/bilateral neck exploration.MethodsRetrospective study of all patients undergone surgery for primary hyperparathyroidism due to single adenoma in a tertiary university hospital in Germany during a 6-year period. Following variables were analyzed: preoperative serum calcium, phosphorus and parathormone, intraoperative parathormone before and after adenoma excision, intraoperative PTH decrease, postoperative serum calcium and parathormone (PTHpostop—pg/ml), calcium and PTH decrease. Bivariate correlations were calculated by the Spearman's correlation test at the 95% significance level.ResultsA total of 339 patients were included in the study. The median age of the patients was 60 years (range 21–90) and 77% were females. The median adenoma weight was 1 g (range 0.1–11). Adenoma weight correlated strong with maximum adenoma diameter (r = 0.72, p < 0.05), moderate with preoperative parathormone (r = 0.44) and parathormone decrease (r = 0.27), whereas there was no correlation with the intraoperative PTH decrease (r = 0.02). There was also a borderline (moderate to weak) correlation with pre- and postoperative calcium levels (r = 0.21 and r = 0.23 respectively) and a negative borderline correlation with phosphorus (r = − 0.21). Patients who required bilateral neck exploration, had significantly lighter adenomas (medianweight 0.8 g vs 1.1 g, p = 0.005).ConclusionsWe conclude that preoperative PTH levels may only serve as an approximate guide to adenoma weight, as direct preoperative prediction is not possible. Serum calcium levels, PTH and calcium decrease correlate only weak with adenoma weight. Patients who require bilateral neck exploration, have significantly (20–25%) lighter adenomas.

Long-term endocrinological outcomes of gamma knife radiosurgery in acromegaly patients

Gamma knife radiosurgery (GKS) is a treatment option for recurrent or persistent disease in patients with acromegaly. ObjectiveWe aimed to retrospectively evaluate acromegaly patients who had undergone GKS in terms of pituitary hormone status, efficacy of GKS, and prognostic factors. MethodOne-hundred and ten acromegaly patients who underwent GKS, and who were referred to our outpatient endocrinology clinic between 2007 and 2017, were included in the study. Anterior pituitary hormones and radiology imaging during follow-up were recorded. Remission for acromegaly was defined as a normal insulin-like growth factor 1 (IGF-1) level adjusted for age and gender, and a random growth hormone (GH) level < 1 ng/ml. Endocrine control was defined as normal GH and IGF-1 levels under medication. ResultsAfter a mean follow-up of 6.5 ± 4.7 years; remission, endocrine control, and uncontrolled status was observed in 16.4%, 60%, and 23.6% of patients; respectively. Adenoma volume was decreased after GKS (P < .0001). Remnant adenoma diameter was higher in the uncontrolled group compared to the remission and endocrine control group. The presence of tumor extension was associated with disease status (P = .03) and higher initial GH and IGF-1 levels. The mean time after GKS to remission was 26.5 months. Six (5.4%) patients had new-onset pituitary deficiency after GKS. In the multivariate analysis, pre-GKS IGF-1 levels and patient's age were associated with disease status. ConclusionGKS is an effective adjuvant treatment with minimal side effects to control GH and IGF-1 levels, increase remission rates, endocrine control, and reduce tumor diameter in persistent acromegaly patients after surgery.

The Safety of Radiofrequency Ablation Using a Novel Temperature-Controlled Probe for the Treatment of Residual Intraductal Lesions after Endoscopic Papillectomy.

Background/AimsTreatment of residual intraductal lesions after endoscopic papillectomy for ampullary adenomas is relatively difficult. Few studies have been conducted using intraductal radiofrequency ablation (RFA) in the treatment of such lesions, and no study has aimed to reduce the side effects of excessive heat caused by RFA. Recently, a temperature-controlled RFA probe was developed to avoid excessive heat. This study aimed to investigate the safety of this new RFA probe in the treatment of intraductal lesions of ampullary adenoma.MethodsPatients who received RFA for residual intraductal lesions after endoscopic papillectomy between November 2017 and June 2019 were retrospectively reviewed. A novel temperature-controlled probe (ELRA) was used for intraductal RFA, and clinical data including adverse events were collected.ResultsTen patients were included in this study. Intraductal adenomas showed low-grade dysplasia in eight patients and high-grade dysplasia in two patients. The median diameter of intraductal adenomas was 9 mm (range, 5 to 10 mm) in the common bile duct and 5 mm (range, 4 to 11 mm) in the pancreatic duct. Adverse events occurred in three patients (30.0%), of which two were mild pancreatitis and one was asymptomatic biliary stricture. Over a median follow-up period of 253 days, only one patient underwent additional surgery, as the remainder showed no adenomatous lesions on follow-up biopsies.ConclusionsThe new temperature-controlled RFA probe can be used with acceptable safety for the treatment of residual intraductal lesions after endoscopic papillectomy. Further evaluation through future prospective studies is needed.

Predictive model of surgical remission in acromegaly: age, presurgical GH levels and Knosp grade as the best predictors of surgical remission.

To identify presurgical clinical, hormonal and radiological variables associated with surgical remission in acromegaly and develop a predictive model for surgical remission. Ambispective study of acromegaly surgical patients followed in two Spanish tertiary hospitals. Patients operated by the same neurosurgeon by endonasal endoscopic transsphenoidal approach (n = 49) were included to develop the predictive model, and patients operated by other neurosurgeons (n = 37) were used for external validation of the predictive model. The predictive model was developed with a multivariate logistic regression model based on the 2000 criteria. 86 acromegalic patients were included. 49 patients, 83.7% with macroadenomas and 32.7% with Knosp grade > 2, were included for the development of the predictive model. The overall rate of surgical remission with the 2000 criteria was 73.5% and 51.0% with the 2010 criteria. Using the 2000 criteria, variables associated with surgical remission were: older age (OR = 1.1, p = 0.001), lower basal presurgical GH levels (OR = 0.9, p = 0.003), Knosp 0-2 (OR = 34.1, p < 0.0001) and lower maximum pituitary adenoma diameter (OR = 0.9, p = 0.019). The model with the best diagnostic accuracy to predict surgical remission combined age, Knosp 0-2 and presurgical GH levels (AIC = 29.7, AUC = 0.95) with a sensitivity of 93.8% and a specificity of 75.0%. The estimated loss of prediction with the external validation (n = 37) was 4.2%. The predictive model with the best diagnosis accuracy for surgical remission combined age, Knosp 0-2 and presurgical GH levels, with a sensitivity of 93.8% and a specificity of 75.0%. This model could be very useful to select candidates to preoperative medical treatment and planning the follow-up.

OR25-06 Morning ACTH Levels as a Reliable Biomarker for Excluding Autonomous Cortisol Secretion in Incidetally Discovered Adrenal Adenomas. A Prospective Cohort

Adrenal incidentalomas are common with a prevalence of 3-10% and in up to 30% of cases may have probable autonomous cortisol secretion. Hypercortisolism is associated with substantial cardiometabolic morbimortality and can physiologically decrease ACTH levels. Objective: To determine the sensitivity, specificity, and positive and negative predictive values of ACTH levels in evaluating autonomous cortisol secretion in a prospective cohort of incidentally discovered adrenal adenomas. Methods: We prospectively evaluated 224 consecutive adult subjects with incidentally discovered adrenal masses on computed tomography. Finally, 168 participants with radiographic adenoma criteria underwent systematic hormonal assessment, including measurements of morning cortisol and ACTH on day 1, and a 1 mg dexamethasone suppression test (DST) on day 2. Hypercortisolism was excluded if the DST was < 1.8 mcg/dL. Autonomous cortisol secretion was defined as a DST > 5.0 mcg/dL and DST levels of 1.8-5.0 mcg/dL were considered to be possibly autonomous hypercortisolism. We evaluated the correlation of ACTH levels with clinical, radiographic, and endocrine variables. In order to identify the most sensitive threshold value for diagnosing autonomous cortisol secretion, we determined ROC curves and negative likelihood ratio (NLR). Concordance of repeated ACTH was assessed using Bland Altman analysis. Results: The characteristics of the cohort were mean age 56 (+/- 11.8) years, 76% female, adenoma size 19 (+/- 7) mm, and 13% bilateral adenomas. Mean ACTH was 15 (+/- 11) pg/ml (range 5-72) and the mean DST was 2.2 (+/- 3.0) ug/dL (range 0.4-25.9). Fifty-four (32%) participants had a DST ≥1.8mcg/dL and 13 (8%) a DST≥5.0 mcg/dL. We found no correlation between ACTH levels and age, gender or body mass index. ACTH was inversely associated with adrenal adenoma diameter (r=-3.3 p=0.002) and volume (r=-2.9 p=0.008). There was an inverse association between ACTH and DST values (r=-3.1 p=0.01). In the subgroup of patients with a second ACTH measurement we found high concordance, with mean difference of 0.16+/-3.6 pg/ml (p=0.83). ROC analysis showed that an ACTH ≥20 pg/ml had a sensitivity of 98% to exclude hypercortisolism, with a negative predictive value of 97% and a negative likelihood ratio of 0.06. The only case with DST≥1.8 and ACTH≥20 had Cushing′s phenotype with both an adrenal adenoma and a pituitary ACTH-producing adenoma. Systematic evaluation of morning cortisol and ACTH allowed the detection of 5 cases of false negative low DST values due to the use of non-oral corticosteroids. Conclusion: In this cohort, an ACTH ≥20pg/ml excluded autonomous cortisol secretion with excellent sensitivity and negative predictive value, providing strong reassurance that there is no clinically relevant hypercortisolism. Therefore, subjects with a normal DST and ACTH ≥20pg/ml should be candidates for relaxed surveillance.

MON-303 Giant Growth Hormone Secreting Pituitary Adenomas: A Single Institution Case Series

The prevalence of growth hormone (GH)-secreting pituitary adenoma is around 11-13% of all pituitary adenomas. Giant GH-secreting pituitary adenomas (≥ 4 cm) are rare tumors, and its prevalence of among acromegalic patients is <5%.This is a retrospective cohort study including patients with giant GH-secreting pituitary adenomas. The study population consisted of 10 patients (5 M/5 F). The mean age at diagnosis was 33.0±12.9 yrs (11-55 yrs). The mean delay between first symptom onset and diagnosis was 2.9 years. The most frequent symptoms were acral enlargement and facial changes (80%), followed by headache (70%) and visual deterioration (50%). One patient had epilepsy. Amenorrhea was presented in three females but obvious galactorrhea in two. The mean adenoma diameter was 42.6±4.7 mm (40-51 mm) at diagnosis. The vast majority of adenomas presented suprasellar extension (100%) or cavernous sinus invasion (80%). Cystic adenomas accounted for 50%. At presentation, mean GH and IGF-1 levels were 40.0±21.4 ng/mL (14.8-51.0) and 2.62±1.09 x ULN (1.08-3.96), respectively. Six patients presented with PRL cosecretion. At diagnosis maximal tumor diameter was not correlated with GH or IGF-1 levels.All patients underwent pituitary surgery as first-line treatment. Three cases were treated with an endoscopic approach and four cases with a microscopic approach. Transcranial approach was also employed in three cases. Postoperative mean GH and IGF-1 levels were 14.9±16.1 ng/mL (0.6-51.0) and 2.25.±0.82 x ULN (1.48-3.74), respectively. After first surgery, only one patient had more than 50% reduction in IGF-1 levels. Five patients (50%) underwent repeat surgery on two to three procedures because remission was not achieved. Postoperative somatostatin receptor ligands (SRLs) were used by all patients. Six patients were treated with dopamine agonist in combination with SRL. Six patients (60%) received postoperative radiotherapy.The mean follow-up period was 12.6±5.3 yrs (4-21 yrs). The mean GH and IGF-1 levels were 1.47±1.54 ng/mL (0.08-5.25) and 0.73±0.44 x ULN (0.08-1.56), respectively at the last visit. Residual adenoma was present at the last MRI in eight patients (mean diameter 9.0±3.6 mm). Panhypopituitarism rose from 10% at baseline to 30% at the last visit. During follow-up, one patient diagnosed breast cancer, while another diagnosed thyroid papillary cancer.Giant GH-secreting pituitary adenomas can have a clinically aggressive behavior with mass effect. Moreover, treatment in patients with giant GH-secreting pituitary adenoma is complex and multimodal therapy is necessary.

Optimal Colonoscopic Surveillance Interval After Normal Baseline Screening Colonoscopy.

The optimal colonoscopic surveillance interval in the Chinese population is unclear. The present study aimed to assess the optimal colonoscopic surveillance interval after normal baseline screening colonoscopy to avoid overuse or underuse of colonoscopy. This retrospective study included individuals with normal baseline colonoscopy who had undergone at least 2 follow-up colonoscopy examinations at the Digestive Endoscopy Center of our hospital between 2000 and 2013. The risk factors for adenoma and the optimal colonoscopic surveillance interval were assessed. A total of 1,005 individuals (419 men; mean age, 49.34 ± 13.29 years) were included in the study. Of these, 169 individuals had adenomas at colonoscopic surveillance (mean, 1.32 ± 0.79 procedures). The mean adenoma diameter was 0.54 ± 0.38 cm, and the mean number of adenomas was 1.76 ± 1.29. The mean adenoma surveillance interval was 4.76 ± 2.89 years. The risk factors for adenoma identification were age more than 50 years and male gender. The optimal colonoscopic surveillance interval was 4.76 years according to an adenoma detection rate of 5%. The optimal colonoscopic surveillance interval is around 5 years for individuals with normal baseline colonoscopy. Age more than 50 years and male gender are risk factors for adenoma identification.

How to do depends on where it settles: Mediastinal parathyroid adenomas.

In this study, we aimed to evaluate demographic characteristics, preoperative adenoma localization, surgical techniques selected according to the size and localization of adenoma, and clinical results of patients undergoing mediastinal parathyroid adenoma excision. Medical records of a total of 11 patients (4 males, 7 females; mean age 52.6 years; range, 25 to 65 years) who underwent excision of mediastinal parathyroid adenoma in our clinic between January 2011 and June 2019 were retrospectively reviewed. Data including demographic characteristics, complaints, preoperative serum calcium, phosphorus, and parathyroid hormone levels, preoperative imaging methods, surgical method, localization and size of adenoma, length of hospital stay, and duration and amount of drainage were recorded. Adenoma was localized in anterior mediastinum in seven patients and in the middle mediastinum in four patients. The mean diameter calculated by taking into account the longest diameter of parathyroid adenoma was 21.1 mm. The mean drainage duration was 3.5 days in two patients undergoing median sternotomy, five days in one patient undergoing thoracotomy, 1.2 days in three patients undergoing video-assisted thoracoscopic surgery, and 0.6 days in five patients undergoing robotic surgery. Minimally invasive approaches such as videoassisted thoracoscopic surgery and robotic-assisted surgery are safe and effective approaches for excision of mediastinal parathyroid adenoma.

Evaluation of the Anti-Tumor Activity of Small Molecules Targeting Eph/Ephrins in APC min/J Mice.

The Eph receptors are the largest receptors tyrosine kinases (RTKs) family in humans and together with ephrin ligands constitute a complex cellular communication system often dysregulated in many tumors. The role of the Eph-ephrin system in colorectal cancer (CRC) has been investigated and different expression of Eph receptors have been associated with tumor development and progression. In light of this evidence, we investigated if a pharmacological approach aimed at inhibiting Eph/ephrin interaction through small molecules could prevent tumor growth in APC min/J mice. The 8-week treatment with the Eph-ephrin antagonist UniPR129 significantly reduced the number of adenomas in the ileum and decreased the diameter of adenomas in the same region. Overall our data suggested as UniPR129 could be able to slow down the tumor development in APC min/J mice. These results further confirm literature data about Eph kinases as a new valuable target in the intestinal cancer and for the first time showed the feasibility of the Eph-ephrin inhibition as a useful pharmacological approach against the intestinal tumorigenesis. In conclusion this work paves the way for further studies with Eph-ephrin inhibitors in order to confirm the Eph antagonism as innovative pharmacological approach with preventive benefit in the intestinal tumor development.

Multicenter external validation of the Zurich Pituitary Score.

Recently, the Zurich Pituitary Score (ZPS) has been proposed as a new quantitative preoperative classification scheme for predicting gross total resection (GTR), extent of resection (EOR), and residual tumor volume (RV) in endoscopic pituitary surgery. We evaluated the external validity of the ZPS. In three reference centers for pituitary surgery, the ZPS was applied and correlated to GTR, EOR, and RV. Furthermore, its inter-rater agreement was assessed. A total of 485 patients (53% male; age, 53.8 ± 15.7) were included. ZPS grades I, II, III, and IV were observed in 110 (23%), 270 (56%), 64 (13%), and 41 (8%) patients, respectively. GTR was achieved in 358 (74%) cases, with mean EOR of 87.6% ± 20.3% and RV of 1.42 ± 2.80cm3. With increasing ZPS grade, strongly significant decreasing trends for GTR (I, 92%; II, 77%; III, 67%; IV, 15%; p < 0.001) and EOR (I, 93.8%; II, 89.9%; III, 88.1%; IV, 75.4%; p < 0.001) were found. Similarly, RV increased steadily ([cm3] I, 0.16; II, 0.61; III, 2.01; IV, 3.84; p < 0.001). We observed intraclass correlation coefficients of 0.837 (95% CI, 0.804-0.865) for intercarotid distance and 0.964 (95% CI, 0.956-0.970) for adenoma diameter, and Cohen's kappa of 0.972 (95% CI, 0.952-0.992) for the ZPS grades. Application of the ZPS in three external cohorts was successful. The ZPS generalized well in terms of GTR, EOR, and RV; demonstrated excellent inter-rater agreement; and can safely and effectively be applied as a quantitative classification of adenomas with relevance to surgical outcome.