Growth Hormone-secreting Tumors Research Articles

Circulating FK506 binding protein 51 mRNA expression in patients with pituitary adenomas

BackgroundFK506 binding protein 51 (FKBP5) is a co-chaperone regulator of the glucocorticoid receptor (GR). Recent studies have reported increased FKBP5 mRNA in the circulation from patients with Cushing disease (CD) which returned to comparable levels seen in healthy controls following successful trans-nasal trans-sphenoidal (TNTS) surgical corticotroph tumor removal. However, the expression of circulating FKBP5 mRNA levels in other pituitary tumor subtypes and its specificity to corticotroph tumors is unknown. MethodsPre-operative blood was collected from consecutive patients undergoing TNTS for pituitary tumors (n = 57) at our center between 2015 and 2019. Total RNA was isolated from whole blood using RiboPure blood RNA isolation kit and real-time qPCR was used to quantitate circulating FKBP5 mRNA expression. ResultsConsistent with the prior report, higher circulating FKBP5 mRNA levels were observed in 20 patients with CD prior to surgical tumor removal, compared to 21 healthy controls (p < 0.0005) and compared to 8 patients harboring gonadotroph pituitary tumors (p < 0.05) and 6 patients with silent corticotroph pituitary tumors (p < 0.05). However, circulating FKBP5 mRNA levels were higher in 10 patients with prolactin (PRL)-secreting pituitary tumors compared to healthy controls (p < 0.05), and did not differ between patients with CD and patients with growth hormone secreting tumors (GH-omas). ConclusionsAlthough we confirm that circulating FKBP5 mRNA is higher in patients with corticotroph tumors compared to healthy subjects, measurement of circulating FKBP5 does not appear to be helpful to distinguish corticotroph tumors from other pituitary tumor sub-types.

Management for caesarean section in a known case of pituitary tumour with severe PIH

The pituitary gland undergoes global hyperplasia during pregnancy. Pituitary tumour cells in patients with prolactinoma and that with growth hormone secreting tumour exhibit symptomatic enlargement during pregnancy, either due to the growth promoting effect of oestrogens or due to the high levels of circulating Progesterone that occur with gestation. Based on their size prolactinoma (>1cm) or microadenoma microadenoma are classified into macroadenoma with severe pregnancy induced hypertension posted for emergency Caesarean section under epidural anaesthesia. Here we present successful anaesthetic management of patient with pituitory microadenoma with severe pregnancy induced hypertension posted for emergency Caesarean section under epidural anaesthesia.

Clinical parameters and treatment outcome in patients of acromegaly: A retrospective analysis of 51 patients.

The aim of the study was to analyze the pattern of clinical presentation and management outcome in patients of acromegaly. It is a cross-sectional study based on the clinical records of 51 patients of Acromegaly. All the recorded clinical data was analyzed to see the pattern of clinical presentation and management outcome. IBM SPSS statistics version 22 was used for statistical analysis. The median age was 32 years. Twenty-seven patients underwent surgery and 6 (22.2%) achieved remission. With pharmacological management, 35.8% patients achieved control of the disease with Octreotide LAR and 7.1% with cabergoline. Eighteen patients were treated with External Beam Radiation (EBR) and Stereotactic Radiosurgery (SRS). Remission rate has been 88.9% with SRS and 33.3% with EBR. The study shows higher prevalence of Growth Hormone (GH) secreting tumour in younger people and men. Remission rate was highest in patients treated with radiotherapy after partial response to TSS.

In Reply to the Letter to the Editor Regarding “Cytotoxicity and Effect of Topical Application of Tranexamic Acid on Human Fibroblast in Spine Surgery”

The literature on the use of intraoperative computed tomography (iCT) is sparse. We provide our experience of the usefulness of iCT in extent of resection in large and giant pituitary adenomas.A retrospective review was performed of cases using the endonasal endoscopic technique in which iCT was used. Demographic factors, number of scans, and impact on the extent of resection are reported, with visual acuity and field changes. Tumors were graded according to the Hardy classification. Patients with cavernous sinus invasion were excluded.All patients received a perioperative computed tomography scan with our iCT scanner. Thirty patients are reported, including 14 large and 16 giant pituitary adenomas, including 14 nonfunctional and 16 growth hormone–secreting tumors. The overall gross total resection (GTR), near-total resection, and subtotal resection rates were 83.3%, 16.7%, and 3.3%, respectively. iCT scanning detected residual in 13 of 30 patients, including 4 with 14 large (29%) and 9 with 16 (56.3%) giant adenomas promoting further surgery. iCT use improved GTR from 43.8% to 81.3% in giant adenomas and from 71% to 86% in large adenomas. Of the 13 patients in whom iCT detected residual disease, none required >2 iCT scans. No intraoperative complications were observed.iCT can improve extent of resection in large and giant pituitary adenomas and facilitate maximum safe resection such as GTR or near-total resection in patients where such should be attempted. iCT use may reduce iatrogenic complications and has select financial benefits in our patients' socioeconomic demographics. However, further prospective controlled studies are required to affirm our conclusions.

Usefulness of Intraoperative Computed Tomography on Extent of Resection of Large and Giant Pituitary Adenomas. Experience from a Developing Country

The literature on the use of intraoperative computed tomography (iCT) is sparse. We provide our experience of the usefulness of iCT in extent of resection in large and giant pituitary adenomas. A retrospective review was performed of cases using the endonasal endoscopic technique in which iCT was used. Demographic factors, number of scans, and impact on the extent of resection are reported, with visual acuity and field changes. Tumors were graded according to the Hardy classification. Patients with cavernous sinus invasion were excluded. All patients received a perioperative computed tomography scan with our iCT scanner. Thirty patients are reported, including 14 large and 16 giant pituitary adenomas, including 14 nonfunctional and 16 growth hormone-secreting tumors. The overall gross total resection (GTR), near-total resection, and subtotal resection rates were 83.3%, 16.7%, and 3.3%, respectively. iCT scanning detected residual in 13 of 30 patients, including 4 with 14 large (29%) and 9 with 16 (56.3%) giant adenomas promoting further surgery. iCT use improved GTR from 43.8% to 81.3% in giant adenomas and from 71% to 86% in large adenomas. Of the 13 patients in whom iCT detected residual disease, none required >2 iCT scans. No intraoperative complications were observed. iCT can improve extent of resection in large and giant pituitary adenomas and facilitate maximum safe resection such as GTR or near-total resection in patients where such should be attempted. iCT use may reduce iatrogenic complications and has select financial benefits in our patients' socioeconomic demographics. However, further prospective controlled studies are required to affirm our conclusions.

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.

Immune-checkpoint inhibitors in pituitary malignancies.

To date, there are no standardized systemic treatment options for patients with metastatic pituitary carcinoma progressed to chemo and radiation therapy. Immune-checkpoint inhibitors (ICIs) have been successfully assessed in other solid malignancies and could be a concrete hope for these patients. We performed a critical review of the literature aimed to evaluate studies assessing ICIs in pituitary malignancies. We also conducted research about published translational data assessing immune-contexture in these malignancies. Some preliminary reports reported a successful administration of pembrolizumab or the combination between nivolumab and ipilimumab in patients with metastatic ACTH-secreting pituitary carcinomas. Translational data suggest that adenomas secreting growth hormone and ACTH have a suppressed immune-microenvironment, which could be more likely to benefit from ICIs. Immune-checkpoint inhibitors can be an effective treatment in patients with pituitary carcinoma and maybe also recurrent adenoma. Tumors secreting growth hormone and ACTH are more likely to benefit from ICIs due to a different immune-microenvironment.

Pituitary Disease in AIP Mutation-Positive Familial Isolated Pituitary Adenoma (FIPA): A Kindred-Based Overview.

Clinically-relevant pituitary adenomas occur in about 1:1000 of the general population, but only about 5% occur in a known genetic or familial setting. Familial isolated pituitary adenomas (FIPA) are one of the most important inherited settings for pituitary adenomas and the most frequent genetic cause is a germline mutation in the aryl hydrocarbon receptor-interacting protein (AIP) gene. AIP mutations lead to young-onset macroadenomas that are difficult to treat. Most are growth hormone secreting tumors, but all other secretory types can exist and the clinical profile of affected patients is variable. We present an overview of the current understanding of AIP mutation-related pituitary disease and illustrate various key clinical factors using examples from one of the largest AIP mutation-positive FIPA families identified to date, in which six mutation-affected members with pituitary disease have been diagnosed. We highlight various clinically significant features of FIPA and AIP mutations, including issues related to patients with acromegaly, prolactinoma, apoplexy and non-functioning pituitary adenomas. The challenges faced by these AIP mutation-positive patients due to their disease and the long-term outcomes in older patients are discussed. Similarly, the pitfalls encountered due to incomplete penetrance of pituitary adenomas in AIP-mutated kindreds are discussed.

Acromegaly and joint pain: is there something more? A cross-sectional study to evaluate rheumatic disorders in growth hormone secreting tumor patients.

The aim of the present study was to evaluate the rheumatic profile in acromegalic patients to better characterize joint pain. The immunological pattern (rheumatoid factor; antinuclear antibodies-ANA, extractable nuclear antigens-ENA-Ab; anti-citrullinated protein antibodies; erythrocyte sedimentation rate) was evaluated in 20 acromegaly subjects (AS) and 20 control subjects (CS). Bilateral joint ultrasound of hands/wrists and nail capillaroscopy were also performed. Articular pain was more frequent in AS than in CS (p = 0.027). No difference was detected in immunological parameters. ANA and ENA-Ab were positive in only 10% of AS and in 5% of CS, while no difference was found in anti-citrullinated protein antibodies. No difference was detected between rheumatoid factor positivity, but threefold higher IgG were detected in AS compared to CS. The erythrocyte sedimentation rate was significantly higher in AS than CS (p = 0.040), while in AS, there was a trend in increased Power Doppler (PWD) articular uptake. The capillaroscopic evaluation showed a significant difference in almost each parameter (presence and number of tortuous capillaries, capillary enlargements, and hemorrhages), showing a moderate-to-severe microangiopathy in AS. The results of our study suggest that joint damage in acromegaly has not an autoimmune etiology. Increased erythrocyte sedimentation rate levels and PWD alteration in acromegalic population reflect a possible inflammatory nature, while the capillaroscopic findings suggest a moderate-to-severe microangiopathy that could help to identify patients with a greater macroangiopathic risk.

Active acromegaly is associated with enhanced left ventricular contractility: Results from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

IntroductionAcromegaly is a relatively rare chronic hormonal disease resulting in disfigurement. In 90% of cases, acromegaly is caused by a benign pituitary monoclonal human growth hormone-secreting tumor. The aim of the present study was to determine the presence of left ventricular (LV) deformation abnormalities using three-dimensional speckle-tracking echocardiography in a group of acromegalic patients. MethodsThirty-eight acromegalic patients were involved in the study. Thirteen patients were excluded due to inadequate image quality. The mean age of the remaining patients was 57.2±13.6 years and seven were male. Their data were compared to an age- and gender-matched control population, which consisted of 34 healthy volunteers (mean age: 52.7±4.9 years, 15 male). ResultsGlobal and mean segmental LV radial strain (RS) (33.2±13.4% vs. 25.2±10.8%, p=0.01 and 36.0±12.1% vs. 28.2±10.0%, p=0.009, respectively) proved to be significantly higher in acromegaly compared to controls. Active acromegalic patients had significantly higher global and mean segmental LV-RS (35.5±14.4% vs. 25.2±10.8%, p=0.03 and 37.9±13.3% vs. 28.2±10.0%, p=0.03, respectively) compared to controls. Between the active and inactive acromegaly groups, only basal LV circumferential strain (-30.2±4.8% vs. -26.7±4.1%, p=0.02) was found to be significantly different. ConclusionThe presented clinical, demographic, therapeutic and echocardiographic features demonstrate that active acromegaly is associated with enhanced LV RS as compared to healthy controls and those with inactive acromegaly.

P1795 Active acromegaly is associated with enhanced left ventricular contractility - A three-dimensional speckle-tracking echocardiographic study

Abstract Introduction Acromegaly is a relatively rare, chronic hormonal disease resulting in disfigurement. In 90% of the cases, acromegaly is caused by a benign pituitary monoclonal human growth hormone-secreting tumor. Hypertension and left ventricular (LV) hypertrophy are the most common cardiovascular comorbidites, but serious valvular regurgitation and heart failure could also develop at the end-stages. The aim of the present study was to determine the presence of LV deformational abnormalities using three-dimensional speckle-tracking echocardiography (3DSTE) in a group of acromegaly patients. Methods Thirty-eight acromegaly patients were involved in the present study. Thirteen patients were excluded due to inadequate image quality. The mean age of the remaining patients were 57.2 ± 13.6 years (7 males). The active acromegaly subgroup consisted of 14 patients (mean age: 58.6 ± 14.6 years, 5 males), while the inactive group contained 11 patients (mean age: 54.0 ± 12.9, 2 males). Their data was compared to an age- and gender matched control population, which comprised of 34 healthy volunteers (mean age: 52.7 ± 4.9 years, 15 males). All subjects have undergone complete two-dimensional Doppler echocardiography extended with 3DSTE. Results Significant differences in left atrial diameter and volume, LV end-diastolic diameter and volume, interventricular septum and LV posterior wall thickness could be demonstrated between the acromegaly group and healthy controls. Global and mean segmental 3DSTE-derived LV radial strain (RS)(33.2 ± 13.4% vs. 25.2 ± 10.8%, p =0.01 and 36.0 ± 12.1% vs. 28.2 ± 10.0%, p =0.009, respectively) proved to be significantly higher in acromegaly patients compared to controls. Active acromegaly patients had a significantly higher global and mean segmental RS (35.5 ± 14.4% vs. 25.2 ± 10.8%, p =0.03 and 37.9 ± 13.3% vs. 28.2 ± 10.0%, p =0.03, respectively) as compared to that of controls. Between active and inactive acromegaly groups only basal LV circumferential strain (-30.2 ± 4.8% vs. -26.7 ± 4.1%, p =0.02) was found to be significantly different. Conclusion With presented clinical, demographic, therapeutic and echocardiographic features, active acromegaly is associated with enhanced LV-RS as compared to the healthy population.

Preoperative Factors Associated with Postoperative Diabetes Insipidus after Transsphenoidal Pituitary Adenectomy

Transsphenoidal pituitary adenectomy is the gold standard method of treatment of pituitaryadenomas. Post-operative diabetes insipid sis one of the common complication of this procedure. In this study we have analyzed pre-operative factors that may be associated with onset of diabetes insipid us following this procedure. A retrospective study of five years was conducted in a tertiary neurosurgical center. Histologically proven cases of pituitary adenomas who underwent transsphenoidalpituitary adenectomy were included in the study. Age and sex of the patients along with size and functional type of tumor were analyzed to see if they predicted the occurrence of diabetesinsipidus post-operatively. Out of 49 cases who underwent transsphenoidalpituitary surgery, 46 cases were proven to be pituitary adenomas histologically. There was male preponderance with male to female ratio of2:1. Age ranged from 15 to 72 with median age of 37 years. Nonfunctional, prolactinomas and growth hormone secreting tumors, were 25, 16and 4 in number. Median size of the tumor was2.35 in largest diameter. Out of these patients13 (28%) patients developed diabetes insipid us. Age, sex of the patient, size of the tumor and functional type of the tumor did not predict the incidence. Age, sex of the patient, size of the tumor and functional type of the tumor do not predict the incidence of diabetes insipid us post-operatively in patients undergoing transsphenoidal pituitaryadenectomy.

Safety and efficacy of repeat radiosurgery for acromegaly: an International Multi-Institutional Study.

Surgical resection is the first line treatment for growth hormone (GH) secreting tumors. Stereotactic radiosurgery (SRS) is recommended for patients who do not achieve endocrine remission after resection. The purpose of this study was to evaluate safety and efficacy of repeat radiosurgery for acromegaly. Three hundred and ninety-eight patients with acromegaly treated with the Gamma Knife radiosurgery (Elekta AB, Stockholm) were identified from the International Gamma Knife Research Foundation database. Among these, 21 patients underwent repeated SRS with sufficient endocrine follow-up and 18 patients had sufficient imaging follow-up. Tumor control was defined as lack of adenoma progression on imaging. Endocrine remission was defined as a normal IGF-1 concentration while off medical therapy. Median time from initial SRS to repeat SRS was 5.0years. The median imaging and endocrine follow-up duration after repeat SRS was 3.4 and 3.8years, respectively. The median initial marginal dose was 17Gy, and the median repeat marginal dose was 23Gy. Of the 18 patients with adequate imaging follow up, 15 (83.3%) patients had tumor control and of 21 patients with endocrine follow-up, 9 (42.9%) patients had endocrine remission at last follow-up visit. Four patients (19.0%) developed new deficits after repeat radiosurgery. Of these, 3 patients had neurologic deficits and 1 patient had endocrine deficit. Repeat radiosurgery for persistent acromegaly offers a reasonable benefit to risk profile for this challenging patient cohort. Further studies are needed to identify patients best suited for this type of approach.

Caracterización de tumores secretores de hormona de crecimiento de acuerdo al patrón granular y su rol en el pronóstico

Classification of growth hormone (GH) - secreting tumors by the granular pattern might predict their clinical behavior in acromegalic patients. There are several other prognostic factors. To compare the features at presentation and cure rates of patients with GH secreting tumors according to the granular pattern, and to define independent prognostic factors for surgical treatment in these patients. A retrospective, observational study of 85 active acromegalic patients surgically treated in two medical centers. Seventy-four patients (87%) were classified as having densely granulated (DG) and 11 (13%) as sparsely granulated (SG) tumors. The latter were less active biochemically, had a higher rate of macroadenoma and cavernous sinus invasion and had a lower rate of biochemical cure than the DG group. Several characteristics were associated with disease persistence but only age (Odds ratio (OR) = 0.93) and cavernous sinus invasion (OR = 21.7) were independently associated in the logistic regression model. The sparsely granulated pattern is associated with a more aggressive behavior, but the main determinants of prognosis are age and cavernous sinus invasion.

SAT-469 Empty Sella Making Big Changes: A Case of Acromegaly and Empty Sella Syndrome

Acromegaly is a condition defined by excess growth hormone (GH). The clinical features of acromegaly including overgrowth of many tissues including cartilage, bone, skin and visceral organs. It often times presents with coarsening of facial features and increased hat or ring size. Cardiovascular disease including hypertension with left ventricular hypertrophy and metabolic deficiencies including insulin resistance are also commonly seen as a result of the GH excess. The most common cause of acromegaly has been found to be GH secreting pituitary adenomas. MRI is generally sufficient to identify these lesions, but rarely a patient with symptoms of acromegaly will be found to have empty sella syndrome. Case: A 37 year old male, with a PMH of uncontrolled HTN presented to the emergency department after his wife found him on the floor, unconscious, foaming at the mouth, and shaking. He had an episode of urinary incontinence and was postictal for 20-30 minutes after the episode. In ED, he was hypertensive at 246/162, CT head showed right frontal intraparenchymal 1.2 cm hemorrhage and MRI brain showed various foci of hyperintensity compatible with hypertensive encephalopathy. He was also hypokalemic (2.9) with evidence of an AKI (BUN 27, Cr 1.73). He was admitted for further evaluation of suspected seizure. Upon further evaluation, the patient admitted to coarsening of facial features as noted on comparison of prior photographs. He also reported difficulties with his wedding ring fitting which he attributed to hand swelling. ROS was other negative with no vision changes or headaches. This sparked concern for a secondary cause of hypertension in the setting of clinical acromegaly. MRI brain was complicated by movement but revealed pituitary characteristics of empty sella syndrome. Insulin like growth factor 1 - 745. ECHO showed severe concentric left ventricular hypertrophy with aortic valve sclerosis and left atrial dilation. Renal Artery ultrasound showed no evidence of renal artery stenosis. The patient was subsequently scheduled for repeat MRI brain pituitary as outpatient under anesthesia to evaluate for possible surgical treatment for acromegaly. Discussion: This case demonstrates that empty sella syndrome does not warrant exclusion of acromegaly. GH secreting tumors can be present despite empty sella syndrome and acromegaly can even cause enlargement of the sella (?) . In these cases, the pituitary tissue lining the sella can be the source of excess GH. Upon case review, the mechanism remains unclear but empty sella syndrome may result from necrosis by infarction or from hemorrhage. Since no resectable mass is present in these cases, medical management with somatostatin analogues remains the only treatment that can be offered to these patients. It is important to keep acromegaly on the differential despite empty sella.

Reduction in Thymoma Size After Pituitary Surgery for Growth Hormone–Secreting Tumor

A thymoma is a rare tumor of the anterior mediastinum and may be under the control of prolactin and growth hormone (GH), as well as GH-insulin-like growth factor 1 (IGF-1)-mediated paracrine and autocrine pathways. The following case report highlights the unexpected outcome in a patient with a mediastinal thymoma after pituitary surgery for a GH-producing macroadenoma. A 58-year-old Caucasian man with a history of acromegaly caused by a pituitary macroadenoma presented with a mediastinal thymoma (proven by biopsy). The thymoma was monitored annually by imaging studies, as the patient was asymptomatic and had declined surgery. The octreotide scan was negative and tests ruled out a GH-releasing hormone (GHRH)-producing tumor. Transsphenoidal surgery for removal of the pituitary tumor was performed. Following surgery, the patient's IGF-1 levels normalized and GH was adequately suppressed in an oral glucose tolerance test. Follow-up imaging after 6 weeks and 10 months of surgery showed the absence of a pituitary tumor and a marked reduction in size of the mediastinal thymoma. In a patient with acromegaly and a thymoma, surgical treatment of the GH-producing tumor might be expected to cause a reduction in thymoma size. Therefore, such tumors in patients with acromegaly may simply be monitored clinically.

Transsphenoidal Approaches for Microsurgical Resection of Pituitary Adenomas in Pediatric Patients

Pituitary adenomas are uncommon in the pediatric population. Although medical treatment can be effective in treating prolactinomas and some growth hormone-secreting tumors, resection is indicated in the setting of pituitary apoplexy, large or giant pituitary adenomas causing mass effect or visual loss, or when medical therapy becomes ineffective or intolerable. Modern microsurgical transsphenoidal approaches are potential avenues for resection in pediatric patients. We evaluated the outcomes and safety of this approach. A retrospective cohort analysis was performed from February 2002 through May 2017 for patients younger than 19 years of age that underwent a transsphenoidal approach for pituitary adenoma resection. Among a total of 634 patients who underwent transsphenoidal approach for pituitary adenoma resection, 24 pediatric cases were identified. Prolactinomas (29.2%) and adrenocorticotropic hormone-secreting (20.8%) pituitary adenomas were the most commonly encountered histologies. Gross total resection was achieved in 75.0% of patients, and complete hormone function normalization was seen in 91.7% of patients. Eight patients (33.3%) required postoperative hormone replacement therapy. Twelve patients (50.0%) underwent fat/fascia use and 1 patient (4.2%) underwent lumbar puncture perioperatively for management of cerebrospinal fluid leak. There were no tumor recurrences during a follow-up period of 24.7 ± 32.1 months. A modern transsphenoidal microsurgical approach proved to be a safe, well-tolerated, and effective modality in the setting of pediatric pituitary adenomas.

Outcomes of Surgical Repair of Skull Base Defects Following Endonasal Pituitary Surgery: A Retrospective Observational Study.

Skull base defects following endonasal surgery for pituitary macroadenoma need to be addressed during the surgery to prevent serious postoperative complications like cerebrospinal fluid (CSF) leak. The objective of this study is to assess the incidence of CSF leak following pituitary surgery and the methods of effective skull base repair. This is a retrospective observational study conducted in a tertiary care hospital after obtaining due clearance from the Institutional ethics committee. The charts of patients who underwentendonasal pituitary surgery between 2013 and 2018 were studied and details noted. Patients undergoing revision surgery or with history of preoperative radiotherapy were excluded from the study. 52 patients were included in the study.Based on the type of CSF leak, the patients were grouped into four. 19 patients (36.5%) had an intraoperative CSF leak. 3 patients developed a postoperative CSF leak. Based on the histopathology, 4 patients had ACTH secreting tumor. 8 patients had growth hormone secreting tumor, 22 had gonadotropin secreting tumor, 9 patients had a non-functioning tumour and 9 patients had prolactinoma. The type of skull base repair performed in these patients were grouped into 4.18 patients underwent type I repair, 21 patients underwent type II repair, 8 patients underwent type III repair and 5 patients underwent type IV repair. We have observed that the pedicled nasoseptal flap is particularly advantageous over other repair techniques, especially in low pressure leaks. The strategy for skull base repair should be tailored to suit each patient to minimise the occurrence of morbidity and the duration of hospital stay.

Clinical Outcomes After Endoscopic Endonasal Resection of Giant Pituitary Adenomas.

Giant pituitary adenomas represent a surgical challenge. We present the results of the endoscopic endonasal approach (EEA) for giant pituitary adenomas. We retrospectively reviewed the medical records of 55 patients with giant pituitary adenomas (>4 cm in maximum diameter) who underwent surgery with an EEA between 2008 and 2016. Factors affecting the extent of resection were evaluated. The mean patient age was 55.5 years. Tumors were nonfunctional in all but 4 patients, including 2 with growth hormone-secreting tumors, 1 with an adrenocorticotropic hormone-secreting tumor, and 1 with prolactinoma. Gross total resection was achieved in 24 patients (44%), and near-total resection (>90%) was achieved in 26 patients (47%). A multilobular configuration (P= 0.002) and cavernous sinus invasion (P= 0.044) negatively affected the extent of resection, whereas tumor size, intraventricular, and anterior or posterior fossa extension did not. Ten patients underwent adjuvant radiotherapy. All patients with hormone-secreting adenomas required adjuvant medical and/or radiotherapy to achieve biochemical remission. Postoperative vision was improved or normalized in 32 patients (66%), stable in 15 patients (31%), and worsened in 1 patient. A new hormonal deficit occurred in 8 patients (17%), whereas recovery of an existing hormonal deficit occurred in 6 patients (20%). The mean duration of follow-up was 41 months. Tumor recurrence/progression occurred in 6 patients (11%). Complications included apoplexy of residual tumor resulting in ischemic stroke in 1 patient, postoperative cerebrospinal fluid leak in 1 patient, and permanent diabetes insipidus in 4 patients (7%). Surgery with the EEA is an excellent option for managing giant pituitary adenomas. It results in superior clinical outcomes to those obtained using traditional microscopic transsphenoidal and transcranial approaches as reported in the literature.

Could statin modify molecular phenotype of pituitary growth hormone-secreting tumors?

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