Removal Of Adenoma Research Articles

SUN-LB076 Potential Role of Gallium-68-Peptides and Fluorine-18-FDG PET/CT and Ki67 in Patients with Post-Surgical Residual Pituitary Adenoma

Purpose: Pituitary adenomas are in most of cases benign lesions. However, in around 25% of cases they can show aggressive behavior, such invasiveness of pituitary region surrounding structures, progressive or rapid increase in size or evolvement in pituitary carcinoma. In recent years, 68Ga-peptides and 18F-FDG PET/CT have been applied in the functional assessment of residual pituitary adenomas. Methods: We retrospectively reviewed our series of patients submitted to 68Ga-peptides and/or 18F-FDG PET-CT for evaluating residual pituitary adenomas after primary surgery. Results: Sixteen patients underwent 68Ga-peptides and/or 18F-FDG PET/CT in the period 2012-2018 at our Institution. A total of 15 68Ga-peptides PET/CT scans and 8 18F-FDG PET/CT scans were performed. Fourteen patients had pituitary adenoma, and two pituitary carcinoma. Nine patients were affected by not-secreting (null cell) pituitary adenoma; 3 patients by Cushing disease; 3 patients by acromegaly and a single patients by prolactinoma. All patients underwent partial removal of the pituitary adenoma, as all cases invaded the cavernous sinus. Mean Ki67 was 4% (SD: 3). Positivity at 68Ga-peptides PET/CT was detected in 10 patients. Positivity at 18F-FDG PET/CT was detected in 6 patients. Six patients were submitted to both PET/CT scans: 4 showed concordant results and two were positive only at 68Ga-peptide PET/CT. Nine patients with residual tumor positive at 68Ga-peptides PET/CT were treated with long-acting somatostatin analogues (L-SSA). Progression of the residual adenoma was observed in 9 patients: 6 were positive at 68Ga-peptide PET/CT and 5 were positive at FDG PET/CT. 5 patients were on treatment with L-SSA. Mean follow-up was 37.8 months (DS:30). The only determinant of progression disease was the Ki67: in patients with progression of pituitary adenoma, mean Ki67 was 5% (SD: 3, p=0.05) and in patients with stable disease its mean value was 1.5% (SD:1.5). Conclusion: 68Ga-peptides and 18F-FDG PET/CT can be useful for functional evaluation of residual pituitary adenomas after primary surgery and in scheduling the therapeutic management. In any case, the main determinant of disease progression is represented by the Ki67 index. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

V02-07 ROBOT-ASSISTED SIMPLE PROSTATECTOMY WITH TUNNEL-SHAPED TRIGONIZATION (RASP-TST) VERSUS STANDARD RASP

INTRODUCTION AND OBJECTIVES:To compare early outcomes of a reconstructive technical modification for robotic-assisted simple prostatectomy (RASP) with those of conventional trigonization approach.METHODS:In a prospective and random model, 20 men who underwent to BPH surgical treatment were allocated in two groups (RASP and TST-RASP). Demographic and preoperative data (including IPSS and Flowmetry scores) were collected.The procedures were carried-out using the Si da Vinci Robotic System (Intuitive Surgical). Through a five-trocars transperitoneal access, we perform a longitudinal incision of the bladder wall and prostate capsule and the removal of prostatic adenoma in both groups. Next, using a three-steps reconstructive technique, a 360 trigonization of the bladder mucosa was proposed in TST-RASP group (Tunnel-Shaped Trigonization) rather than classic trigonization (RASP group). The TST enrolls the advancement of a bladder mucosa flap until the prostatic urethra (first step) followed by a running suture ...

Detectability and surgical outcomes in parathyroid surgery – a single-centre experience

The incidence of primary hyperparathyroidismand referrals for the removal of parathyroid adenomas are increasing. Factors that improve the detectability, and ultimately the surgical outcome, are the focus of this retrospective study. We included 117 patients who had parathyroid operations with intraoperative monitoring of parathyroid hormone (PTH). Sestamibi, ultrasound and, in selected cases, fusion with computed tomograms (CT), were done to locate the lesion preoperatively. Concentrations of calcium and PTH before and after operation, specimen weight, and preoperative vitamin D concentrations, were assessed. The sensitivity of sestamibi and ultrasound for the preoperative location of adenomas was 92% and 80%, respectively. Sestamibi located them more accurately in patients with low preoperative concentrations of vitamin D (p = 0.037) and with heavier adenomas (p < 0.001). We found no significant association between the preoperative concentrations of PTH and detectability on preoperative scans (p = 0.058). Postoperative follow up showed that 97% of the 117 patients were biochemically cured. Accurate location helps to lower morbidity as it facilitates a targeted approach. Further studies are needed to explore the role of vitamin D in the location of parathyroid adenomas before parathyroidectomy.

Melanosis Coli

A 59-year-old man taking an oral Aloe vera supplement and with a history of colonic polyps 6 years prior, presented for a surveillance colonoscopy. From the anal verge to the ileocecal valve the colonic mucosa was diffusely darkly pigmented, consistent with marked melanosis coli. Melanosis coli is a benign condition in which macrophages in the colonic lamina propria are stained by lipofuscin pigment as a result of phagocytosis of apoptotic epithelial cells caused by exposure to plant-based anthraquinone laxatives, usually over a period of at least 2–3 months. Senna, cascara, aloe, and rhubarb supplements are some of the most common sources of anthraquinones. Neither the small bowel nor colonic polyps are stained as a result of anthraquinone exposure, as can be seen in photographs of the ileocecal valve (Figure A) and polyps (Figures B and C). The sharp contrast produced by the lack of color change in neoplastic polyp tissue can render otherwise subtle polyps more readily visible. In this patient the presence of melanosis coli aided in the detection and removal of a 10-mm flat cecal tubular adenoma and 10 additional small sessile tubular adenomas.

Thyroid function in Klinefelter syndrome: a multicentre study from KING group.

The prevalence and the etiopathogenesis of thyroid dysfunctions in Klinefelter syndrome (KS) are still unclear. The primary aim of this study was to evaluate the pathogenetic role of hypogonadism in the thyroid disorders described in KS, with the scope to distinguish between patients with KS and hypogonadism due to other causes (Kallmann syndrome, idiopathic hypogonadotropic hypogonadism, iatrogenic hypogonadism and acquired hypogonadotropic hypogonadism after surgical removal of pituitary adenomas) called non-KS. Therefore, we evaluated thyroid function in KS and in non-KS hypogonadal patients. This is a case-control multicentre study from KING group: Endocrinology clinics in university-affiliated medical centres. One hundred and seventy four KS, and sixty-two non-KS hypogonadal men were enrolled. The primary outcome was the prevalence of thyroid diseases in KS and in non-KS. Changes in hormonal parameters were evaluated. Exclusion criterion was secondary hypothyroidism. Analyses were performed using Student's t test. Mann-Whitney test and Chi-square test. FT4 was significantly lower in KS vs non-KS. KS and non-KS presented similar TSH and testosterone levels. Hashimoto's thyroiditis (HT) was diagnosed in 7% of KS. Five KS developed hypothyroidism. The ratio FT3/FT4 was similar in both groups. TSH index was 1.9 in KS and 2.3 in non-KS. Adjustment for differences in age, sample size and concomitant disease in multivariate models did not alter the results. We demonstrated in KS no etiopathogenic link to hypogonadism or change in the set point of thyrotrophic control in the altered FT4 production. The prevalence of HT in KS was similar to normal male population, showing absence of increased risk of HT associated with the XXY karyotype.

Functioning gonadotroph adenoma with severe ovarian hyperstimulation syndrome: A new emergency in pituitary adenoma surgery? Surgical considerations and literature review

The authors reported 2 cases of functioning gonadotroph pituitary adenoma (FGPA) revealed by an ovarian hyperstimulation syndrome (OHSS) in young women. In the first case, OHSS was observed after GnRH analog injection. Pelvic echography revealed multiple voluminous ovarian cysts. Dopamine agonist posology failed in estradiol hypersecretion control, which necessitated endoscopic endonasal transsphenoidal surgery. The patient experienced improvement in pelvic pain as estradiol hypersecretion decreased during the first few postoperative days. Outcome was favorable, and her menstrual cycle was normal after two months. The second case was a young girl with spontaneous pelvic pain and elevated plasma FSH and estradiol levels. FGPA was confirmed on cerebral MRI. Dopamine agonists were introduced, and surgical removal of the pituitary tumor was scheduled for 7 days later. In the meantime, the patient was admitted and underwent surgery for bilateral adnexal torsion related to OHSS. The pituitary tumor was removed one week later. Outcome was favorable, and estradiol and FSH plasma levels were normal after 3 months. The ovarian cysts were no longer visible on echography after 3 months. Given the lack of efficacy of the current standard medical therapy, surgical removal of pituitary adenomas is the reference treatment for FGPA. The authors suggest that severe OHSS related to FGPA should be considered as a relative surgical emergency and that surgery should not be unduly delayed, given the unpredictable risk of adnexal torsion, particularly in case of voluminous ovarian cysts. The authors performed a literature review on this topic.

Effect of preoperative detrusor underactivity on long-term surgical outcomes of photovaporization and holmium laser enucleation in men with benign prostatic hyperplasia: a lesson from 5-year serial follow-up data.

To investigate the impact of preoperative detrusor underactivity (DU) on serial treatment outcomes over the course of 5years after photovaporization (PV) or holmium laser enucleation (HoLEP) in patients with benign prostatic hyperplasia (BPH), to compare its impact after PV vs HoLEP, and to identify predictors of long-term lower urinary tract symptoms (LUTS) improvement. This study involved 245 patients with BPH who had complete 5-year follow-up data (PV using 120W-HPS, n = 143, HoLEP, n = 102), grouped as follows: PV-HPS-DU(+), n = 114; PV-HPS-DU(-), n = 29; HoLEP-DU(+), n = 56; and HoLEP-DU(-), n = 46. Bladder contractility index (BCI) < 100 was regarded as DU. Serial treatment outcomes for the International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry and serum PSA level at 6months, and at 1, 2, 3, 4 and 5years after surgery, were compared among the groups. LUTS improvement was defined as a reduction in total IPSS of ≥50% relative to baseline. Improvement in total IPSS, quality of life (QoL) index and post-void residual urine volume (PVR) in the PV-HPS-DU(+) and PV-HPS-DU(-) groups were maintained up to 5years after PV, except for maximum urinary flow rate (Qmax ) and bladder voiding efficiency. In the HoLEP-DU(+) and HoLEP-DU(-) groups, improvements in all outcome variables were maintained up to 5years after HoLEP. Deteriorations in subtotal voiding symptom score, total IPSS and Qmax with time during the long-term period after surgery were more pronounced in the PV-HPS-DU(+) and HoLEP-DU(+) groups than in the PV-HPS-DU(-) and HoLEP-DU(-) groups. Reductions in subtotal voiding symptom score, total IPSS, QoL index, and serum PSA were greater in the HoLEP-DU(+) group than in the PV-HPS-DU(+) group throughout follow-up. The type of surgery (HoLEP vs PV) and higher baseline BCI were independent predictors of LUTS improvement at 5 years after surgery. Generally, improvement of micturition symptoms, QoL and PVR in patients with DU appears to be maintained up to 5years after PV or HoLEP. Deterioration of voiding symptoms and urinary flow rate at long-term follow-up visits after PV or HoLEP was more pronounced in patients with LUTS/BPH with DU than in those without DU. Patients with BPH with DU may benefit from more complete removal of prostatic adenoma by HoLEP and greater baseline bladder contractility in terms of micturition symptoms and QoL.

Recovery of Adrenal Function after Pituitary Surgery in Patients with Cushing Disease: Persistent Remission or Recurrence?

Background: Cushing disease (CD) represents the principal cause of endogenous hypercortisolism. The first-line therapy of CD is surgical removal of the ACTH-secreting pituitary adenoma, which is generally followed by adrenal insufficiency (AI). Objective: To analyze the recovery of AI in patients with CD after pituitary surgery in relation with recurrence and persistent remission of CD. Patients and Methods: We performed a retrospective analysis of patients with CD who met the following inclusion criteria: adult age, presence of AI 2 months after the surgical intervention, and a minimum follow-up of 3 years after the surgical intervention. Results: Sixty-one patients were followed for a median of 6 years. Ten (16.4%) patients recurred during follow-up. The patients who restored adrenal function did so after a median time of 19 months, with a significantly shorter time in the recurrence group (12.5 vs. 25 months, p = 0.008). All 10 patients who recurred recovered their adrenal function within 22 months. The recovery rate of AI in the persistent remission group was 37.3% (19/51) at 3 years and 55.8% (24/43) at 5 years. In all patients the duration of AI was negatively associated with disease recurrence. Conclusion: The duration of postsurgical AI in patients with recurrent CD is significantly shorter than that in patients with persistently remitted CD, and this parameter may be a useful predictor of recurrence. Patients showing a normal pituitary-adrenal axis within 2 years after surgery should be strictly monitored as they are at higher risk of disease relapse.

Association between family history of colorectal cancer and the risk of metachronous colorectal neoplasia following polypectomy in patients aged

The relationship between a family history of colorectal cancer (CRC) and the risk of metachronous colorectal neoplasia (CRN) following polypectomy remains unknown. We aimed to compare the risk of metachronous CRN according to CRC family history in groups of patients aged <50 and ≥50years. We studied patients who underwent ≥1 adenoma removal between 2010 and 2014 and follow-up surveillance colonoscopic examinations until 2017. Among the 9866 patients studied, 544 (5.5%) had ≥1 first-degree relatives (FDRs) affected by CRC. In patients aged <50years (n=7787), as compared with having no family history of CRC, a positive family history in any FDR (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.16-1.62), a father (HR 1.35, 95% CI 1.09-1.68), or a mother (HR 1.32, 95% CI 1.005-1.74) was associated with an increased risk of metachronous CRN after adjusting for confounding factors. However, in patients aged ≥50years (n=2079), there was no significant association between having an FDR with CRC and the risk of metachronous CRN. For metachronous advanced CRN, the association between its risk and family history of CRC was not observed in either the <50years or ≥50years of age group. Having an FDR with CRC at a young age (<50years) appears to be closely related to the risk of metachronous CRN. However, considering that the risk of metachronous advanced CRN did not depend on CRC family history, the interval of post-polypectomy surveillance colonoscopy may not need to be adjusted depending on CRC family history.

Appropriate Surveillance Interval after Colonoscopic Polypectomy in Patients Younger than 50 Years.

BackgroundCurrent postpolypectomy surveillance guidelines are based on studies in patients aged ≥50 years. Equal application of the guidelines in patients aged < 50 years may be unreasonable. We aimed to determine an appropriate surveillance interval after adenoma removal in patients aged < 50 years.MethodsWe studied 10,013 patients who underwent ≥ 1 adenoma removal and follow-up colonoscopy. The cumulative risk of metachronous advanced colorectal neoplasia (ACRN) was compared among the eight groups based on age (30–39, 40–44, 45–49 and ≥ 50 years) and baseline adenoma characteristics (low- [LRA] and high-risk adenoma [HRA]).ResultsThe risk of metachronous ACRN in patients aged 30–39 and 40–44 years with HRA was comparable to that in those aged ≥ 50 years with LRA (P = 0.839 and P = 0.381, respectively). However, the risk in those aged 45–49 years with HRA was higher than in those aged ≥ 50 years with LRA (P = 0.003), and the risk was not significantly different from that in those aged ≥ 50 years with HRA (P = 0.092). Additionally, the 5-year cumulative risk in those aged 45–49 years with LRA was not significantly different from that in those aged ≥ 50 years with LRA.ConclusionThe postpolypectomy surveillance interval can be extended up to 5 years in patients aged 30–44 years with HRA, similar to those aged ≥ 50 years with LRA. However, the interval in patients aged 45–49 years with HRA and LRA should be 3 and 5 years, respectively, similar to those aged ≥ 50 years.

Colorectal cancer screening guidelines for Nigeria in 2019

Colorectal cancer (CRC) is a major public health issue in Nigeria. The incidence is rising, and majority of the patients diagnosed with CRC, die of the disease burden. CRC is an ideal cancer for screening and early detection. It has been well documented that screening for CRC, by a variety of methods, leads to a sustained reduction in mortality from the disease in two ways: increased detection of early stage with more curable cancer and detection and removal of adenomas, which are known precursors to CRC. Screening has also been shown to be cost-effective in terms of quality-adjusted life-years gained compared to nonscreening. CRC screening can be approached as an organized program or on an opportunistic basis. Opportunistic screening is the only option in systems that lack the resources, infrastructure, and framework needed for an organized approach. A myriad of CRC screening tests exist, which can be divided into two main categories namely biological sample-based tests, which include fecal, blood, and urine tests, and colonic structure-based tests, which include flexible sigmoidoscopy, colonoscopy, and imaging studies such as computed tomography colonography, magnetic resonance imaging colonography, and double-contrast barium enema. The recommendation for CRC screening includes offering patients the opportunity to select test, based on their preference, affordability, and test availability. This decision-making process is personalized and requires an understanding between the patient and doctor. This guideline reviews the available evidence and makes recommendation on the screening method for CRC in Nigeria.

Vocal Quality Assessment of Patients with Pituitary Adenomas Operated via Endoscopic and Microscopic Approaches.

To evaluate whether there is any difference in voice quality between patients who were operated via microscopic and endoscopic approaches for pituitary adenomas. The study group consisted of 59 patients and 30 healthy volunteers. They were all males and divided into three groups as; microscopically operated (MO) (n=30), endoscopically operated (EO) (n=29) and control (n=30). Subjective and objective voice analyses were performed. There was no significant relationship within groups according to Voice Handicap Index-10 (p=0.053). Fundamental frequency, jitter %, jitter PQQ5 parameters revealed that there was a statistically significant difference between EO and MO groups. No statistically significant difference was observed within EO, MO and control groups with respect to harmonics-to-noise ratio median scores. The present study assessed the effects of endoscopic and microscopic techniques for removal of pituitary adenomas on quality of voice. As it keeps the anatomically realistic model of sinuses and nasal cavity which provides resonance for the voice, endoscopic intervention found out to be superior by means of vocal quality.

Intraoral approach for the removal of a pleomorphic adenoma of the parapharyngeal space

Intraoral approach for the removal of a pleomorphic adenoma of the parapharyngeal space

Comparison of Intraoperative Cortisol Levels after Preoperative Hydrocortisone Administration versus Placebo in Patients with an Intact Hypothalamic-Pituitary-Adrenal Axis Undergoing Endoscopic Transsphenoidal Removal of Non-Functioning Pituitary Adenomas: A Double-Blind Randomized Trial

Comparison of Intraoperative Cortisol Levels after Preoperative Hydrocortisone Administration versus Placebo in Patients with an Intact Hypothalamic-Pituitary-Adrenal Axis Undergoing Endoscopic Transsphenoidal Removal of Non-Functioning Pituitary Adenomas: A Double-Blind Randomized Trial

Receipt of Colonoscopy Following Diagnosis of Advanced Adenomas: An Analysis within Integrated Healthcare Delivery Systems.

To reduce colorectal cancer incidence and mortality, experts recommend surveillance colonoscopy 3 years after advanced adenoma removal. Little is known about adherence to that interval. We describe patterns of and factors associated with subsequent colonoscopy among persons with ≥3 adenomas and/or ≥1 adenoma with villous/tubulovillous histology in four U.S. integrated healthcare delivery systems. We report Kaplan-Meier estimators of the cumulative percentage of patients undergoing colonoscopy 6 months to 3.5 years after an index colonoscopy with high-risk findings. Combining data from three healthcare systems, we used multivariable logistic regression with inverse probability of censoring weights to estimate ORs and 95% confidence intervals (CI) for associations between patient characteristics and receipt of subsequent colonoscopy. Among 6,909 persons with advanced adenomas, the percent receiving a subsequent colonoscopy 6 months to 3.5 years later ranged from 18.3% (95% CI: 11.7%-27.8%) to 59.5% (95% CI: 53.8%-65.2%) across healthcare systems. Differences remained significant in the multivariable model. Patients with ≥3 adenomas were more likely than those with 1 to 2 villous/tubulovillous adenomas to undergo subsequent colonoscopy. Subsequent colonoscopy was also more common for patients ages 60-74 and less common for patients ages 80 to 89 compared with those ages 50 to 54 years at their index colonoscopy. Sex, race/ethnicity, and comorbidity index score were generally not associated with subsequent colonoscopy receipt. Colonoscopy within the recommended interval following advanced adenoma was underutilized and varied by healthcare system, age, and number of adenomas. Strategies to improve adherence to surveillance colonoscopy following advanced adenomas are needed.

To cap/cuff or ring: do distal attachment devices improve the adenoma detection?

ABSTRACTIntroduction: Colonoscopy reduces the risk of colorectal cancer, by interrupting the adenoma–carcinoma sequence enabling the detection and removal of adenomas before they turn into colorectal cancer. Colonoscopy has its limitations as adenoma miss rates as high as 25% have been reported. The reasons for missed pathology are complicated and multi-factorial. The recent drive to improve adenoma detection rates has led to a plethora of new technologies.Areas covered: An increasing number of advanced endoscopes and distal attachment devices have appeared in the market. Advanced endoscopes aim to improve mucosal visualization by widening the field of view. Distal attachment devices aim to increase adenoma detection behind folds by flattening folds on withdrawal. In this review article, we discuss the three following distal attachment devices: the transparent cap, the Endocuff, and the Endoring.Expert commentary: The authors believe that the distal attachment devices will have a greater benefit for endoscopists with low baseline adenoma detection rates.

Plasmakinetic Vapoenucleation of the Prostate by Nesbit Technique

Introduction: Transurethral resection of the prostate (TURP) has been the gold standard in surgical management of patients with benign prostatic hyperplasia (BPH). The procedure has stood the test of time. The place of conventional TURP has come under scrutiny with emergence of bipolar electrosurgical systems that utilize normal saline for cutting. Plasmakinetic (bipolar) energy has demonstrated several advantages over conventional monopolar TURP. There has been an increasing trend favoring enucleation procedures using laser.1 The argument given is that they do more complete removal of prostatic adenoma up to the capsule. Recently, bipolar “enucleation” and “vapoenucleation” procedures have been proposed as advancements in the technology.2 We have tried to modify this technique of “vapoenucleation” by enucleating the lobes in a simple way using Nesbit's technique, which is simpler and easy to reproduce. We use the plasmakinetic button electrode for doing vaporization. Patients and Methods: The study was conducted at our center from January 2016 till June 2016 for a 6-month period and included 35 consecutive patients with obstructive lower urinary tract symptoms associated with BPH. Patients with moderate to severe enlargement (between >50 g and <100 g) of the prostate were included in the study. Any patients with renal failure, upper tract dilation, or secondary bladder stones were excluded from the study. Complete preoperative assessment with IPSS score, postvoid residual urine (PVRU) volume, and maximum flow rate (Qmax) were done in all cases. Patients' consent was obtained in all cases. The classical Nesbit approach was used for enucleation of the prostatic lobes. The equipment used was bipolar resectoscope (Olympus medical systems). An initial vaporization/resection was done at 12 o' clock position followed by vapoenucleation of right lateral lobe from 12 o' clock position till 7 o' clock position in anticlockwise manner. Similarly the procedure was repeated on the left side from 12 o' clock position till 5 o' clock position in clockwise manner. In the end, the lobes lying at the base devoid of most of the blood supply were resected quickly with a cutting loop. No morcellator was used for removal of prostatic tissue, thereby reducing procedure time. Finally, hemostasis is secured. Postoperative assessment was done at 3 months and included IPSS score, PVRU volume, and Qmax. Immediate postoperative outcomes such as catheter-free trial, blood loss, operative time, and hospital stay were recorded. Late complications during the 3 months follow-up were recorded. Results: Thirty-five patients underwent plasmakinetic vapoenucleation of the prostate (PKVEP). The mean prostate volume on preoperative ultrasonography was 65.7 cc and mean operative time was 55 minutes. Mean catheterization time was 37.6 hours, whereas mean hospital stay was 64 hours. The mean resected tissue weight was 32 g. There was a significant improvement from baseline in terms of IPSS, Qmax, and PVRU volume in all the patients. No significant complications were noted within the short follow-up of 3 months. Conclusions: Transurethral PKVEP is a safe and effective method in management of BPH. In our study, we found the learning curve to be more flat as it mimics the Nesbit's technique of monopolar TURP. No competing financial interests exist. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 7 mins 12 secs Presented as video at the World Congress of Endourology 2016 held at Cape Town, South Africa on November 8–12, 2016.

Transsphenoidal surgery for pituitary adenomas: early results from a single center.

To evaluate early results of transsphenoidal surgery for pituitary adenomas. Retrospective evaluation of 90 consecutive patients undergoing endoscopic pituitary adenoma surgery (2007-2016) at "Maggiore della Carità" Hospital in Novara, Italy. Age at diagnosis, sex, symptoms at presentation, hormonal and radiological data, complications of surgery, and short-term follow-up information were collected. The majority of patients were male (M/F: 1.5/1, mean age at diagnosis 62.1 ± 1.5years mean ± SEM). Most patients (91.1%) presented with a macroadenoma (27.4mm ± 1.1mm mean ± SEM), while 77.8% were non-functioning pituitary adenomas. Clinical presentations related to mass effect were visual impairment (74.0%) and/or hypopituitarism (55.1%). The main surgery complication was insipidus diabetes (12.2%), followed by cerebral hemorrhage (4.4%), cerebrospinal fluid (CSF) leaks (4.4%), syndrome of inappropriate antidiuresis (SIAD) (2.2%), and epistaxis (2.2%); only one patient died because of stroke. Risk of complications was not associated with tumor size (OR = 0.588, 95% CI 0.967-1.081, p = 0.443). Visual function improved in 70.6% of patients, while recovery of normal pituitary function occurred in 48.1%. Early neuroimaging studies demonstrated no residual tumor in 27.6% of patients. Invasion of cavernous sinus (OR = 3.293, 95% CI 0.897-16.738, p = 0.05) and maximum tumor diameter (OR = 6.857, 95% CI 1.039-1.309, p < 0.01) were associated with an unfavorable surgical outcome. Transsphenoidal endoscopic surgery for pituitary adenomas is safe and is frequently followed by improvement in visual symptoms, whereas recovery of pituitary function is less common. In our patients, complete surgical removal of adenomas is comparable to that of other series, but further investigations will be necessary to clarify the long-term risk of tumor recurrence.

EXPERIENCE OF LONG-TERM TERIPARATIDE USE FOR THE TREATMENT OF POSTOPERATIVE HYPOPARATHYROIDISM ASSOCIATED WITH OSTEOPOROSIS IN ELDERLY PATIENT

The aim of studyis to reflect the possibilities and effectiveness of teriparatide for the treatment of postoperative hypoparathyroidism associated with severe systemic osteoporosis, based on the data of the clinical case.Materials and methods.Patient N., aged 69, having a history of resection of 2/3 of the stomach according by Bilrot-2, urolithiasis, hypertension; since 2011 has been repeatedly hospitalized in National Medical Research Centre of Endocrinology, Ministry of Health of Russia, for secondary hyperparathyroidism and severe systemic osteoporosis. In 2016 thyroidectomy was performed in connection with papillary thyroid cancer and removal of left parathyroid gland adenoma, after which the patient developed postoperative hypoparathyroidism with severe uncontrolled hypocalcemia. As a replacement therapy, a synthetic analogue of parathyroid hormone, teriparatide, was used. For this work we used epicrisis of 2011–2016, as well as the results of the patient’s examination performed during the inpatient treatment in the Endocrinology Department of City Clinical Hospital № 4 (Ivanovo) from 2016 to 2018.Results.As a result of treatment with teriparatide in this patient, according to the results of a three-year follow-up, there is a positive clinical effect in the form of absence of convulsive syndrome, normalization of total and ionized calcium levels, absence of new compression fractures of vertebral bodies. Since the recovery of parathyroid gland function after surgery has not occurred, the use of this drug to the patient is recommended for the life term.Conclusion.The study describes a clinical case involving teriparatide as a therapy for postoperative hypoparathyroidism in combination with severe systemic osteoporosis and impaired calcium absorption in an elderly patient. The clinical effect of this type of treatment over a period of 3 years was proved in the form of normalization of phosphorus-calcium metabolism and the processes of bone remodeling in the absence of any side effects.

Pituitary neoplasms associated with intracranial aneurysm: A report of 4 cases and literature review

Objective To summarize the imaging findings, treatment and prognosis of pituitary adenoma associated with intracranial aneurysm. Methods From July 2014 to June 2017, 4 patients (3 females and 1 male) with pituitary macroadenoma associated with intracranial aneurysm were admitted to Neurosurgery Department of the Second Affiliated Hospital of Zhejiang University School of Medicine. Among them, 1 patient had bilateral ophthalmic artery aneurysms and 2 cases had right ophthalmic artery aneurysms. All those 3 cases underwent endovascular treatment of intracranial aneurysms followed by transsphenoidal surgery for pituitary adenomas. The other 1 patient with anterior communicating artery aneurysm underwent successful clipping of aneurysm after removal of pituitary adenoma. Results Of the 4 patients with pituitary adenoma and intracranial aneurysm, 3 underwent endovascular embolization of the aneurysm followed by endoscopic transsphenoidal pituitary adenoma resection. MRI showed no recurrence after resection. Digital subtraction angiography (DSA) was performed and revealed that the aneurysm had no recurrence and a good prognosis. One patient with anterior communicating artery aneurysm, although undergoing aneurysm clipping and pituitary adenoma resection, eventually gave up treatment due to pulmonary infection, resulting in a poor prognosis. Conclusions For patients with pituitary adenoma with high risk factors, it is recommended to perform magnetic resonance angiography (MRA) and/or DSA before surgery. MRI T1 and T2 weighted sequences showing flow shadow is an important factor for pituitary adenoma with intracranial aneurysms. For patients with pituitary adenomas with intracranial aneurysms, one or two stages of surgery should be performed according to the presence or absence of aneurysm, and a relatively good prognosis can be obtained. Key words: Pituitary neoplasms; Intracranial aneurysm; Diagnosis; Treatment; Prognosis