Untreated Pituitary Adenoma Research Articles

Mental health disorders in newly diagnosed non-functional pitutary adenoma under initial observation: an observational cohort study using the nationwide MarketScan database.

Nonfunctioning pituitary adenomas account for 15-30% of pituitary tumors. Studies exploring the role of an intracranial tumor diagnosis, specifically nonfunctioning pituitary adenomas, on mental health disorders (MHDs) in patients have been limited. We characterize the incidence and factors affecting the development of MHDs in untreated pituitary adenomas. Utilizing a large-scale private payor database, MarketScan, we performed a retrospective study of patients with an untreated pituitary adenomas and corresponding MHD. We found that in patients diagnosed with an untreated pituitary adenomas, approximately 15% were newly diagnosed with a MHD within 1 year of the pituitary adenoma diagnosis. Independent risk factors included female gender and substance abuse. Headaches, visual symptoms, and higher Charlson Co-morbidity indexes were also independently associated with a subsequent diagnosis of MHD. On multivariable analysis, patients in the pituitary tumor cohort were more likely to be diagnosed with a MHD than those in the matched cohort (aOR: 1.31, CI: 1.19-1.44). By identifying risk factors, advanced screening can focus on non-operative pituitary adenoma patients at high-risk for the development of MHD.

Transsphenoidal surgery assisted by a new guidance device: Results of a series of 747 cases

Objective The objective of this study is to report the efficacy and safety of microsurgical transsphenoidal surgery using a frame for sella guidance in a series of patients with untreated pituitary adenoma. Methods In this study, seven hundred and forty-seven patients undergoing transsphenoidal resection of a pituitary adenoma involving use of the frame were included. Follow-up of twelve to one hundred months was performed in all patients. Results During the procedures using the frame, pituitary adenomas were fully exposed, and no cavernous sinus haemorrhage due to anteroposterior displacement or internal carotid artery lesion due to right-and-left deviation occurred. The duration of the surgical procedure ranged from 28 min to 87 min with a mean of 44 min. The most frequent tumour type was prolactin-secreting adenoma (32.4%), followed by clinically non-functioning adenoma (NFPA) (28.5%), growth hormone-secreting adenoma (25.0%), and adrenocorticotropin-secreting adenoma (13.7%). Normalisation of visual defects occurred in 226 (42.2%) of the 535 patients with visual disturbances. Normalisation of hormone occurred in 458 of 551 patients with endocrine-active tumour in the follow-up period. Two patients died as a consequence of surgery. Conclusion The endonasal transsphenoidal technique is a safe, quick, and effective approach to pituitary adenomas. Our guidance frame allows the surgeon to open and close the wound rapidly, which avoids trajectory deviation and shortens the duration of the surgical procedure.

Two Cases of Acromegaly with Empty Sella Syndrome Treated by Long-Acting Release Octreotide

Two cases of typical acromegaly with empty sella syndrome presented to our institution. In the natural course of untreated pituitary adenoma, empty sella syndrome may result from necrosis by infarction or from hemorrhage of the pituitary gland. In our patients, the secretion of growth hormone continued in spite of the existence of empty sella syndrome. In one case, we confirmed the hypersecretion of growth hormone from sella by jugular vein sampling. Medical therapy with somatostatin analogue was attempted because there was no obvious mass in the sella. After 6~12 months of treatment with long-acting release octreotide, clinical features in our patients were improved, and the level of growth hormone and IGF-1 were also normalized. (J Kor Endocrine Soc 22:135~141, 2007)

Expression of Bcl-2, Bax and p53 proteins in pituitary adenomas: an immunohistochemical study.

Although pituitary adenomas are usually benign lesions, their growth rate is highly variable and unpredictable. Apoptosis appears to be an important process in neoplastic lesions. The purpose of this study was to investigate the expression of apoptosis-related proteins including Bcl-2, bax and p53 in pituitary adenomas and its correlation with hormone function, tumor size, local control, and proliferative activity. The expression of Bcl-2, Bax and p53 proteins and hormonal function were determined in formalin-fixed, paraffin-embedded tissue from 41 untreated pituitary adenomas using immunohistochemistry. The patients were followed for a median of 60 months (range, 12 to 95). Patient charts were reviewed to record tumor recurrence and size. Tumor proliferative activity was assessed by immunohistochemistry using Ki-67 antibody. Of 41 pituitary adenomas, 26 (63%) were hormone-secreting and 15 (37%) non-functioning, 34 (83%) were macroadenoma and 7 (17%) microadenoma, and 15 (37%) showed local relapse. Six (14%) adenomas were of low proliferative activity, whereas the others (86%) were non-proliferative. Immunohistochemically, 31 adenomas (75%) showed bcl-2 positivity, 37 (90%) bax positivity, and 7 (17%) p53 positivity. Statistical analysis revealed that Bcl-2 protein expression significantly diminished in prolactin-secreting and non-functioning adenomas (P = 0.005 and P = 0.006, respectively), and increased in growth hormone-secreting adenomas (P = 0.003). In addition, expression of bax protein significantly decreased in recurrent tumors, in contrast to p53 protein, which showed a significant increase (P = 0.03 and P = 0.002, respectively). We think that apoptosis-related proteins such as Bcl-2, Bax and p53 may be significantly related to hormone function and local control in pituitary adenomas.

Cerebrospinal fluid rhinorrhea in patients with untreated pituitary adenoma: Report of two cases

We report the cases of two patients with untreated pituitary adenoma who presented with cerebrospinal fluid rhinorrhea. The surgical treatment and mechanisms involved in this rare condition are discussed.

Gonadal Function in Fifty Men with Untreated Pituitary Adenomas*

Abstract Gonadal function was studied in 50 men with untreated pituitary adenomas. Seventy-four percent had impaired gonadotropin secretion, 82% had GH deficiency, 52% had TSH deficiency, 30% had ACTH deficiency, and 31% had PRL deficiency. Several unexpected abnormalities of gonadal function were found, including the following. 1) Four of the 14 men who could provide a semen specimen had normal total sperm counts in spite of subnormal serum testosterone concentration. 2) Although 35 of the 50 men (70%) had serum testosterone concentrations and LH responses to gonadotropin-releasing hormone that were either both normal or both subnormal, 11 men (22%) had subnormal serum testosterone concentrations but normal LH responses and 4 men (8%) had normal serum testosterone but subnormal LH responses. 3) Twelve men (24%) had supranormal serum FSH concentrations basally and/or in response to gonadotropin-releasing hormone. These 12 men had serum concentrations of testosterone that were low or low normal and serum c...

Nature and Treatment of Cerebrospinal Fluid Rhinorrhea in Pituitary Tumors

Untreated pituitary adenomas seldom produce cerebrospinal fluid rhinorrhea because the expanding tumor acts as a “stopper.” Rhinorrhea developing immediately after trans-sphenoidal procedures and sometimes after intracranial operation was a well known complication in the past, but the more common and persistent sphenoid sinus fistula usually develops as a later sequel of radiation therapy or surgery.

PITUITARY-ADRENAL FUNCTION TESTS IN PATIENTS WITH UNTREATED PITUITARY TUMOURS

The pituitary-adrenal function of twenty-three patients with untreated pituitary adenomas or suprasellar tumours has been assessed by the response to corticotrophin, pyrogen, vasopressin, insulin-induced hypoglycæmia, and metyrapone. Only three patients gave a completely normal series of responses, but there were considerable differences in the incidence of abnormal results obtained with the various tests. The responses to the metyrapone and hypoglycæmia tests were subnormal in approximately half the patients, whereas only two reacted subnormally to pyrogen. In some patients the stress of air encephalography produced a greater hydrocortisone response than vasopressin injection or hypoglycæmia.