Growth hormone-secreting pituitary adenomas(GHPAs)cause acromegaly,a condition characterized by persistent excess of growth hormone(GH)and its target hormone,insulin-like growth factor 1(IGF-1).This hormonal imbalance...Growth hormone-secreting pituitary adenomas(GHPAs)cause acromegaly,a condition characterized by persistent excess of growth hormone(GH)and its target hormone,insulin-like growth factor 1(IGF-1).This hormonal imbalance gives rise to diverse comorbidities,ultimately resulting in a shortened lifespan compared to the general population(Piccard et al.,2012).Extensive research has demonstrated that tumors exert a pivotal promoting effects on inflammation,and conversely,inflammatory responses exert reciprocal influence on various biological processes of tumors(Fridlender et al.,2009;Piccard et al.,2012).The microbiome profoundly impacts brain function,behavior,and neuroendocrine responses to stress.Through the hypothalamic-pituitary-adrenal(HPA)axis,the neuroendocrine system modulates the composition and permeability of the gastrointestinal tract,indicating a bidirectional network between gut microbiome and neuroendocrine system(Farzi et al.,2018).In the present study,we explored the microbiome profile in patients with GH adenomas and its potential role in inflammation,utilizing Mendelian randomization(MR)to reveal the casual relationship between microbiome and inflammation markers.展开更多
BACKGROUND Pituitary neuroendocrine tumors(PitNETs),formerly referred to as pituitary adenomas,are prevalent intracranial neoplasms that,although often benign histologically,can demonstrate invasive growth,therapeutic...BACKGROUND Pituitary neuroendocrine tumors(PitNETs),formerly referred to as pituitary adenomas,are prevalent intracranial neoplasms that,although often benign histologically,can demonstrate invasive growth,therapeutic resistance,and recurrence.Emerging evidence supports the presence of a subpopulation of tumorinitiating cells with stem-like properties-pituitary adenoma stem cells(PASCs)-that may drive these aggressive features.This systematic review aims to critically examine the evidence on PASCs,their phenotypic and functional characteristics,and their role in PitNET pathophysiology.AIM To study the molecular markers,signaling pathways,research models,and phenotypic traits of PASCs,and to assess their potential significance for future translational and clinical applications.METHODS A comprehensive literature search was conducted in PubMed,Scopus,and Ovid MEDLINE in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Thirty-four studies were included based on predefined eligibility criteria.Data were extracted regarding PASC isolation methods(e.g.,neurosphere formation,side population sorting),marker expression[e.g.,SRY-related HMG-box transcription factor(SOX)2,octamer-binding transcription factor 4,CD133,Nestin],pathway involvement(e.g.,Wnt/betacatenin,Notch,Sonic hedgehog),and functional behaviors such as self-renewal,differentiation,tumorigenicity,and therapy resistance.RESULTS Following duplicate removal,315 unique articles were screened,with 47 full texts assessed for eligibility.Ultimately,34 studies published between 2007 and 2025 met the inclusion criteria.The majority utilized human PitNET samples(83%),with a subset employing rat-derived cell lines(28%)or murine models(15%).PASCs were identified and characterized using various in vitro and in vivo approaches.Commonly reported stemness markers included SOX2(59%),CD133(38%),Nestin(35%),and octamer-binding transcription factor 4(26%),with others such as SOX9,paired-like homeobox 1,and C-X-C chemokine receptor type 4 also frequently cited.Wnt/betacatenin(18%)and phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin(9%)signaling pathways were most implicated,followed by Notch,Sonic hedgehog,and janus kinase/signal transducer and activator of transcription cascades.Functional assays revealed consistent findings of tumor initiation(44%),selfrenewal(35%),and tumor progression or invasion(35%).Notably,a minority of studies explored therapeutic interventions targeting PASCs,including gamma-secretase inhibitors and possible novel combinations of molecular agents.CONCLUSION The accumulating evidence on PASCs highlights their pivotal role in PitNET tumorigenesis,progression,and therapy resistance.Their molecular and functional overlap with normal pituitary stem cells underscores the need for further lineage-tracing and in vivo validation.展开更多
BACKGROUND Acromegaly is caused by a pituitary neuroendocrine tumor(PitNET)with excessive production of growth hormone(GH),leading to multisystem complications.Previous studies have identified predictors of disease pe...BACKGROUND Acromegaly is caused by a pituitary neuroendocrine tumor(PitNET)with excessive production of growth hormone(GH),leading to multisystem complications.Previous studies have identified predictors of disease persistence following surgery and poor response to medical treatment,including tumor size,vertical and horizontal extensions of the adenoma,hyperintensity in T2-weighted magnetic resonance imaging,granulation density,and pre-and postoperative GH and insulin-like growth factor 1(IGF-1)levels.AIM To evaluate PitNET volume as a complementary prognostic factor in patients with acromegaly.METHODS This is a retrospective descriptive study with an analytical component evaluating the correlation between the volumetric analysis of GH-producing PitNETs,IGF-1 levels before and after surgery,disease control during follow-up,and the line of therapy required for disease control in a cohort of patients treated at two centers:Endocrinology Department of the Central Military Hospital and Centros Médicos Colsanitas,Bogotá,Colombia.RESULTS A total of 77 patients with acromegaly(42 men,35 women)were included in this study.The mean age at diagnosis was 42 years(SD:12),with a mean disease duration of 9.9 years(SD:7.2).The mean pituitary tumor volume was 4358 mm^(3)(SD:6291,interquartile range[IQR]:13602).Patients with controlled acromegaly had a mean PitNET volume of 3202 mm^(3)(SD:4845,95%CI:621-5784)compared to 5513 mm^(3)(SD:7447,95%CI:1545-9482)in the uncontrolled group(P=0.15).A PitNET volume exceeding 3697 mm^(3)was associated with a higher likelihood of requiring third or fourth-line therapy(50%vs 36%;P=0.03).CONCLUSION PitNET volume was associated with the need for higher-line therapy to manage acromegaly but did not correlate with long-term disease control or with pre-or postsurgical IGF-1 levels.Nevertheless,a trend towards an inverse relationship between tumor volume and future disease control was observed.While macroadenoma classification remains crucial,among patients with macroadenomas,those with a volume exceeding 3697 mm³could have worse prognosis.展开更多
This study highlights the significance of considering pituitary neuroendocrine tumor volume when determining the appropriate line of therapy for patients with acromegaly.The findings suggest that,although tumor volume...This study highlights the significance of considering pituitary neuroendocrine tumor volume when determining the appropriate line of therapy for patients with acromegaly.The findings suggest that,although tumor volume may assist in predicting the need for more aggressive treatment strategies,it is not a reliable indicator of disease persistence following surgical intervention.Further research is warranted to investigate additional factors influencing acromegaly treatment outcomes to enhance patient care.展开更多
Acromegaly,characterized by persistent hypersecretion of growth hormone(GH),is most often caused by a pituitary neuroendocrine tumor(PitNET),though,less often,ectopic GH or GH-releasing hormone secretion from various ...Acromegaly,characterized by persistent hypersecretion of growth hormone(GH),is most often caused by a pituitary neuroendocrine tumor(PitNET),though,less often,ectopic GH or GH-releasing hormone secretion from various neoplasms outside the pituitary gland could cause it.Nearly 70%of somatotroph PitNETs are macroadenomas at diagnosis.Transsphenoidal surgery,the most effective treatment modality for acromegaly,could achieve remission in 73%.However,the remission rates could reach 87%if surgery is followed by medical therapy.Due to variable therapeutic responses to surgical and medical therapy,pre-treatment awareness regarding the best therapeutic modality based on clinical,biochemical,radiological,histopathological and genetic parameters would help in accurate pretreatment decision-making.Earlier studies have identified poor prognosis markers like tumor size,tumor invasion,T2-weighted hyperintensity,granulation,and pretreatment GH and/or insulin-like growth factor 1 levels.In a recent study,published by Alvarez et al identified that preoperative PitNET volume is a good predictor of control of acromegaly following surgical treatment and the likelihood of requiring more aggressive additional therapies after surgery.They found that PitNET volume exceeding 3697 mm³was associated with poorer disease control in patients with somatotroph PitNETs.展开更多
BACKGROUND Noonan syndrome(NS)is an autosomal dominant,multisystem disorder with a prevalence of 1 in 1000-2500.Multiple etiologies have been proposed for short stature in NS,including resistance to growth hormone(GH)...BACKGROUND Noonan syndrome(NS)is an autosomal dominant,multisystem disorder with a prevalence of 1 in 1000-2500.Multiple etiologies have been proposed for short stature in NS,including resistance to growth hormone(GH)and GH deficiency(GHD).Irrespective of the presence of GHD,NS is a Food and Drug Administration-approved indication for recombinant-GH therapy.Few case reports of combined anterior pituitary hormone deficiency(CPHD)in NS have been reported.AIM To describe the clinico-biochemical characteristics of NS with CPHD and to assess the response to recombinant GH therapy.METHODS An ambispective case-control study was conducted to compare the clinicohormonal profile and response to recombinant-GH in pediatric patients with NS and CPHD and pediatric patients with NS but without CPHD.RESULTS Five children with NS and CPHD were compared to 6 patients with NS but without CPHD.The most common anterior pituitary hormone involvement in combination with GHD was adrenocorticotrophic hormone deficiency causing hypocortisolemia(n=3,60%),followed by hypogonadotropic hypogonadism and secondary hypothyroidism(n=1 each).Pituitary hypoplasia was seen in the magnetic resonance imaging of all patients with CPHD.Patients with NS and CPHD had lower standard deviation scores of height(-4.18 vs-2.52,P=0.009),bodyweight,and body mass index but a slightly better first year response to recombinant GH(9.2 vs 5.5,P=0.06).There were no differences in dysmorphisms and other anomalies between the two groups.Patients with NS and CPHD had a similar response to GH as patients with CPHD but without NS.One patient with NS and CPHD developed hypocortisolism after GH initiation.CONCLUSION Hypoplasia of the pituitary and GHD with involvement of other pituitary hormones may be seen in NS and may determine response to recombinant GH therapy.展开更多
BACKGROUND Pituitary macroadenomas represent a significant challenge in clinical management due to their variable presentations and complex treatment considerations.This manuscript explores the multidisciplinary appro...BACKGROUND Pituitary macroadenomas represent a significant challenge in clinical management due to their variable presentations and complex treatment considerations.This manuscript explores the multidisciplinary approach to understanding and managing pituitary macroadenomas,integrating neurosurgery,endocrinology,radiology,and pathology perspectives.AIM To summarize the literature on pituitary macroadenoma and outline the possible multidisciplinary approach in the diagnosis,management,and rehabilitation of individuals with pituitary adenomas,to add to already preexisting knowledge,in managing these cases enhancing better ocular and systemic outcomes.METHODS A search was conducted on an online publication database(PubMed)using the term“pituitary adenoma”including all results published over twenty years(2004-2024).Results were sorted for relevance,language,and completeness.RESULTS A total of 176 records were returned.The guidelines of the PRISMA 2020 statement were followed in this study.A total of 23 records were excluded due to being out of scope while a further 13 records were duplicates.Another 17 records were not available as full-length articles and were also excluded.The references of each included record was further searched for relevant publications.A total of 141 records were therefore used in this minireview.CONCLUSION Pituitary macroadenomas pose substantial clinical challenges due to their size and potential for significant hormonal and neurological impact,modern therapeutic strategies offer effective management options.Early detection and comprehensive treatment are essential for optimizing patient outcomes and maintaining quality of life.Continued research and advancements in medical technology are likely to further enhance the management and prognosis of this condition in the future.展开更多
Objective： To explore the pituitary function of acute pituitary apoplexy and its effect by transsphenoidal surgery. Methods： The clinical data and endocrine hormones level of 25 patients with acute pituitary apoplex...Objective： To explore the pituitary function of acute pituitary apoplexy and its effect by transsphenoidal surgery. Methods： The clinical data and endocrine hormones level of 25 patients with acute pituitary apoplexy who underwent transsphenoidal surgery from Jan. 2002 to June 2004 were retrospectively analyzed. Results： 13 cases underwent surgery within 3 days after admission and 22 cases within 1 week. Of the 25 cases, 9 patients suffered the impairment of pituitary-thyroidal function, 14 cases of pituitary-adrenal function and 11 cases of pituitary-gonadal function before surgery. After surgery, 5/9, 8/14 and 7/11 were recovered from the corresponding hypopituitarism. Conclusion： Hypopituitarism is a major manifestation of acute pituitary apoplexy. Urgent surgery decompression contributed to the improvement of pituitary function. Patients with hypopituitarism after surgery required the corresponding hormones replacement therapy.展开更多
Objective: To study the relationship between histopathology and clinical prognosis of invasive pituitary adenoma subjected to transsphenoidal surgery. Methods: The enrolled were 82 patients with invasive pituitary ade...Objective: To study the relationship between histopathology and clinical prognosis of invasive pituitary adenoma subjected to transsphenoidal surgery. Methods: The enrolled were 82 patients with invasive pituitary adenomas undergoing transsphenoidal surgery during Jan. 2000 - May 2003 in our department with full MR imaging findings, pathology data and follow-up information. The follow-up duration was 5-30 months. Results: MR imaging findings of invasive pituitary adenoma included: depression of the sellar floor, involvement of sphenoid sinus and cavernous sinus, breakthrough of diaphragma sellae, encasement of internal carotid artery, etc. Pathological examination revealed that the invasion rate of dura in sella turcica was the highest among the structures around tumor. Pituitary adenoma apoplexy was found in 20 cases (24.4%). The total removal rate for PRL-secreting adenomas was significantly lower than that for non-secreting adenomas (P<0.01), but non-, GH-, ACTH-secreting adenomas had no significant differences. The recurrence rate of PRL-secreting adenomas was higher than that of non- and GH-secreting adenomas (P<0.05). Conclusion: Among invasive pituitary adenomas, the therapeutic effects of non-and GH-secreting pituitary adenomas are better than that of PRL-secreting adenomas. Invasive biological behaviors of invasive pituitary adenomas result in radical operation failure and postoperative recurrence.展开更多
A case of“Hypopituitarism and pituitary apoplex induced by pituitary Adenomas”was collected in the Third Affiliated Hospital of Inner Mongolia medical University Geriatric Department.A rare and atypical disease as i...A case of“Hypopituitarism and pituitary apoplex induced by pituitary Adenomas”was collected in the Third Affiliated Hospital of Inner Mongolia medical University Geriatric Department.A rare and atypical disease as it is,delayed diagnosis and treatment is easily seen among those cases.Therefore,the paper aims to investigate the difference of clinical characteristics and treatment outcome of pituitary adenomas in elder patient through the case analysis.Clinically,patients with pituitary dysfunction may have life-threatening crisis so that timely diagnosis and aggressive treatment can be effective in reducing the pituitary crisis and reducing the misdiagnosis rate.展开更多
An increasing amount of evidence demonstrates the anti-aging effect of Heshouwu in pill form. In this study, a subacute aging rat model was established by continuous intraperitoneal injection of D-galactose and treate...An increasing amount of evidence demonstrates the anti-aging effect of Heshouwu in pill form. In this study, a subacute aging rat model was established by continuous intraperitoneal injection of D-galactose and treated with Heshouwu decoction （a Chinese herb for tonifying the kidney, comprising Heshouwu pill, Herba Epimedii, Radix Salviae Miltiorrhiae, and Poria）. Heshouwu pill treated rats were the positive control group. Radioimmunoassay, immunohistochemical staining, and western blot assay showed hypothalamic gonadotropin-releasing hormone, hypothalamic substance P, and serum gonadotropin levels to be significantly increased in the model rats; the concentrations of hypothalamic ~3-endorphin, and serum levels of insulin-like growth factor I and testosterone were significantly decreased. 1713- and 3[3-hydroxysteroid dehydrogenase expression in testicular tissue was also decreased. Intragastric administration of Heshouwu decoction at high （9.6 g/mL/100 g）, medium （4.8 g/mL/100 g）, and low （2.4 g/mlJ100 g） doses, Heshouwu decoction pretreatment at a medium dose （4.8 g/mL/100 g）, and Heshouwu pill （2.06 g/mL/100 g） significantly reversed these changes. Heshouwu decoction pretreatment and high-dose Heshouwu decoction had the greatest anti-aging effects. These experimental findings indicate that Heshouwu decoction can improve hypothalamic-pituitary-testicular axis secretion in a subacute aging rat model, and prevent and delay gonadal axis aging, with an effect superior to that of Heshouwu pill.展开更多
To investigate effect of the soluble epidermal growth factor receptor (sEGFR/sErbB1) level in the periph-eral blood in development, invasiveness, apoplexy of each type of pituitary tumor. Methods The sEGFR level was d...To investigate effect of the soluble epidermal growth factor receptor (sEGFR/sErbB1) level in the periph-eral blood in development, invasiveness, apoplexy of each type of pituitary tumor. Methods The sEGFR level was determined in peripheral serum from 190 patients with pituitary diseases by enzyme linked immunosobent assay. The sEGFR levels were measured in 10 pituitary Rathke’s pouch, 18 pituitary hyperplasia, 161 pituitary adenomas including 30 microadenomas, 83 large adenomas, 48 giant adenomas, 1 pituitary carcinoma, and 28 hea-lthy controls. Results In the patients with pituitary hyperplasia, microadenoma, large adenoma, giant adenoma, and pituitary carci-noma, the sEGFR level was 188.92 ± 32.62, 209.83 ± 19.01, 333.20 ± 69.33, 405.85 ± 37.38, and 617.45 fmol/mL indepen-dently. They were all significantly higher than patients with pituitary Rathke’s pouch (156.78 ± 18.24 fmol/mL, P < 0.001) and healthy control group (159.11 ± 40.50 fmol/mL, P < 0.05). The sEGFR level in pituitary carcinoma was higher than pi-tuitary adenoma. In patients with pituitary adenoma, the sEGFR level was positive correlated to the size of pituitary adeno-mas (r = 0.998), the significant difference was observed for the sEGFR level in each group of the patients with pituitary adenomas (P < 0.001). Furthermore, in patients with pituitary ACTH-secreting microadenomas, the serum sEGFR levels in invasiveness (295.00 ± 77.80 fmol/mL) was higher than that in non-invasiveness (210.60 ± 16.4 fmol/mL, P < 0.05). In pati-ents with pituitary ACTH-secreting, PRL-secreting, GH-secreting, and non-functioning large adenomas, the serum sEGFR levels in invasiveness (407.86 ± 28.50, 399.25 ± 30.10, 386.00 ± 13.08, and 369.25 ± 36.70 fmol/mL) was higher than that in non-invasiveness (335.25 ± 63.49, 300.64 ± 47.57, 297.00 ± 61.93, and 269.30 ± 25.68 fmol/mL) respectively (P < 0.05). In patients with invasive pituitary PRL-secreting, GH-secreting, and non-functioning giant adenomas, the serum sEGFR levels not significantly different in between invasiveness (417.50 ± 35.94, 409.50 ± 69.14, and 417.50 ± 44.13 fmol/mL) and non-invasiveness (386.00 ± 49.64, 417.50 ± 44.03, and 409.51 ± 35.17 fmol/mL) (P > 0.05). In patients with pituitary large adeno-mas, the sEGFR levels in pituitary apoplexy (377.48 ± 39.18 fmol/mL) was higher than that in non-pituitary apoplexy (343.18 ± 68.17 fmol/mL, P > 0.05). Conclusions The increased level of peripheral serum sEGFR is concomitant with development, proliferous size of the adenomas in patients with pituitary adenomas. In addition, the elevated levels of serum sEGFR occur in pituitary apoplexy as clinical active tumors, and the non-invasive ACTH secreting adenomas. The sEGFR levels could be differen-tiated helpfully between pituitary adenomas and non-pituitary adenomas. These data suggest that serum sEGFR could be as a referable marker of the size and activation of proliferation in pituitary adenoma.展开更多
Objective: To investigate the predictability of MRI and the possiblebiological markers of cavernous sinus invasion of pituitary adenomas associated with fourphenomenas: angiogenesis, cell proliferation, apoptosis and ...Objective: To investigate the predictability of MRI and the possiblebiological markers of cavernous sinus invasion of pituitary adenomas associated with fourphenomenas: angiogenesis, cell proliferation, apoptosis and matrix metalloproteinase. Methods: Weevaluated 45 patients with pituitary adenoma according to the MRI, surgical findings and theimmunohistochemistry staining of tumor tissues. Results: The results have shown that the sensitivityof MRI for predicting cavernous sinus invasion in this prospective study was 60%, its specificity85%, its positive predictive value 83.33%, negative predictive value 62.96%. 45 specimens ofpituitary adenomas were analyzed for expression of F8, VEGF, Ki-67, c-myc, Bcl-2, nm23 and MMP-9immunoreactivity using immunoperoxidase staining. MVD was assessed using F8-related antigen. Theresults have shown that MVD of invasive pituitary adenomas was significantly higher than that ofnoninvasive (P 【 0.001). There was an association between the invasion of pituitary adenomas andKi-67 LI (P = 0.039) or the expression of VEGF (P 【 0.001) and MMP-9 (P 【 0.001). But c-myc LI andBcl-2 expression have no association with invasiveness of pituitary adenomas (P = 0.061 versus P =0.201). On the other hand, there is an inverse relationship between nm23 expression and tumorinvasion (P 【 0.001). Conclusion: Parasellar extension of pituitary adenomas through the medial wallof the cavernous sinus is diagnosed at surgery, and with sensitive gadolinium-enhanced MRI, itsextent can be partly determined by radiology. Although our study has shown that MVD and theexpression of VEGF, Ki-67, nm23 and MMP-9 have associations with invasiveness of pituitary adenomas,they are lack of specificity. These markers can only provide some useful information.展开更多
BACKGROUND Pituitary carcinoma is a rare type of malignancy that can be very difficult to diagnose and treat.Many cases were diagnosed at autopsy.Delays in diagnosis often adversely impact patients’outcomes.Even with...BACKGROUND Pituitary carcinoma is a rare type of malignancy that can be very difficult to diagnose and treat.Many cases were diagnosed at autopsy.Delays in diagnosis often adversely impact patients’outcomes.Even with prompt diagnosis,treatment decisions remain challenging in the absence of randomized controlled trials.CASE SUMMARY We report two cases of pituitary carcinoma in men with a history of pituitary adenoma.In the first case,a 55-year-old man was initially diagnosed with pituitary macroadenoma.He underwent subtotal debulking of the tumor followed by adjuvant radiotherapy.Subsequently,he developed relapsed disease and multifocal intracranial metastases and a diagnosis of pituitary carcinoma was rendered.He passed away despite several lines of systemic therapies including temozolomide,lomustine and bevacizumab.Another 52-year-old man was diagnosed with atypical pituitary adenoma with presentation of sudden onset of vision loss in the right eye.He had recurrent pituitary carcinoma with spinal metastases,treated with surgery,radiation and temozolomide.CONCLUSION Pituitary carcinoma is a rare neoplasm with poor prognosis that is difficult to diagnose and treat.The small number of cases restricts our ability to design randomized clinical trials.Management is largely driven by retrospective studies and case series.Establishing molecular biomarkers and comprehensive genomic profiling could help in decisions about diagnosis and management of pituitary carcinoma.展开更多
BACKGROUND Shock is among the most common conditions that clinicians face in intensive care unit(ICU),of which hypovolemic shock is encountered most frequently;some patients instead suffer from neurogenic,cardiogenic,...BACKGROUND Shock is among the most common conditions that clinicians face in intensive care unit(ICU),of which hypovolemic shock is encountered most frequently;some patients instead suffer from neurogenic,cardiogenic,or infectious forms of shock.However,there are additional types of shock from unusual causes that are often undiagnosed.Here,we report the case of a patient who was initially misdiagnosed with hypovolemic shock,but exhibited persistent hypotension because of continuous fluid replacement and vasoactive drug administration,and was eventually diagnosed with hypopituitarism with crisis.CASE SUMMARY A 73-year-old Chinese man was admitted to the neurosurgery department following injury caused by a heavy object with symptoms of anemia and high fever.He was transferred to the ICU on the fourth day after hospitalization because of hypotension and unconsciousness.Blood analysis indicated that the patient was suffering from anemia and thrombocytopenia.Ultrasonography showed that there was no apparent abnormality in the cardiac structure but there was mild tricuspid regurgitation.Computed tomography revealed that there were signs of hemorrhage at the right basal ganglia;accordingly,hypovolemic shock,possibly septic shock,was initially considered.Even after routine treatment for shock,the hypotension remained severe.The patient was again thoroughly examined to investigate the underlying cause.The antishock therapy was supplemented with corticosteroids to counter potential hypopituitarism.The patient made a full recovery,and the blood pressure returned to normal.CONCLUSION A case of pituitary adenoma with multiple injuries was identified.Because of hypopituitarism,functionality of the corresponding endocrine system was restricted,with the most pronounced manifestation being unstable blood circulation requiring hormone replacement therapy.Such cases are relatively rare but may occur if multiple injuries are sustained.The present case represents a reference for the clinical treatment of patients with multiple injuries.展开更多
BACKGROUND Pituitary apoplexy represents one of the most serious,life threatening endocrine emergencies that requires immediate management.Gonadotropin-releasing hormone agonist(GnRHa)can induce pituitary apoplexy in ...BACKGROUND Pituitary apoplexy represents one of the most serious,life threatening endocrine emergencies that requires immediate management.Gonadotropin-releasing hormone agonist(GnRHa)can induce pituitary apoplexy in those patients who have insidious pituitary adenoma coincidentally.CASE SUMMARY A 46-year-old woman,with a history of hypertension and menorrhagia was transferred to our hospital from a secondary care hospital after complaints of headache and vomiting,with loss of consciousness 5 min after an injection of GnRHa.The drug was prescribed by her gynecologist due to the presence of uterine myomas.The clinical neurological examination revealed right cranial nerve III palsy,ptosis and movement limitation of the right eye.Our first clinical consideration was a pituitary apoplexy.Blood hormonal analysis revealed mild hyperprolactinemia and high follicle stimulating hormone level;PTH and calcium was high with glomerular filtration rate mildly to moderately decrease.A computed tomography scan,revealed an enlarged pituitary gland(3.5 cm)impinging upon the optic chiasm with bone involvement of the sella.Following contrast media administration,the lesion showed homogeneous enhancement with high-density focus that suggests hemorrhagic infarction of the tumor.Transsphenoidal endoscopic surgery was perfomed and adenomatous tissue was removed.Immunohistochemistry was positive for luteinizing hormone(LH)and follicular-stimulating hormone(FSH).A solid hypoechoic nodule(14 mm x 13 mm x 16 mm)was found in the caudal portion of the right thyroid lobe after a parathyroid ultrasound.A genetic test of Multiple Endocrine Neoplasia type 1(MEN1)was negative.A right lower parathyroidectomy was performed and the pathologic study showed the presence of an encapsulated parathyroid carcinoma of 1.5 cm.A MEN type 4 genetic test was performed result was negative.CONCLUSION This case demonstrates an uncommon complication of GnRH agonist therapy in the setting of a pituitary macroadenoma and the casual finding of parathyroid carcinoma.It also highlights the importance of suspecting the presence of a multiple endocrine neoplasia syndrome and to carry out relevant genetic studies.展开更多
Introduction: Pituitary neuroendocrine tumor (PitNET) may present multisecreting forms. Identifying its forms helps to guide management. This management is a real challenge, given the limited resources in our regions....Introduction: Pituitary neuroendocrine tumor (PitNET) may present multisecreting forms. Identifying its forms helps to guide management. This management is a real challenge, given the limited resources in our regions. In view of advances in the management of these multisecreting pituitary neuroendocrine tumors and the lack of published data in Africa, and in Senegal particularly, this survey was carried out with the aim of describing the epidemiological, clinical and therapeutic aspects of multisecreting PitNETs. Patients and Method: It was a multicenter, retrospective, descriptive and analytical study carried out on files collected from 1st January 2008 to 31 December 2022 in the neurosurgery departments of the Fann and Principal hospitals in Dakar and the endocrinology department of the Abass Ndao hospital in Dakar. Results: Of the 242 patients treated for PitNET, 09 presented (the mean age of our patients was 41.7 ± 11 years) with bihormonal PitNET, i.e. a proportion of 3.71%. Two types of association were found: 08 tumors with GH (Growth Hormon) + PRL (prolactin) secretion and 01 PitNET with ACTH (Adreno Corticotropic Homon) + prolactin secretion. Clinically, gonadotropic insufficiency was found in all patients (100%). Dysmorphic syndrome was found in 6 patients (66.7%) and tumor syndrome in 7 patients (77.8%). Ophthalmological evaluation revealed a decrease in visual acuity in 66.6% of patients. All had macroadenomas, with extension noted in 02 patients. All patients underwent transsphenoidal surgery with complications such as transient diabetes insipidus (3 patients, 33.3%), followed by cerebrospinal fluid leaks (1 patient, 11.1%). Remission was noted in all 5 patients tested. A comparison between the different secretory forms did not reveal any significant difference in the frequency of postoperative complications. Conclusion: Despite the lack of immunohistochemistry, two types of association were found: ACTH-PRL and GH-PRL. All were macroadenomas, the majority with an associated tumor syndrome. The latter was significantly less frequent in bisecreting PitNETs compared with monosecreting and non-functional forms. However, there was no significant difference in the occurrence of post-operative complications between the three secretory forms of PitNETs.展开更多
Objective:This study mainly discusses the clinical effect of treating pituitary adenoma by using single nostril transsphenoidal resection of pituitary adenoma under neuro-endoscope,and analyzes the influence on hospit...Objective:This study mainly discusses the clinical effect of treating pituitary adenoma by using single nostril transsphenoidal resection of pituitary adenoma under neuro-endoscope,and analyzes the influence on hospitalization time and bleeding volume.Methods:A total of 335 patients with pituitary adenoma treated in our hospital from January 2017 to January 2019 were randomly selected for study.The patients were divided into two groups by number table method.167 patients in the reference group underwent single nostril transsphenoidal resection of pituitary adenoma under microscope.Also,168 patients in the study group underwent single nostril transsphenoidal resection of pituitary adenoma under neuroendoscope.The hospitalization time and bleeding volume and other surgical treatment effects were observed and compared.Results:There was no significant difference in the levels of prolactin(PRL),adrenocorticotropic hormone(ACTH)and thyroid stimulating hormone(TSH)between the two groups before operation(P>0.05);After surgical treatment,the levels of PRL,ACTH and TSH in the study group were lower than those in the control group(P<0.05);In terms of surgical indexes,the operation time and hospital stay in the study group were shorter than those in the reference group,and the amount of surgical bleeding was less than that in the reference group(P<0.05);The total tumor resection rate in the study group was higher than that in the reference group,and the incidence of complications such as nasal septal defect,cerebrospinal fluid leakage and diabetes insipidus in the study group was lower than that in the reference group(P<0.05).Conclusion:For pituitary adenoma diseases,using single nostril transsphenoidal resection of pituitary adenoma under neuroendoscope can improve the tumor resection rate,reduce the bleeding volume and shorten postoperative hospitalization time.展开更多
AIM:To analyze pituitary hormone and melatonin circadian rhythms, and to correlate hormonal alterations with clinical performance, hepatic disease severity and diagnostic tests used for the detection of hepatic enceph...AIM:To analyze pituitary hormone and melatonin circadian rhythms, and to correlate hormonal alterations with clinical performance, hepatic disease severity and diagnostic tests used for the detection of hepatic encephalopathy in cirrhosis. METHODS:Twenty-six patients with cirrhosis were enrolled in the study. Thirteen patients hospitalized for systemic diseases not affecting the liver were included as controls. Liver disease severity was assessed by the Child-Pugh score. All patients underwent detailed neurological assessment, electroencephalogram (EEG), brain magnetic resonance imaging (MRI), assays of pituitary hormone, cortisol and melatonin, and complete blood chemistry evaluation. RESULTS: Pituitary hormone and melatonin circadian patterns were altered in cirrhosis patients without clinical encephalopathy. Circadian hormone alterations were different in cirrhosis patients compared with controls. Although cortisol secretion was not altered in any patient with cirrhosis, the basal cortisol levels were lowand correlated with EEG and brain MRI abnormalities. Melatonin was the only hormone associated with the severity of liver insufficiency. CONCLUSION: Abnormal pituitary hormone and melatonin circadian patterns are present in cirrhosis before the development of hepatic encephalopathy. These abnormalities may be early indicators of impending hepatic encephalopathy. Factors affecting the human biologic clock at the early stages of liver insufficiency require further study.展开更多
Objective:To evaluate the alleviating effects of melatonin on oxidative changes in the testes and pituitary gland induced by subacute chlopyrifos（CPF） exposure in rats.Methods:Forty adult male Wistar rats divided in...Objective:To evaluate the alleviating effects of melatonin on oxidative changes in the testes and pituitary gland induced by subacute chlopyrifos（CPF） exposure in rats.Methods:Forty adult male Wistar rats divided into 4 groups of 10 animals were used for the study.Croup I received soya oil（2 mL/kg） while group II was administered with melatonin（0.5 mg/kg）.Group III was administered CPF only(8.5 mg/kg <sup> </sup>l/10th of the LD<sub>50</sub>) while group Ⅳ was pretreated with melatonin（0.5 mg/kg） and then exposed to CPF（8.5 mg/kg）,10 min later.The regimens were administered by gavage once daily for a period of 28 d.At the end of the exposure period, the rats were sacrificed and the testicular tissues and pituitary glands were evaluated for the malonaldehyde（MDA） concentration and activities of superoxide dismutase（SOD） and catalase（CAT）.Results:CPF increased MDA concentrations and reduced the activities of SOD and CAT in the testes and pituitary gland.Melatonin pretreatment reduced the testicular and pituitary MDA concentrations and improves the SOD and CAT activities.Conclusions:the study showed that subacute CPF-induced oxidative stress in the testes and pituitary glands were alleviated by melatonin due to its antioxidant property.展开更多
基金supported by the National Natural Science Foundation of China(82372624 to X.J.)Guangdong Basic and Applied Basic Research Foundation(2024A1515013102 and 2022A1515012430 to X.J.)The funders had no role in study design,data collection and interpretation,or the decision to submit the work for publication.
文摘Growth hormone-secreting pituitary adenomas(GHPAs)cause acromegaly,a condition characterized by persistent excess of growth hormone(GH)and its target hormone,insulin-like growth factor 1(IGF-1).This hormonal imbalance gives rise to diverse comorbidities,ultimately resulting in a shortened lifespan compared to the general population(Piccard et al.,2012).Extensive research has demonstrated that tumors exert a pivotal promoting effects on inflammation,and conversely,inflammatory responses exert reciprocal influence on various biological processes of tumors(Fridlender et al.,2009;Piccard et al.,2012).The microbiome profoundly impacts brain function,behavior,and neuroendocrine responses to stress.Through the hypothalamic-pituitary-adrenal(HPA)axis,the neuroendocrine system modulates the composition and permeability of the gastrointestinal tract,indicating a bidirectional network between gut microbiome and neuroendocrine system(Farzi et al.,2018).In the present study,we explored the microbiome profile in patients with GH adenomas and its potential role in inflammation,utilizing Mendelian randomization(MR)to reveal the casual relationship between microbiome and inflammation markers.
文摘BACKGROUND Pituitary neuroendocrine tumors(PitNETs),formerly referred to as pituitary adenomas,are prevalent intracranial neoplasms that,although often benign histologically,can demonstrate invasive growth,therapeutic resistance,and recurrence.Emerging evidence supports the presence of a subpopulation of tumorinitiating cells with stem-like properties-pituitary adenoma stem cells(PASCs)-that may drive these aggressive features.This systematic review aims to critically examine the evidence on PASCs,their phenotypic and functional characteristics,and their role in PitNET pathophysiology.AIM To study the molecular markers,signaling pathways,research models,and phenotypic traits of PASCs,and to assess their potential significance for future translational and clinical applications.METHODS A comprehensive literature search was conducted in PubMed,Scopus,and Ovid MEDLINE in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Thirty-four studies were included based on predefined eligibility criteria.Data were extracted regarding PASC isolation methods(e.g.,neurosphere formation,side population sorting),marker expression[e.g.,SRY-related HMG-box transcription factor(SOX)2,octamer-binding transcription factor 4,CD133,Nestin],pathway involvement(e.g.,Wnt/betacatenin,Notch,Sonic hedgehog),and functional behaviors such as self-renewal,differentiation,tumorigenicity,and therapy resistance.RESULTS Following duplicate removal,315 unique articles were screened,with 47 full texts assessed for eligibility.Ultimately,34 studies published between 2007 and 2025 met the inclusion criteria.The majority utilized human PitNET samples(83%),with a subset employing rat-derived cell lines(28%)or murine models(15%).PASCs were identified and characterized using various in vitro and in vivo approaches.Commonly reported stemness markers included SOX2(59%),CD133(38%),Nestin(35%),and octamer-binding transcription factor 4(26%),with others such as SOX9,paired-like homeobox 1,and C-X-C chemokine receptor type 4 also frequently cited.Wnt/betacatenin(18%)and phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin(9%)signaling pathways were most implicated,followed by Notch,Sonic hedgehog,and janus kinase/signal transducer and activator of transcription cascades.Functional assays revealed consistent findings of tumor initiation(44%),selfrenewal(35%),and tumor progression or invasion(35%).Notably,a minority of studies explored therapeutic interventions targeting PASCs,including gamma-secretase inhibitors and possible novel combinations of molecular agents.CONCLUSION The accumulating evidence on PASCs highlights their pivotal role in PitNET tumorigenesis,progression,and therapy resistance.Their molecular and functional overlap with normal pituitary stem cells underscores the need for further lineage-tracing and in vivo validation.
文摘BACKGROUND Acromegaly is caused by a pituitary neuroendocrine tumor(PitNET)with excessive production of growth hormone(GH),leading to multisystem complications.Previous studies have identified predictors of disease persistence following surgery and poor response to medical treatment,including tumor size,vertical and horizontal extensions of the adenoma,hyperintensity in T2-weighted magnetic resonance imaging,granulation density,and pre-and postoperative GH and insulin-like growth factor 1(IGF-1)levels.AIM To evaluate PitNET volume as a complementary prognostic factor in patients with acromegaly.METHODS This is a retrospective descriptive study with an analytical component evaluating the correlation between the volumetric analysis of GH-producing PitNETs,IGF-1 levels before and after surgery,disease control during follow-up,and the line of therapy required for disease control in a cohort of patients treated at two centers:Endocrinology Department of the Central Military Hospital and Centros Médicos Colsanitas,Bogotá,Colombia.RESULTS A total of 77 patients with acromegaly(42 men,35 women)were included in this study.The mean age at diagnosis was 42 years(SD:12),with a mean disease duration of 9.9 years(SD:7.2).The mean pituitary tumor volume was 4358 mm^(3)(SD:6291,interquartile range[IQR]:13602).Patients with controlled acromegaly had a mean PitNET volume of 3202 mm^(3)(SD:4845,95%CI:621-5784)compared to 5513 mm^(3)(SD:7447,95%CI:1545-9482)in the uncontrolled group(P=0.15).A PitNET volume exceeding 3697 mm^(3)was associated with a higher likelihood of requiring third or fourth-line therapy(50%vs 36%;P=0.03).CONCLUSION PitNET volume was associated with the need for higher-line therapy to manage acromegaly but did not correlate with long-term disease control or with pre-or postsurgical IGF-1 levels.Nevertheless,a trend towards an inverse relationship between tumor volume and future disease control was observed.While macroadenoma classification remains crucial,among patients with macroadenomas,those with a volume exceeding 3697 mm³could have worse prognosis.
文摘This study highlights the significance of considering pituitary neuroendocrine tumor volume when determining the appropriate line of therapy for patients with acromegaly.The findings suggest that,although tumor volume may assist in predicting the need for more aggressive treatment strategies,it is not a reliable indicator of disease persistence following surgical intervention.Further research is warranted to investigate additional factors influencing acromegaly treatment outcomes to enhance patient care.
文摘Acromegaly,characterized by persistent hypersecretion of growth hormone(GH),is most often caused by a pituitary neuroendocrine tumor(PitNET),though,less often,ectopic GH or GH-releasing hormone secretion from various neoplasms outside the pituitary gland could cause it.Nearly 70%of somatotroph PitNETs are macroadenomas at diagnosis.Transsphenoidal surgery,the most effective treatment modality for acromegaly,could achieve remission in 73%.However,the remission rates could reach 87%if surgery is followed by medical therapy.Due to variable therapeutic responses to surgical and medical therapy,pre-treatment awareness regarding the best therapeutic modality based on clinical,biochemical,radiological,histopathological and genetic parameters would help in accurate pretreatment decision-making.Earlier studies have identified poor prognosis markers like tumor size,tumor invasion,T2-weighted hyperintensity,granulation,and pretreatment GH and/or insulin-like growth factor 1 levels.In a recent study,published by Alvarez et al identified that preoperative PitNET volume is a good predictor of control of acromegaly following surgical treatment and the likelihood of requiring more aggressive additional therapies after surgery.They found that PitNET volume exceeding 3697 mm³was associated with poorer disease control in patients with somatotroph PitNETs.
文摘BACKGROUND Noonan syndrome(NS)is an autosomal dominant,multisystem disorder with a prevalence of 1 in 1000-2500.Multiple etiologies have been proposed for short stature in NS,including resistance to growth hormone(GH)and GH deficiency(GHD).Irrespective of the presence of GHD,NS is a Food and Drug Administration-approved indication for recombinant-GH therapy.Few case reports of combined anterior pituitary hormone deficiency(CPHD)in NS have been reported.AIM To describe the clinico-biochemical characteristics of NS with CPHD and to assess the response to recombinant GH therapy.METHODS An ambispective case-control study was conducted to compare the clinicohormonal profile and response to recombinant-GH in pediatric patients with NS and CPHD and pediatric patients with NS but without CPHD.RESULTS Five children with NS and CPHD were compared to 6 patients with NS but without CPHD.The most common anterior pituitary hormone involvement in combination with GHD was adrenocorticotrophic hormone deficiency causing hypocortisolemia(n=3,60%),followed by hypogonadotropic hypogonadism and secondary hypothyroidism(n=1 each).Pituitary hypoplasia was seen in the magnetic resonance imaging of all patients with CPHD.Patients with NS and CPHD had lower standard deviation scores of height(-4.18 vs-2.52,P=0.009),bodyweight,and body mass index but a slightly better first year response to recombinant GH(9.2 vs 5.5,P=0.06).There were no differences in dysmorphisms and other anomalies between the two groups.Patients with NS and CPHD had a similar response to GH as patients with CPHD but without NS.One patient with NS and CPHD developed hypocortisolism after GH initiation.CONCLUSION Hypoplasia of the pituitary and GHD with involvement of other pituitary hormones may be seen in NS and may determine response to recombinant GH therapy.
文摘BACKGROUND Pituitary macroadenomas represent a significant challenge in clinical management due to their variable presentations and complex treatment considerations.This manuscript explores the multidisciplinary approach to understanding and managing pituitary macroadenomas,integrating neurosurgery,endocrinology,radiology,and pathology perspectives.AIM To summarize the literature on pituitary macroadenoma and outline the possible multidisciplinary approach in the diagnosis,management,and rehabilitation of individuals with pituitary adenomas,to add to already preexisting knowledge,in managing these cases enhancing better ocular and systemic outcomes.METHODS A search was conducted on an online publication database(PubMed)using the term“pituitary adenoma”including all results published over twenty years(2004-2024).Results were sorted for relevance,language,and completeness.RESULTS A total of 176 records were returned.The guidelines of the PRISMA 2020 statement were followed in this study.A total of 23 records were excluded due to being out of scope while a further 13 records were duplicates.Another 17 records were not available as full-length articles and were also excluded.The references of each included record was further searched for relevant publications.A total of 141 records were therefore used in this minireview.CONCLUSION Pituitary macroadenomas pose substantial clinical challenges due to their size and potential for significant hormonal and neurological impact,modern therapeutic strategies offer effective management options.Early detection and comprehensive treatment are essential for optimizing patient outcomes and maintaining quality of life.Continued research and advancements in medical technology are likely to further enhance the management and prognosis of this condition in the future.
基金This project was supported by a grant from the National Natural Science Foundation of China (No. 39670736).
文摘Objective： To explore the pituitary function of acute pituitary apoplexy and its effect by transsphenoidal surgery. Methods： The clinical data and endocrine hormones level of 25 patients with acute pituitary apoplexy who underwent transsphenoidal surgery from Jan. 2002 to June 2004 were retrospectively analyzed. Results： 13 cases underwent surgery within 3 days after admission and 22 cases within 1 week. Of the 25 cases, 9 patients suffered the impairment of pituitary-thyroidal function, 14 cases of pituitary-adrenal function and 11 cases of pituitary-gonadal function before surgery. After surgery, 5/9, 8/14 and 7/11 were recovered from the corresponding hypopituitarism. Conclusion： Hypopituitarism is a major manifestation of acute pituitary apoplexy. Urgent surgery decompression contributed to the improvement of pituitary function. Patients with hypopituitarism after surgery required the corresponding hormones replacement therapy.
基金This project was supported by a grant from the National Natural Science Foundation of China (No. 39670736).
文摘Objective: To study the relationship between histopathology and clinical prognosis of invasive pituitary adenoma subjected to transsphenoidal surgery. Methods: The enrolled were 82 patients with invasive pituitary adenomas undergoing transsphenoidal surgery during Jan. 2000 - May 2003 in our department with full MR imaging findings, pathology data and follow-up information. The follow-up duration was 5-30 months. Results: MR imaging findings of invasive pituitary adenoma included: depression of the sellar floor, involvement of sphenoid sinus and cavernous sinus, breakthrough of diaphragma sellae, encasement of internal carotid artery, etc. Pathological examination revealed that the invasion rate of dura in sella turcica was the highest among the structures around tumor. Pituitary adenoma apoplexy was found in 20 cases (24.4%). The total removal rate for PRL-secreting adenomas was significantly lower than that for non-secreting adenomas (P<0.01), but non-, GH-, ACTH-secreting adenomas had no significant differences. The recurrence rate of PRL-secreting adenomas was higher than that of non- and GH-secreting adenomas (P<0.05). Conclusion: Among invasive pituitary adenomas, the therapeutic effects of non-and GH-secreting pituitary adenomas are better than that of PRL-secreting adenomas. Invasive biological behaviors of invasive pituitary adenomas result in radical operation failure and postoperative recurrence.
文摘A case of“Hypopituitarism and pituitary apoplex induced by pituitary Adenomas”was collected in the Third Affiliated Hospital of Inner Mongolia medical University Geriatric Department.A rare and atypical disease as it is,delayed diagnosis and treatment is easily seen among those cases.Therefore,the paper aims to investigate the difference of clinical characteristics and treatment outcome of pituitary adenomas in elder patient through the case analysis.Clinically,patients with pituitary dysfunction may have life-threatening crisis so that timely diagnosis and aggressive treatment can be effective in reducing the pituitary crisis and reducing the misdiagnosis rate.
基金supported by the Talent Introduction Fund of Hebei University, No. 2010-183the Medical Science Special Fund of Hebei University, No. 2012A1005+1 种基金the Key Project of Hebei Provincial Health Department, No. 20110151a grant from Hebei Provincial Administration of Traditional Chinese Medicine, No. 2011104
文摘An increasing amount of evidence demonstrates the anti-aging effect of Heshouwu in pill form. In this study, a subacute aging rat model was established by continuous intraperitoneal injection of D-galactose and treated with Heshouwu decoction （a Chinese herb for tonifying the kidney, comprising Heshouwu pill, Herba Epimedii, Radix Salviae Miltiorrhiae, and Poria）. Heshouwu pill treated rats were the positive control group. Radioimmunoassay, immunohistochemical staining, and western blot assay showed hypothalamic gonadotropin-releasing hormone, hypothalamic substance P, and serum gonadotropin levels to be significantly increased in the model rats; the concentrations of hypothalamic ~3-endorphin, and serum levels of insulin-like growth factor I and testosterone were significantly decreased. 1713- and 3[3-hydroxysteroid dehydrogenase expression in testicular tissue was also decreased. Intragastric administration of Heshouwu decoction at high （9.6 g/mL/100 g）, medium （4.8 g/mL/100 g）, and low （2.4 g/mlJ100 g） doses, Heshouwu decoction pretreatment at a medium dose （4.8 g/mL/100 g）, and Heshouwu pill （2.06 g/mL/100 g） significantly reversed these changes. Heshouwu decoction pretreatment and high-dose Heshouwu decoction had the greatest anti-aging effects. These experimental findings indicate that Heshouwu decoction can improve hypothalamic-pituitary-testicular axis secretion in a subacute aging rat model, and prevent and delay gonadal axis aging, with an effect superior to that of Heshouwu pill.
文摘To investigate effect of the soluble epidermal growth factor receptor (sEGFR/sErbB1) level in the periph-eral blood in development, invasiveness, apoplexy of each type of pituitary tumor. Methods The sEGFR level was determined in peripheral serum from 190 patients with pituitary diseases by enzyme linked immunosobent assay. The sEGFR levels were measured in 10 pituitary Rathke’s pouch, 18 pituitary hyperplasia, 161 pituitary adenomas including 30 microadenomas, 83 large adenomas, 48 giant adenomas, 1 pituitary carcinoma, and 28 hea-lthy controls. Results In the patients with pituitary hyperplasia, microadenoma, large adenoma, giant adenoma, and pituitary carci-noma, the sEGFR level was 188.92 ± 32.62, 209.83 ± 19.01, 333.20 ± 69.33, 405.85 ± 37.38, and 617.45 fmol/mL indepen-dently. They were all significantly higher than patients with pituitary Rathke’s pouch (156.78 ± 18.24 fmol/mL, P < 0.001) and healthy control group (159.11 ± 40.50 fmol/mL, P < 0.05). The sEGFR level in pituitary carcinoma was higher than pi-tuitary adenoma. In patients with pituitary adenoma, the sEGFR level was positive correlated to the size of pituitary adeno-mas (r = 0.998), the significant difference was observed for the sEGFR level in each group of the patients with pituitary adenomas (P < 0.001). Furthermore, in patients with pituitary ACTH-secreting microadenomas, the serum sEGFR levels in invasiveness (295.00 ± 77.80 fmol/mL) was higher than that in non-invasiveness (210.60 ± 16.4 fmol/mL, P < 0.05). In pati-ents with pituitary ACTH-secreting, PRL-secreting, GH-secreting, and non-functioning large adenomas, the serum sEGFR levels in invasiveness (407.86 ± 28.50, 399.25 ± 30.10, 386.00 ± 13.08, and 369.25 ± 36.70 fmol/mL) was higher than that in non-invasiveness (335.25 ± 63.49, 300.64 ± 47.57, 297.00 ± 61.93, and 269.30 ± 25.68 fmol/mL) respectively (P < 0.05). In patients with invasive pituitary PRL-secreting, GH-secreting, and non-functioning giant adenomas, the serum sEGFR levels not significantly different in between invasiveness (417.50 ± 35.94, 409.50 ± 69.14, and 417.50 ± 44.13 fmol/mL) and non-invasiveness (386.00 ± 49.64, 417.50 ± 44.03, and 409.51 ± 35.17 fmol/mL) (P > 0.05). In patients with pituitary large adeno-mas, the sEGFR levels in pituitary apoplexy (377.48 ± 39.18 fmol/mL) was higher than that in non-pituitary apoplexy (343.18 ± 68.17 fmol/mL, P > 0.05). Conclusions The increased level of peripheral serum sEGFR is concomitant with development, proliferous size of the adenomas in patients with pituitary adenomas. In addition, the elevated levels of serum sEGFR occur in pituitary apoplexy as clinical active tumors, and the non-invasive ACTH secreting adenomas. The sEGFR levels could be differen-tiated helpfully between pituitary adenomas and non-pituitary adenomas. These data suggest that serum sEGFR could be as a referable marker of the size and activation of proliferation in pituitary adenoma.
文摘Objective: To investigate the predictability of MRI and the possiblebiological markers of cavernous sinus invasion of pituitary adenomas associated with fourphenomenas: angiogenesis, cell proliferation, apoptosis and matrix metalloproteinase. Methods: Weevaluated 45 patients with pituitary adenoma according to the MRI, surgical findings and theimmunohistochemistry staining of tumor tissues. Results: The results have shown that the sensitivityof MRI for predicting cavernous sinus invasion in this prospective study was 60%, its specificity85%, its positive predictive value 83.33%, negative predictive value 62.96%. 45 specimens ofpituitary adenomas were analyzed for expression of F8, VEGF, Ki-67, c-myc, Bcl-2, nm23 and MMP-9immunoreactivity using immunoperoxidase staining. MVD was assessed using F8-related antigen. Theresults have shown that MVD of invasive pituitary adenomas was significantly higher than that ofnoninvasive (P 【 0.001). There was an association between the invasion of pituitary adenomas andKi-67 LI (P = 0.039) or the expression of VEGF (P 【 0.001) and MMP-9 (P 【 0.001). But c-myc LI andBcl-2 expression have no association with invasiveness of pituitary adenomas (P = 0.061 versus P =0.201). On the other hand, there is an inverse relationship between nm23 expression and tumorinvasion (P 【 0.001). Conclusion: Parasellar extension of pituitary adenomas through the medial wallof the cavernous sinus is diagnosed at surgery, and with sensitive gadolinium-enhanced MRI, itsextent can be partly determined by radiology. Although our study has shown that MVD and theexpression of VEGF, Ki-67, nm23 and MMP-9 have associations with invasiveness of pituitary adenomas,they are lack of specificity. These markers can only provide some useful information.
文摘BACKGROUND Pituitary carcinoma is a rare type of malignancy that can be very difficult to diagnose and treat.Many cases were diagnosed at autopsy.Delays in diagnosis often adversely impact patients’outcomes.Even with prompt diagnosis,treatment decisions remain challenging in the absence of randomized controlled trials.CASE SUMMARY We report two cases of pituitary carcinoma in men with a history of pituitary adenoma.In the first case,a 55-year-old man was initially diagnosed with pituitary macroadenoma.He underwent subtotal debulking of the tumor followed by adjuvant radiotherapy.Subsequently,he developed relapsed disease and multifocal intracranial metastases and a diagnosis of pituitary carcinoma was rendered.He passed away despite several lines of systemic therapies including temozolomide,lomustine and bevacizumab.Another 52-year-old man was diagnosed with atypical pituitary adenoma with presentation of sudden onset of vision loss in the right eye.He had recurrent pituitary carcinoma with spinal metastases,treated with surgery,radiation and temozolomide.CONCLUSION Pituitary carcinoma is a rare neoplasm with poor prognosis that is difficult to diagnose and treat.The small number of cases restricts our ability to design randomized clinical trials.Management is largely driven by retrospective studies and case series.Establishing molecular biomarkers and comprehensive genomic profiling could help in decisions about diagnosis and management of pituitary carcinoma.
基金Supported by the Doctoral Research Fund Project of The Second Affiliated Hospital of Anhui Medical University,No.2018BSJJ005.
文摘BACKGROUND Shock is among the most common conditions that clinicians face in intensive care unit(ICU),of which hypovolemic shock is encountered most frequently;some patients instead suffer from neurogenic,cardiogenic,or infectious forms of shock.However,there are additional types of shock from unusual causes that are often undiagnosed.Here,we report the case of a patient who was initially misdiagnosed with hypovolemic shock,but exhibited persistent hypotension because of continuous fluid replacement and vasoactive drug administration,and was eventually diagnosed with hypopituitarism with crisis.CASE SUMMARY A 73-year-old Chinese man was admitted to the neurosurgery department following injury caused by a heavy object with symptoms of anemia and high fever.He was transferred to the ICU on the fourth day after hospitalization because of hypotension and unconsciousness.Blood analysis indicated that the patient was suffering from anemia and thrombocytopenia.Ultrasonography showed that there was no apparent abnormality in the cardiac structure but there was mild tricuspid regurgitation.Computed tomography revealed that there were signs of hemorrhage at the right basal ganglia;accordingly,hypovolemic shock,possibly septic shock,was initially considered.Even after routine treatment for shock,the hypotension remained severe.The patient was again thoroughly examined to investigate the underlying cause.The antishock therapy was supplemented with corticosteroids to counter potential hypopituitarism.The patient made a full recovery,and the blood pressure returned to normal.CONCLUSION A case of pituitary adenoma with multiple injuries was identified.Because of hypopituitarism,functionality of the corresponding endocrine system was restricted,with the most pronounced manifestation being unstable blood circulation requiring hormone replacement therapy.Such cases are relatively rare but may occur if multiple injuries are sustained.The present case represents a reference for the clinical treatment of patients with multiple injuries.
基金Supported by FIS del Instituto de Salud Carlos Ⅲ(FEDER from E.U.),Spain,No.PI13/00322 and PI16/00884
文摘BACKGROUND Pituitary apoplexy represents one of the most serious,life threatening endocrine emergencies that requires immediate management.Gonadotropin-releasing hormone agonist(GnRHa)can induce pituitary apoplexy in those patients who have insidious pituitary adenoma coincidentally.CASE SUMMARY A 46-year-old woman,with a history of hypertension and menorrhagia was transferred to our hospital from a secondary care hospital after complaints of headache and vomiting,with loss of consciousness 5 min after an injection of GnRHa.The drug was prescribed by her gynecologist due to the presence of uterine myomas.The clinical neurological examination revealed right cranial nerve III palsy,ptosis and movement limitation of the right eye.Our first clinical consideration was a pituitary apoplexy.Blood hormonal analysis revealed mild hyperprolactinemia and high follicle stimulating hormone level;PTH and calcium was high with glomerular filtration rate mildly to moderately decrease.A computed tomography scan,revealed an enlarged pituitary gland(3.5 cm)impinging upon the optic chiasm with bone involvement of the sella.Following contrast media administration,the lesion showed homogeneous enhancement with high-density focus that suggests hemorrhagic infarction of the tumor.Transsphenoidal endoscopic surgery was perfomed and adenomatous tissue was removed.Immunohistochemistry was positive for luteinizing hormone(LH)and follicular-stimulating hormone(FSH).A solid hypoechoic nodule(14 mm x 13 mm x 16 mm)was found in the caudal portion of the right thyroid lobe after a parathyroid ultrasound.A genetic test of Multiple Endocrine Neoplasia type 1(MEN1)was negative.A right lower parathyroidectomy was performed and the pathologic study showed the presence of an encapsulated parathyroid carcinoma of 1.5 cm.A MEN type 4 genetic test was performed result was negative.CONCLUSION This case demonstrates an uncommon complication of GnRH agonist therapy in the setting of a pituitary macroadenoma and the casual finding of parathyroid carcinoma.It also highlights the importance of suspecting the presence of a multiple endocrine neoplasia syndrome and to carry out relevant genetic studies.
文摘Introduction: Pituitary neuroendocrine tumor (PitNET) may present multisecreting forms. Identifying its forms helps to guide management. This management is a real challenge, given the limited resources in our regions. In view of advances in the management of these multisecreting pituitary neuroendocrine tumors and the lack of published data in Africa, and in Senegal particularly, this survey was carried out with the aim of describing the epidemiological, clinical and therapeutic aspects of multisecreting PitNETs. Patients and Method: It was a multicenter, retrospective, descriptive and analytical study carried out on files collected from 1st January 2008 to 31 December 2022 in the neurosurgery departments of the Fann and Principal hospitals in Dakar and the endocrinology department of the Abass Ndao hospital in Dakar. Results: Of the 242 patients treated for PitNET, 09 presented (the mean age of our patients was 41.7 ± 11 years) with bihormonal PitNET, i.e. a proportion of 3.71%. Two types of association were found: 08 tumors with GH (Growth Hormon) + PRL (prolactin) secretion and 01 PitNET with ACTH (Adreno Corticotropic Homon) + prolactin secretion. Clinically, gonadotropic insufficiency was found in all patients (100%). Dysmorphic syndrome was found in 6 patients (66.7%) and tumor syndrome in 7 patients (77.8%). Ophthalmological evaluation revealed a decrease in visual acuity in 66.6% of patients. All had macroadenomas, with extension noted in 02 patients. All patients underwent transsphenoidal surgery with complications such as transient diabetes insipidus (3 patients, 33.3%), followed by cerebrospinal fluid leaks (1 patient, 11.1%). Remission was noted in all 5 patients tested. A comparison between the different secretory forms did not reveal any significant difference in the frequency of postoperative complications. Conclusion: Despite the lack of immunohistochemistry, two types of association were found: ACTH-PRL and GH-PRL. All were macroadenomas, the majority with an associated tumor syndrome. The latter was significantly less frequent in bisecreting PitNETs compared with monosecreting and non-functional forms. However, there was no significant difference in the occurrence of post-operative complications between the three secretory forms of PitNETs.
文摘Objective:This study mainly discusses the clinical effect of treating pituitary adenoma by using single nostril transsphenoidal resection of pituitary adenoma under neuro-endoscope,and analyzes the influence on hospitalization time and bleeding volume.Methods:A total of 335 patients with pituitary adenoma treated in our hospital from January 2017 to January 2019 were randomly selected for study.The patients were divided into two groups by number table method.167 patients in the reference group underwent single nostril transsphenoidal resection of pituitary adenoma under microscope.Also,168 patients in the study group underwent single nostril transsphenoidal resection of pituitary adenoma under neuroendoscope.The hospitalization time and bleeding volume and other surgical treatment effects were observed and compared.Results:There was no significant difference in the levels of prolactin(PRL),adrenocorticotropic hormone(ACTH)and thyroid stimulating hormone(TSH)between the two groups before operation(P>0.05);After surgical treatment,the levels of PRL,ACTH and TSH in the study group were lower than those in the control group(P<0.05);In terms of surgical indexes,the operation time and hospital stay in the study group were shorter than those in the reference group,and the amount of surgical bleeding was less than that in the reference group(P<0.05);The total tumor resection rate in the study group was higher than that in the reference group,and the incidence of complications such as nasal septal defect,cerebrospinal fluid leakage and diabetes insipidus in the study group was lower than that in the reference group(P<0.05).Conclusion:For pituitary adenoma diseases,using single nostril transsphenoidal resection of pituitary adenoma under neuroendoscope can improve the tumor resection rate,reduce the bleeding volume and shorten postoperative hospitalization time.
文摘AIM:To analyze pituitary hormone and melatonin circadian rhythms, and to correlate hormonal alterations with clinical performance, hepatic disease severity and diagnostic tests used for the detection of hepatic encephalopathy in cirrhosis. METHODS:Twenty-six patients with cirrhosis were enrolled in the study. Thirteen patients hospitalized for systemic diseases not affecting the liver were included as controls. Liver disease severity was assessed by the Child-Pugh score. All patients underwent detailed neurological assessment, electroencephalogram (EEG), brain magnetic resonance imaging (MRI), assays of pituitary hormone, cortisol and melatonin, and complete blood chemistry evaluation. RESULTS: Pituitary hormone and melatonin circadian patterns were altered in cirrhosis patients without clinical encephalopathy. Circadian hormone alterations were different in cirrhosis patients compared with controls. Although cortisol secretion was not altered in any patient with cirrhosis, the basal cortisol levels were lowand correlated with EEG and brain MRI abnormalities. Melatonin was the only hormone associated with the severity of liver insufficiency. CONCLUSION: Abnormal pituitary hormone and melatonin circadian patterns are present in cirrhosis before the development of hepatic encephalopathy. These abnormalities may be early indicators of impending hepatic encephalopathy. Factors affecting the human biologic clock at the early stages of liver insufficiency require further study.
基金Partly supported by Ahmadu Bello University Board of Research(Grant No.ABU/UBR/125/09)
文摘Objective:To evaluate the alleviating effects of melatonin on oxidative changes in the testes and pituitary gland induced by subacute chlopyrifos（CPF） exposure in rats.Methods:Forty adult male Wistar rats divided into 4 groups of 10 animals were used for the study.Croup I received soya oil（2 mL/kg） while group II was administered with melatonin（0.5 mg/kg）.Group III was administered CPF only(8.5 mg/kg <sup> </sup>l/10th of the LD<sub>50</sub>) while group Ⅳ was pretreated with melatonin（0.5 mg/kg） and then exposed to CPF（8.5 mg/kg）,10 min later.The regimens were administered by gavage once daily for a period of 28 d.At the end of the exposure period, the rats were sacrificed and the testicular tissues and pituitary glands were evaluated for the malonaldehyde（MDA） concentration and activities of superoxide dismutase（SOD） and catalase（CAT）.Results:CPF increased MDA concentrations and reduced the activities of SOD and CAT in the testes and pituitary gland.Melatonin pretreatment reduced the testicular and pituitary MDA concentrations and improves the SOD and CAT activities.Conclusions:the study showed that subacute CPF-induced oxidative stress in the testes and pituitary glands were alleviated by melatonin due to its antioxidant property.
