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Zhang M, Xia C, Tang J, Yao L, Hu N, Li J, Peng W, Hu S, Ye Z, Zhang X, Huang J, Li Z. Evaluation of high-resolution pituitary dynamic contrast-enhanced MRI using deep learning-based compressed sensing and super-resolution reconstruction. Eur Radiol 2025:10.1007/s00330-025-11574-5. [PMID: 40221940 DOI: 10.1007/s00330-025-11574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 02/04/2025] [Accepted: 03/06/2025] [Indexed: 04/15/2025]
Abstract
OBJECTIVE This study aims to assess diagnostic performance of high-resolution dynamic contrast-enhanced (DCE) MRI with deep learning-based compressed sensing and super-resolution (DLCS-SR) reconstruction for identifying microadenomas. MATERIALS AND METHODS This prospective study included 126 participants with suspected pituitary microadenomas who underwent DCE MRI between June 2023 and January 2024. Four image groups were derived from single-scan DCE MRI, which included 1.5-mm slice thickness images using DLCS-SR (1.5-mm DLCS-SR images), 1.5-mm slice thickness images with deep learning-based compressed sensing reconstruction (1.5-mm DLCS images), 1.5-mm routine images, and 3-mm slice thickness images using DLCS-SR (3-mm DLCS-SR images). Diagnostic criteria were established by incorporating laboratory findings, clinical symptoms, medical histories, previous imaging, and certain pathologic reports. Two readers assessed the diagnostic performance in identifying pituitary abnormalities and microadenomas. Diagnostic agreements were assessed using κ statistics, and intergroup comparisons for microadenoma detection were performed using the DeLong and McNemar tests. RESULTS The 1.5-mm DLCS-SR images (κ = 0.746-0.848) exhibited superior diagnostic agreement, outperforming 1.5-mm DLCS (κ = 0.585-0.687), 1.5-mm routine (κ = 0.449-0.487), and 3-mm DLCS-SR images (κ = 0.347-0.369) (p < 0.001 for all). Additionally, the performance of 1.5-mm DLCS-SR images in identifying microadenomas [area under the receiver operating characteristic curve (AUC), 0.89-0.94] surpassed that of 1.5-mm DLCS (AUC, 0.83-0.87; p = 0.042 and 0.011, respectively), 1.5-mm routine (AUC, 0.76-0.78; p < 0.001), and 3-mm DLCS-SR images (AUC, 0.72-0.74; p < 0.001). CONCLUSION The findings revealed superior diagnostic performance of 1.5-mm DLCS-SR images in identifying pituitary abnormalities and microadenomas, indicating the clinical-potential of high-resolution DCE MRI. KEY POINTS Question What strategies can overcome the resolution limitations of conventional dynamic contrast-enhanced (DCE) MRI, and which contribute to a high false-negative rate in diagnosing pituitary microadenomas? Findings Deep learning-based compressed sensing and super-resolution reconstruction applied to DCE MRI achieved high resolution while improving image quality and diagnostic efficacy. Clinical relevance DCE MRI with a 1.5-mm slice thickness and high in-plane resolution, utilizing deep learning-based compressed sensing and super-resolution reconstruction, significantly enhances diagnostic accuracy for pituitary abnormalities and microadenomas, enabling timely and effective patient management.
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Affiliation(s)
- Meng Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Yao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Na Hu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaqi Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Wanlin Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Sixian Hu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zheng Ye
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Jin Huang
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, China.
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
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2
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Newall N, Valetopoulou A, Khan DZ, Borg A, Bouloux PMG, Bremner F, Buchfelder M, Cudlip S, Dorward N, Drake WM, Fernandez-Miranda JC, Fleseriu M, Geltzeiler M, Ginn J, Gurnell M, Harris S, Jaunmuktane Z, Korbonits M, Kosmin M, Koulouri O, Layard Horsfall H, Mamelak AN, Mannion R, McBride P, McCormack AI, Melmed S, Miszkiel KA, Raverot G, Santarius T, Schwartz TH, Serrano I, Zada G, Baldeweg SE, Kolias AG, Marcus HJ. Identifying research priorities for pituitary adenoma surgery: an international Delphi consensus statement. Pituitary 2025; 28:36. [PMID: 40042764 PMCID: PMC11882698 DOI: 10.1007/s11102-025-01502-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2025] [Indexed: 03/09/2025]
Abstract
PURPOSE Pituitary surgery is the mainstay treatment for most pituitary adenomas, but many questions remain about perioperative and long-term management and outcomes. This study aimed to identify the most pressing research priorities in pituitary surgery with input from patients, caregivers, and healthcare professionals. METHODS An initial survey of patients, caregivers, and healthcare professionals assembled priorities related to preoperative care, surgical techniques, and postoperative management in pituitary surgery. Priorities were thematically grouped into summary priorities, and those answered by existing evidence were omitted following a literature review. An interim survey asked patients, caregivers, and healthcare professionals to select their top 10 priorities from the remaining list. The highest-ranked priorities advanced to a consensus meeting, where the top 10 questions were prioritized. RESULTS In the initial survey, 147 participants-60.5% of whom were patients, caregivers, or patient support group representatives-submitted 785 priorities, which were then condensed into 52 summary priorities. After a literature review, 33 unanswered priorities were included in the interim survey, completed by 155 respondents, of whom 54.2% were patients, caregivers, or patient support group representatives. The top-ranked priorities were discussed by 14 participants (7 patients and 7 healthcare professionals) during a consensus meeting. The top 10 priorities covered a variety of themes including enhancing diagnosis and management of pituitary adenomas, advancing surgical techniques and technologies, optimizing the prediction of outcomes and complications, and improving patient support and follow-up. CONCLUSIONS The top 10 research priorities in pituitary surgery aim to align researchers and direct funding in order to maximize impact and champion patient representation.
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Affiliation(s)
- Nicola Newall
- National Hospital for Neurology and Neurosurgery, London, UK.
- Department of Computer Sciences, UCL Hawkes Institute, University College London, London, UK.
| | - Alexandra Valetopoulou
- National Hospital for Neurology and Neurosurgery, London, UK
- Department of Computer Sciences, UCL Hawkes Institute, University College London, London, UK
| | - Danyal Z Khan
- National Hospital for Neurology and Neurosurgery, London, UK
- Department of Computer Sciences, UCL Hawkes Institute, University College London, London, UK
| | - Anouk Borg
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Pierre M G Bouloux
- Department of Endocrinology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fion Bremner
- National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Simon Cudlip
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neil Dorward
- National Hospital for Neurology and Neurosurgery, London, UK
| | - William M Drake
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | | | | | | | - Joy Ginn
- The Pituitary Foundation, Bristol, UK
| | - Mark Gurnell
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | | | | | - Márta Korbonits
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Michael Kosmin
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Olympia Koulouri
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hugo Layard Horsfall
- National Hospital for Neurology and Neurosurgery, London, UK
- Department of Computer Sciences, UCL Hawkes Institute, University College London, London, UK
- The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK
| | | | - Richard Mannion
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | - Gerald Raverot
- Department of Endocrinology, French Reference Center for Rare Pituitary Diseases HYPO, Hospices Civils de Lyon, 69002, Lyon, France
| | - Thomas Santarius
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Inma Serrano
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Gabriel Zada
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stephanie E Baldeweg
- Division of Medicine, Department of Experimental and Translational Medicine, University College London, London, UK
- Department of Endocrinology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Angelos G Kolias
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Hani J Marcus
- National Hospital for Neurology and Neurosurgery, London, UK
- Department of Computer Sciences, UCL Hawkes Institute, University College London, London, UK
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3
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Zhang Z, Li P, Yang X, Yin J, He J, Hu Y, Liu P. Identifying Subgroups with Rapid Tumor Growth Rate in Adult Pituitary Neuroendocrine Tumors: A Comprehensive Analysis of Clinical and Imaging Features. World Neurosurg 2025; 194:123520. [PMID: 39608491 DOI: 10.1016/j.wneu.2024.11.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 11/23/2024] [Indexed: 11/30/2024]
Abstract
OBJECTIVE To comprehensively investigate the clinical and imaging features associated with the tumor growth rate (TGR) of pituitary neuroendocrine tumors (PitNETs). METHODS The tumor volume was assessed using magnetic resonance imaging. The potential growth-related parameters were compared among different TGR subgroups. Logistic regression analysis and receiver operating characteristic curves were used to identify risk factors and evaluate their diagnostic accuracy for rapid TGR, respectively. RESULTS The study included 81 patients with PitNETs who met the inclusion criteria. Receiver operating characteristic curves were used to determine the optimal cut-off values for age and tumor volume at initial diagnosis. The factors significantly associated with rapid TGR were age <55 years, T2 heterogeneity, and Knosp grade ≥3 (P < 0.05). No significant differences were found among other clinical and imaging subgroups. Multivariate regression analysis confirmed that these factors increased the risk of rapid TGR (P < 0.05). The area under the curve for predicting rapid TGR using age <55 years, T2 heterogeneity, Knosp grade ≥3, and a combined model of these factors were 0.677 (95% confidence interval [CI], 0.564-0.777), 0.705 (95% CI, 0.593-0.801), 0.680 (95% CI, 0.567-0.780), and 0.834 (95% CI, 0.735-0908), respectively. Additionally, the expression of cell lineage-specific transcription factors and Ki-67 exhibited a significant correlation with age <55 years and T2 heterogeneity; however, no association was observed with Knosp grade. CONCLUSIONS The TGR of PitNETs is associated with age, T2 heterogeneity, and Knosp grade. Integrating these factors improves the accuracy of prediction for TGR. Therefore, understanding the TGR in PitNETs can provide valuable evidence for tailoring individualized treatment strategies for patients.
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Affiliation(s)
- Zhe Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Peng Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaojie Yang
- Beijing Anding Hospital Capital Medical University, Key Laboratory for Diagnosis and Treatment of Mental Disorders, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Jie Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, China
| | - Junhua He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Tongde Hospital, Hangzhou, Zhejiang Province, China
| | - Yanan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Pinan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Department of Neural Reconstruction, Beijing Neurosurgery Institute, Beijing, China.
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4
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Meij BP, van Stee LL. Transsphenoidal Surgery for Pituitary Tumors. Vet Clin North Am Small Anim Pract 2025; 55:95-118. [PMID: 39227253 DOI: 10.1016/j.cvsm.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Transsphenoidal surgery for the treatment of pituitary masses in cats and dogs has become a more established treatment over the last 2 decades. Although expert centers and surgeons that provide this service remain limited, the patient population presented for pituitary surgery increases with wider availability of advanced imaging, together with more challenging cases. In this review, the current state of hypophysectomy is described with future challenges and opportunities.
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Affiliation(s)
- Björn P Meij
- Small Animal Surgery, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht 3584CM, The Netherlands
| | - Lucinda L van Stee
- Small Animal Surgery, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht 3584CM, The Netherlands.
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5
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Erkan B, Cil MS, Cingoz M, Burhan S, Aksoy S, Yuzkan S, Akpinar E, Demir S, Tanriverdi O, Kocak B, Cakir I, Ciftci S, Ozturk FY, Gunaldi O, Altuntas Y, Niyazioglu M, Hatipoglu ES. Lateralization outcomes of bilateral inferior petrosal sinus sampling: desmopressin vs CRH. Hormones (Athens) 2024:10.1007/s42000-024-00620-4. [PMID: 39676152 DOI: 10.1007/s42000-024-00620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 12/02/2024] [Indexed: 12/17/2024]
Abstract
PURPOSE Bilateral inferior petrosal sinus sampling (BIPSS) is the gold standard for localizing ACTH-dependent Cushing's syndrome (CS). While corticotropin-releasing hormone (CRH) was initially used for stimulation, desmopressin has become a common alternative. This research evaluates desmopressin's effectiveness in lateralizing Cushing's disease (CD) during BIPSS compared to CRH stimulation. METHODS The study included 33 individuals with ACTH-dependent CS who underwent BIPSS and had diagnoses confirmed by endoscopic endonasal transsphenoidal pituitary surgery (EETPS). Fourteen participants underwent BIPSS with CRH and 19 with desmopressin. A comparative analysis was conducted. RESULTS BIPSS accurately lateralized 76% of cases, specifically, 71% with CRH and 79% with desmopressin (p = 0.2). For tumors < 6 mm on MRI, overall accuracy was 82%, namely, 75% with CRH and 90% with desmopressin (p = 0.4). IPSS achieved 100% accuracy in the four cases with no lesion on preoperative MRI. CONCLUSION This study demonstrates no significant difference in lateralization accuracy between desmopressin and CRH for IPSS. In challenging cases, especially those with microadenomas or non-lesional CD, desmopressin with IPSS aids in preoperative lateralization.
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Affiliation(s)
- Buruc Erkan
- Department of Neurosurgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Mehmet Said Cil
- Department of Neurosurgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Mehmet Cingoz
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Sebnem Burhan
- Department of Endocrinology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Seyma Aksoy
- Department of Endocrinology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Sabahattin Yuzkan
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Ebubekir Akpinar
- Department of Neurosurgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Suat Demir
- Department of Neurosurgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Osman Tanriverdi
- Department of Neurosurgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Burak Kocak
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Ilkay Cakir
- Department of Endocrinology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Bakirkoy, Istanbul, 34147, Turkey
| | - Sema Ciftci
- Department of Endocrinology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Bakirkoy, Istanbul, 34147, Turkey
| | - Feyza Yener Ozturk
- Department of Endocrinology, University of Health Sciences, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Sisli, Istanbul, 34371, Turkey
| | - Omur Gunaldi
- Department of Neurosurgery, Medicana Atakoy Hospital, Istanbul, Turkey
| | - Yuksel Altuntas
- Department of Endocrinology, University of Health Sciences, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Sisli, Istanbul, 34371, Turkey
| | - Mutlu Niyazioglu
- Department of Endocrinology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Esra Suheda Hatipoglu
- Department of Endocrinology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey.
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Li H, Liu Z, Li F, Xia Y, Zhang T, Shi F, Zeng Q. Identification of Prolactinoma in Pituitary Neuroendocrine Tumors Using Radiomics Analysis Based on Multiparameter MRI. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:2865-2873. [PMID: 38844718 PMCID: PMC11612092 DOI: 10.1007/s10278-024-01153-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 12/05/2024]
Abstract
This study aims to investigate the feasibility of preoperatively predicting histological subtypes of pituitary neuroendocrine tumors (PitNETs) using machine learning and radiomics based on multiparameter MRI. Patients with PitNETs from January 2016 to May 2022 were retrospectively enrolled from four medical centers. A cfVB-Net network was used to automatically segment PitNET multiparameter MRI. Radiomics features were extracted from the MRI, and the radiomics score (Radscore) of each patient was calculated. To predict histological subtypes, the Gaussian process (GP) machine learning classifier based on radiomics features was performed. Multi-classification (six-class histological subtype) and binary classification (PRL vs. non-PRL) GP model was constructed. Then, a clinical-radiomics nomogram combining clinical factors and Radscores was constructed using the multivariate logistic regression analysis. The performance of the models was evaluated using receiver operating characteristic (ROC) curves. The PitNET auto-segmentation model eventually achieved the mean Dice similarity coefficient of 0.888 in 1206 patients (mean age 49.3 ± SD years, 52% female). In the multi-classification model, the GP of T2WI got the best area under the ROC curve (AUC), with 0.791, 0.801, and 0.711 in the training, validation, and external testing set, respectively. In the binary classification model, the GP of T2WI combined with CE T1WI demonstrated good performance, with AUC of 0.936, 0.882, and 0.791 in training, validation, and external testing sets, respectively. In the clinical-radiomics nomogram, Radscores and Hardy' grade were identified as predictors for PRL expression. Machine learning and radiomics analysis based on multiparameter MRI exhibited high efficiency and clinical application value in predicting the PitNET histological subtypes.
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Affiliation(s)
- Hongxia Li
- Department of Radiology, The Second Hospital of Shandong University, No.247 Beiyuan Road, Jinan, 250033, China
| | - Zhiling Liu
- Department of Radiology, Shandong Provincial Hospital, Jinan, 250098, China
| | - Fuyan Li
- Department of Radiology, Shandong Medical Imaging Research Institute, Jinan, 250021, China
| | - Yuwei Xia
- Shanghai United Imaging Intelligence, Co., Ltd, 701 Yunjin Road, Xuhui District, Shanghai, 200030, China
| | - Tong Zhang
- Department of Radiology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin City, 150001, China
| | - Feng Shi
- Shanghai United Imaging Intelligence, Co., Ltd, 701 Yunjin Road, Xuhui District, Shanghai, 200030, China
| | - Qingshi Zeng
- Department of Radiology, Shandong Provincial Qianfoshan Hospital, No.16766 Jingshi Road, Jinan, 250013, China.
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Shafiq I, Williams ZR, Vates GE. Advancement in perioperative management of pituitary adenomas-Current concepts and best practices. J Neuroendocrinol 2024; 36:e13427. [PMID: 38964869 DOI: 10.1111/jne.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/30/2024] [Accepted: 06/16/2024] [Indexed: 07/06/2024]
Abstract
Pituitary adenomas are very common representing 18.1% of all brain tumors and are the second most common brain pathology. Transsphenoidal surgery is the mainstay of treatment for all pituitary adenomas except for prolactinomas which are primarily treated medically with dopamine agonists. A thorough endocrine evaluation of pituitary adenoma preoperatively is crucial to identify hormonal compromise caused by the large sellar mass, identifying prolactin-producing tumors and comorbidities associated with Cushing and acromegaly to improve patient care and outcome. Transsphenoidal surgery is relatively safe in the hands of experienced surgeons, but still carries a substantial risk of causing hypopituitarism that required close follow-up in the immediate postoperative period to decrease mortality. A multidisciplinary team approach with endocrinologists, ophthalmologists, and neurosurgeons is the cornerstone in the perioperative management of pituitary adenomas.
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Affiliation(s)
- Ismat Shafiq
- Division of Endocrinology, Diabetes, and Metabolism, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Zoë R Williams
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - G Edward Vates
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
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8
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Wang MTM, Meyer JA, Danesh-Meyer HV. Neuro-ophthalmic evaluation and management of pituitary disease. Eye (Lond) 2024; 38:2279-2288. [PMID: 39039214 PMCID: PMC11306754 DOI: 10.1038/s41433-024-03187-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 07/24/2024] Open
Abstract
Neuro-ophthalmic evaluation is a crucial component of the diagnostic and prognostic assessment of pituitary disease and compressive chiasmopathy, and can inform the timing of vision-restoring tumour resection surgery. The most common disease affecting the pituitary with neuro-ophthalmic implications are pituitary adenomas. Neuro-ophthalmic manifestations include decreased vision, abnormal colour vision and impaired visual field or diplopia. The recognition of these syndromes is critical to achieve early diagnosis and treatment and to improve prognosis. The pattern of vision loss in chiasmal compression is determined by the anatomical relationship between the pituitary lesion and optic chiasm, and potential visual field defects include bitemporal deficits, junctional scotomas, monocular cecocentral defects, and incongruous homonymous hemianopias. Rarer neuro-ophthalmic manifestations of pituitary disease include ophthalmoplegia, nystagmus, and obstructive hydrocephalus. There is growing evidence that demonstrates the strong diagnostic utility of optical coherence tomography (OCT) parameters in detecting the presence of compressive chiasmopathy, as well as the prognostic ability to predict the rate and degree of visual recovery following decompression surgery. Long-term neuro-ophthalmic monitoring is critical for detecting delayed vision loss following resection surgery, which may represent tumour recurrence or secondary complications.
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Affiliation(s)
- Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Juliette A Meyer
- Vision Research Foundation, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand.
- Vision Research Foundation, Auckland, New Zealand.
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9
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Van Weehaeghe D, Lapauw B, Fraioli F, Cecchin D, Verger A, Guedj E, Albert NL, Brendel M, Yakushev I, Barthel H, Traub-Weidinger T, Tolboom N, Giessen EVD. EANM position on positron emission tomography in suspected functional pituitary neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2024; 51:2367-2370. [PMID: 38687371 DOI: 10.1007/s00259-024-06728-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Donatienne Van Weehaeghe
- Department of Radiology and Nuclear Medicine, Ghent University hospital, C. Heymanslaan 10, Ghent, 9000, Belgium.
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Diego Cecchin
- Department of Medicine, Unit of Nuclear Medicine, University Hospital of Padova, Padova, Italy
| | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU Nancy, IADI, INSERM U1254, Nancy, F- 54000, France
| | - Eric Guedj
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix Marseille Univ, Marseille, France
| | - Nathalie L Albert
- Department of Nuclear Medicine, LMU Hospital, LMU Munich, Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, German Center for Neurodegenerative Diseases (DZNE), Munich Cluster for Systems Neurology (SyNergy), LMU Hospital, LMU Munich, Munich, Germany
| | - Igor Yakushev
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University Medical Centre, Leipzig, Germany
| | - Tatjana Traub-Weidinger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Nelleke Tolboom
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Elsmarieke Van De Giessen
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
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MacFarlane J, Korbonits M. Growth hormone receptor antagonist pegvisomant and its role in the medical therapy of growth hormone excess. Best Pract Res Clin Endocrinol Metab 2024; 38:101910. [PMID: 38981769 DOI: 10.1016/j.beem.2024.101910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Pegvisomant is a growth-hormone (GH) receptor antagonist that prevents the formation of the active heterotrimer of the dimerised GH receptor and the GH molecule necessary for downstream signal transduction. Over the past 20 years, it has become a key therapeutic option for physicians treating syndromes of GH/IGF-1 excess. Sufficient longitudinal follow-up data suggest that it can be deemed both safe and effective. It is the drug with the greatest potential for achieving an amelioration of the biochemical effects of GH excess with a corresponding normalisation of IGF-1 levels; however, insufficient dose titration has lessened real-world therapeutic outcomes. Theoretical concerns about stimulating tumour growth have been resolved as this has not been observed, while derangement of liver enzymes and local skin-related adverse reactions may occur in a minority of the patients. It may be a particularly impactful medication for the treatment of children, young people, and those with inherited disorders of GH excess, where other treatment modalities often fail. Combination therapy of pegvisomant with first- and second-generation somatostatin receptor ligands or with dopamine agonists remains an ongoing area of interest and research. High cost remains a barrier to the use of pegvisomant in many settings.
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Affiliation(s)
- James MacFarlane
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
| | - Márta Korbonits
- Centre for Endocrinology, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
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11
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Haberbosch L, MacFarlane J, Koulouri O, Gillett D, Powlson AS, Oddy S, Halsall DJ, Huynh KA, Jones J, Cheow HK, Spranger J, Mai K, Strasburger CJ, Mannion RJ, Gurnell M. Real-world experience with 11C-methionine positron emission tomography in the management of acromegaly. Eur J Endocrinol 2024; 190:307-313. [PMID: 38482632 DOI: 10.1093/ejendo/lvae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND L-[methyl-11C]-methionine-positron emission tomography (Met-PET) is a potentially important imaging adjunct in the diagnostic workup of pituitary adenomas, including somatotroph tumors. Met-PET can identify residual or occult disease and make definitive therapies accessible to a subgroup of patients who would otherwise require lifelong medical therapy. However, existing data on its use are still limited to small case series. Here, we report the largest single-center experience (n = 61) in acromegaly. METHODS A total of 189 cases of acromegaly were referred to our national Met-PET service in the last 12 years. For this analysis, we have reviewed outcomes in those 61 patients managed exclusively by our multidisciplinary team (single center, single surgeon). Referral indications were as follows: indeterminate magnetic resonance imaging (MRI; n = 38, 62.3%), occult residual (n = 14, 23.0%), (radio-)surgical planning (n = 6, 9.8%), and occult de novo tumor (n = 3, 4.9%). RESULTS A total of 33/61 patients (54.1%) underwent PET-guided surgery. Twenty-four of 33 patients (72.7%) achieved complete biochemical remission following (re-)surgery. Insulin-like growth factor 1 levels were reduced to <2 × upper limit of normal (ULN) in 6 of the remaining 9 cases, 3 of whom achieved levels of <1.1 × ULN compared with mean preoperative levels of 2.4 × ULN (SD 0.8) for n = 9. Only 3 patients developed single new hormonal deficits (gonadotropic/thyrotropic insufficiency). There were no neurovascular complications after surgery. CONCLUSION In patients with persistent/recurrent acromegaly or occult tumors, Met-PET can facilitate further targeted intervention (surgery/radiosurgery). This led to complete remission in most cases (24/33) or significant improvement with comparatively low risk of complications. L-[methyl-11C]-methionine-positron emission tomography should therefore be considered in all patients who are potential candidates for further surgical intervention but present no clear target on MRI.
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Affiliation(s)
- Linus Haberbosch
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Endocrinology and Metabolism, European Reference Network on Rare Endocrine Conditions (Endo-ERN), Berlin 10117, Germany
- Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Digital Clinician Scientist Program, Berlin Institute of Health, Berlin 10117, Germany
| | - James MacFarlane
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Olympia Koulouri
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Daniel Gillett
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Andrew S Powlson
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Sue Oddy
- Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
| | - David J Halsall
- Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
| | - Kevin A Huynh
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Jonathan Jones
- Department of Radiology, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
| | - Heok K Cheow
- Department of Radiology, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
- Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
| | - Joachim Spranger
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Endocrinology and Metabolism, European Reference Network on Rare Endocrine Conditions (Endo-ERN), Berlin 10117, Germany
| | - Knut Mai
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Endocrinology and Metabolism, European Reference Network on Rare Endocrine Conditions (Endo-ERN), Berlin 10117, Germany
| | - Christian J Strasburger
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Endocrinology and Metabolism, European Reference Network on Rare Endocrine Conditions (Endo-ERN), Berlin 10117, Germany
| | - Richard J Mannion
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
| | - Mark Gurnell
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
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12
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Khan DZ, Hanrahan JG, Baldeweg SE, Dorward NL, Stoyanov D, Marcus HJ. Current and Future Advances in Surgical Therapy for Pituitary Adenoma. Endocr Rev 2023; 44:947-959. [PMID: 37207359 PMCID: PMC10502574 DOI: 10.1210/endrev/bnad014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/14/2023] [Accepted: 05/17/2023] [Indexed: 05/21/2023]
Abstract
The vital physiological role of the pituitary gland, alongside its proximity to critical neurovascular structures, means that pituitary adenomas can cause significant morbidity or mortality. While enormous advancements have been made in the surgical care of pituitary adenomas, numerous challenges remain, such as treatment failure and recurrence. To meet these clinical challenges, there has been an enormous expansion of novel medical technologies (eg, endoscopy, advanced imaging, artificial intelligence). These innovations have the potential to benefit each step of the patient's journey, and ultimately, drive improved outcomes. Earlier and more accurate diagnosis addresses this in part. Analysis of novel patient data sets, such as automated facial analysis or natural language processing of medical records holds potential in achieving an earlier diagnosis. After diagnosis, treatment decision-making and planning will benefit from radiomics and multimodal machine learning models. Surgical safety and effectiveness will be transformed by smart simulation methods for trainees. Next-generation imaging techniques and augmented reality will enhance surgical planning and intraoperative navigation. Similarly, surgical abilities will be augmented by the future operative armamentarium, including advanced optical devices, smart instruments, and surgical robotics. Intraoperative support to surgical team members will benefit from a data science approach, utilizing machine learning analysis of operative videos to improve patient safety and orientate team members to a common workflow. Postoperatively, neural networks leveraging multimodal datasets will allow early detection of individuals at risk of complications and assist in the prediction of treatment failure, thus supporting patient-specific discharge and monitoring protocols. While these advancements in pituitary surgery hold promise to enhance the quality of care, clinicians must be the gatekeepers of the translation of such technologies, ensuring systematic assessment of risk and benefit prior to clinical implementation. In doing so, the synergy between these innovations can be leveraged to drive improved outcomes for patients of the future.
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Affiliation(s)
- Danyal Z Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
| | - John G Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
| | - Stephanie E Baldeweg
- Department of Diabetes & Endocrinology, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
- Centre for Obesity and Metabolism, Department of Experimental and Translational Medicine, Division of Medicine, University College London, London WC1E 6BT, UK
| | - Neil L Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
- Digital Surgery Ltd, Medtronic, London WD18 8WW, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
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13
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Bauman MMJ, Graves JP, Harrison DJ, Hassett LC, Bancos I, Johnson DR, Van Gompel JJ. The utility of PET for detecting corticotropinomas in Cushing disease: a scoping review. Neurosurg Rev 2023; 46:160. [PMID: 37393399 DOI: 10.1007/s10143-023-02077-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023]
Abstract
While magnetic resonance imaging (MRI) is the current standard imaging method for diagnosing and localizing corticotropinomas in Cushing disease, it can fail to detect adenomas in up to 40% of cases. Recently, positron emission tomography (PET) has shown promise as a diagnostic tool to detect pituitary adenomas in Cushing disease. We perform a scoping review to characterize the uses of PET in diagnosing Cushing disease, with a focus on describing the types of PET investigated and defining PET-positive disease. A scoping review was conducted following the PRISMA-ScR guidelines. Thirty-one studies fulfilled our inclusion criteria, consisting of 10 prospective studies, 8 retrospective studies, 11 case reports, and 2 illustrative cases with a total of 262 patients identified. The most commonly utilized PET modalities in prospective/retrospective studies were FDG PET (n = 5), MET PET (n = 5), 68 Ga-DOTATATE PET (n = 2), 13N-ammonia PET (n = 2), and 68 Ga-DOTA-CRH PET (n = 2). MRI positivity ranged from 13 to 100%, while PET positivity ranged from 36 to 100%. In MRI-negative disease, PET positivity ranged from 0 to 100%. Five studies reported the sensitivity and specificity of PET, which ranged from 36 to 100% and 50 to 100%, respectively. PET shows promise in detecting corticotropinomas in Cushing disease, including MRI-negative disease. MET PET has been highly investigated and has demonstrated excellent sensitivity and specificity. However, preliminary studies with FET PET and 68 Ga-DOTA-CRH PET show promise for achieving high sensitivity and specificity and warrant further investigation.
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Affiliation(s)
- Megan M J Bauman
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, MN, Rochester, USA
| | - Jeffrey P Graves
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel Jeremiah Harrison
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, MN, Rochester, USA
| | | | - Irina Bancos
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | | | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, MN, Rochester, USA.
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
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14
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Hurtado Andrade MD, Tama E, Atkinson JLD, Chang AY. A False Pituitary Tumor. JCEM CASE REPORTS 2023; 1:luad054. [PMID: 37908583 PMCID: PMC10580463 DOI: 10.1210/jcemcr/luad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 11/02/2023]
Abstract
A false pituitary tumor describes pituitary enlargement due to intracranial hypotension. Reported previously primarily in the neurological literature, we present this case referred to endocrinology for evaluation of a pituitary mass. A 24-year-old male was referred to endocrinology for evaluation of pituitary enlargement without a hypo-enhancing lesion on magnetic resonance imaging (MRI). The main symptom reported was headache that was worse in the standing position and in the afternoon. He had no symptoms or signs of pituitary mass-effect, or hormone excess or deficiencies. Past medical history was relevant for a history of nerve schwannoma status post resection with subsequent spinal fusion. Biochemical evaluation of pituitary hormones was normal. Upon review of his pituitary MRI, other abnormalities seen were suggestive of intracranial hypotension. Based on his history and imaging findings, he was diagnosed with intracranial hypotension causing a "false pituitary tumor" rather than pituitary enlargement or abnormality. Further evaluation revealed multiple spinal leaks that were patched. His symptoms subsided within a few days of repair. Endocrinologists should be aware of the possible misdiagnosis of a pituitary mass due to intracranial hypotension.
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Affiliation(s)
- Maria D Hurtado Andrade
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Elif Tama
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Alice Y Chang
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
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15
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de Figueiredo RLP, de Souza Junior JF, Triarca PJL, Beer-Furlan A, Melo NAD, de Oliveira Santos BF, Oliveira AMP. Measuring pituitary tumor volume: a comparison of the simplified and non-simplified ellipsoid equation with the 3D planimetric volume assessment. Pituitary 2023:10.1007/s11102-023-01317-4. [PMID: 37115292 DOI: 10.1007/s11102-023-01317-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE The ellipsoid equation came in an attempt to facilitate the estimation of tumor volume, by measuring the height, width, and anteroposterior length of the lesion. The estimated tumor volume can sometimes be different between methods, thus, it is of extreme interest to evaluate if the methods are significantly different, as well as to discuss the main limitations of each one. METHODS This is an observational, analytical, cross-sectional study. A systematic review of the literature was also performed in order to discuss the results observed in the present study. RESULTS A total of 82 patients (43 males and 39 females) ranging in age from 15 to 78 years (mean 47.95 ± 14.76) were included in the study. Seven patients were classified as Knosp grade 0 (8.5%), 36 Knosp grade 1 (44%), 14 Knosp grade 2 (17%), 20 Knosp grade 3 (24.4%), 5 Knosp grade 4 (6.1%). The tumor volume estimated by 3D planimetric assessment, non-simplified ellipsoid equation, and simplified ellipsoid formula averaged 10.68 cm³, 10.36 cm³, and 9.9 cm³ respectively. CONCLUSION A simplified form of the ellipsoid equation increases the divergence between the measurement obtained in planimetry, and should be discouraged, in view of the new automated methods of performing quick calculations using periodic digits. The non-simplified form underestimated the tumor volume by 2.9% on average but did so regularly. In clinical practice, measurement should be accompanied by an evaluation of tumor morphology.
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Affiliation(s)
| | | | | | | | | | - Bruno Fernandes de Oliveira Santos
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil
- Department of Otolaryngology, Fundação Beneficência Hospital de Cirurgia, Aracaju, Sergipe, Brazil
| | - Arthur Maynart Pereira Oliveira
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil.
- Department of Otolaryngology, Fundação Beneficência Hospital de Cirurgia, Aracaju, Sergipe, Brazil.
- Department of Neurosurgery, Fundação Beneficência Hospital de Cirurgia, Aracaju, Sergipe, Brazil.
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16
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Abstract
Importance Pituitary adenomas are neoplasms of the pituitary adenohypophyseal cell lineage and include functioning tumors, characterized by the secretion of pituitary hormones, and nonfunctioning tumors. Clinically evident pituitary adenomas occur in approximately 1 in 1100 persons. Observations Pituitary adenomas are classified as either macroadenomas (≥10 mm) (48% of tumors) or microadenomas (<10 mm). Macroadenomas may cause mass effect, such as visual field defects, headache, and/or hypopituitarism, which occur in about 18% to 78%, 17% to 75%, and 34% to 89% of patients, respectively. Thirty percent of pituitary adenomas are nonfunctioning adenomas, which do not produce hormones. Functioning tumors are those that produce an excess of normally produced hormones and include prolactinomas, somatotropinomas, corticotropinomas, and thyrotropinomas, which produce prolactin, growth hormone, corticotropin, and thyrotropin, respectively. Approximately 53% of pituitary adenomas are prolactinomas, which can cause hypogonadism, infertility, and/or galactorrhea. Twelve percent are somatotropinomas, which cause acromegaly in adults and gigantism in children, and 4% are corticotropinomas, which secrete corticotropin autonomously, resulting in hypercortisolemia and Cushing disease. All patients with pituitary tumors require endocrine evaluation for hormone hypersecretion. Patients with macroadenomas additionally require evaluation for hypopituitarism, and patients with tumors compressing the optic chiasm should be referred to an ophthalmologist for formal visual field testing. For those requiring treatment, first-line therapy is usually transsphenoidal pituitary surgery, except for prolactinomas, for which medical therapy, either bromocriptine or cabergoline, is usually first line. Conclusions and Relevance Clinically manifest pituitary adenomas affect approximately 1 in 1100 people and can be complicated by syndromes of hormone excess as well as visual field defects and hypopituitarism from mass effect in larger tumors. First-line therapy for prolactinomas consists of bromocriptine or cabergoline, and transsphenoidal pituitary surgery is first-line therapy for other pituitary adenomas requiring treatment.
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Affiliation(s)
- Nicholas A Tritos
- Neuroendocrine Unit, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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17
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Taheri MS, Ghomi Z, Mirshahi R, Moradpour M, Niroomand M, Yarmohamadi P, Zeidabadi H. Usefulness of subtraction images for accurate diagnosis of pituitary microadenomas in dynamic contrast-enhanced magnetic resonance imaging. Acta Radiol 2023; 64:1148-1154. [PMID: 35731731 DOI: 10.1177/02841851221107344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dynamic contrast-enhanced magnetic resonance imaging (MRI) is the modality of choice for the diagnosis of pituitary microadenomas; however, it may be associated with a relatively high false-negative rate, especially in small lesions. PURPOSE To evaluate the usefulness of subtraction images for enhancing the visual detection of pituitary microadenomas. MATERIAL AND METHODS In total, 50 patients with clinically established diagnosis hyperprolactinemia, acromegaly, and Cushing's disease were enrolled. Ten patients referred for brain MRI for reasons other than pituitary abnormality were selected as control group. Routine dynamic MRI of the pituitary gland and obtained subtraction MRI scans were scrutinized separately on different sessions by an experienced radiologist blinded to the study design and patient's data. The investigator's opinion on the presence or absence of a lesion and lesion size were collected. RESULTS In patients with pituitary microadenoma, dynamic MRI images were reported positive in 42 (84%) patients and negative in 8 (16%). Subtraction images were described as positive in all patients (100%)-including all patients with negative dynamic MRI-and the difference was statistically significant (P=0.016). Undetected lesions on dynamic MRI had a mean size of 2.84 ± 1.79 mm (median= 2.20 mm, interquartile range=1.62-4.62 mm) and a significant inverse correlation was noted between lesion size and negative report of dynamic MRI (P=0.018). Brain MRI scans in the control group were reported negative for pituitary microadenoma in both dynamic contrast-enhanced and subtraction images. CONCLUSION Subtraction images can successfully identify all lesions detectable with conventional dynamic MRI as well as improving visualization of lesions undetected on dynamic MRI, especially in small lesions.
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Affiliation(s)
- Morteza Sanei Taheri
- Department of Radiology, Shohade-E-Tajrish hospital, 556492Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Ghomi
- Department of Radiology, School of Medicine, 556492Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Moein Moradpour
- Department of Radiology, Shohade-E-Tajrish hospital, 556492Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahtab Niroomand
- Internal Medicine Department, Endocrinology Division, 556492Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parsa Yarmohamadi
- Young Researchers and Elite Club, Tehran Medical Sciences, 68106Islamic Azad University, Tehran, Iran
| | - Hamideh Zeidabadi
- Gynecology and Obstetrics Department,Tehran University of Medical Science, 213474Imam Khomeini Hospital Complex Imam Hospital, Tehran, Iran
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18
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Couselo M, Frara S, Giustina A, Casanueva FF. Pituitary tumor centers of excellence for Cushing's disease. Pituitary 2022; 25:772-775. [PMID: 36087228 PMCID: PMC9587956 DOI: 10.1007/s11102-022-01264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 10/29/2022]
Affiliation(s)
- Marcos Couselo
- Santiago de Compostela University, IDIS-Complejo Hospitalario Universitario de Santiago (CHUS), CIBER de Fisiopatologia Obesidad y Nutricion (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Felipe F Casanueva
- Santiago de Compostela University, IDIS-Complejo Hospitalario Universitario de Santiago (CHUS), CIBER de Fisiopatologia Obesidad y Nutricion (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain.
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19
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Bashari WA, Gillett D, MacFarlane J, Scoffings D, Gurnell M. Pituitary Imaging. THE PITUITARY 2022:677-721. [DOI: 10.1016/b978-0-323-99899-4.00022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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20
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Dekkers AJ, de Vries F, Zamanipoor Najafabadi AH, van der Hoeven EM, Verstegen MJT, Pereira AM, van Furth WR, Biermasz NR. Costs and Its Determinants in Pituitary Tumour Surgery. Front Endocrinol (Lausanne) 2022; 13:905019. [PMID: 35872986 PMCID: PMC9302462 DOI: 10.3389/fendo.2022.905019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/04/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Value-based healthcare (VBHC) provides a framework to improve care by improving patient outcomes and reducing healthcare costs. To support value-based decision making in clinical practice we evaluated healthcare costs and cost drivers in perioperative care for pituitary tumour patients. METHODS We retrospectively assessed financial and clinical data for surgical treatment up to the first year after surgery of pituitary tumour patients treated between 2015 and 2018 in a Dutch tertiary referral centre. Multivariable regression analyses were performed to identify determinants of higher costs. RESULTS 271 patients who underwent surgery were included. Mean total costs (SD) were €16339 (13573) per patient, with the following cost determinants: surgery time (€62 per minute; 95% CI: 50, 74), length of stay (€1331 per day; 95% CI 1139, 1523), admission to higher care unit (€12154 in total; 95% CI 6413, 17895), emergency surgery (€10363 higher than elective surgery; 95% CI: 1422, 19305) and postoperative cerebrospinal fluid leak (€14232; 95% CI 9667, 18797). Intradural (€7128; 95% CI 10421, 23836) and combined transsphenoidal/transcranial surgery (B: 38494; 95% CI 29191, 47797) were associated with higher costs than standard. Further, higher costs were found in these baseline conditions: Rathke's cleft cyst (€9201 higher than non-functioning adenoma; 95% CI 1173, 17230), giant adenoma (€19106 higher than microadenoma; 95% CI 12336, 25877), third ventricle invasion (€14613; 95% CI 7613, 21613) and dependent functional status (€12231; 95% CI 3985, 20477). In patients with uncomplicated course, costs were €8879 (3210) and with complications €17551 (14250). CONCLUSIONS Length of hospital stay, and complications are the main drivers of costs in perioperative pituitary tumour healthcare as were some baseline features, e.g. larger tumors, cysts and dependent functional status. Costs analysis may correspond with healthcare resource utilization and guide further individualized care path development and capacity planning.
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Affiliation(s)
- Alies J. Dekkers
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Alies J. Dekkers,
| | - Friso de Vries
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands
| | - Amir H. Zamanipoor Najafabadi
- Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, Leiden, Netherlands
| | | | - Marco J. T. Verstegen
- Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, Leiden, Netherlands
| | - Alberto M. Pereira
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, Netherlands
| | - Wouter R. van Furth
- Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, Leiden, Netherlands
| | - Nienke R. Biermasz
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands
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21
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Koh CH, Khan DZ, Digpal R, Layard Horsfall H, Ali AMS, Baldeweg SE, Bouloux PM, Dorward NL, Drake WM, Evanson J, Grieve J, Stoyanov D, Korbonits M, Marcus HJ. The clinical outcomes of imaging modalities for surgical management Cushing's disease - A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:1090144. [PMID: 36714581 PMCID: PMC9880448 DOI: 10.3389/fendo.2022.1090144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Cushing's disease presents major diagnostic and management challenges. Although numerous preoperative and intraoperative imaging modalities have been deployed, it is unclear whether these investigations have improved surgical outcomes. Our objective was to investigate whether advances in imaging improved outcomes for Cushing's disease. METHODS Searches of PubMed and EMBASE were conducted. Studies reporting on imaging modalities and clinical outcomes after surgical management of Cushing's disease were included. Multilevel multivariable meta-regressions identified predictors of outcomes, adjusting for confounders and heterogeneity prior to investigating the effects of imaging. RESULTS 166 non-controlled single-arm studies were included, comprising 13181 patients over 44 years.The overall remission rate was 77.0% [CI: 74.9%-79.0%]. Cavernous sinus invasion (OR: 0.21 [CI: 0.07-0.66]; p=0.010), radiologically undetectable lesions (OR: 0.50 [CI: 0.37-0.69]; p<0.0001), previous surgery (OR=0.48 [CI: 0.28-0.81]; p=0.008), and lesions ≥10mm (OR: 0.63 [CI: 0.35-1.14]; p=0.12) were associated with lower remission. Less stringent thresholds for remission was associated with higher reported remission (OR: 1.37 [CI: 1.1-1.72]; p=0.007). After adjusting for this heterogeneity, no imaging modality showed significant differences in remission compared to standard preoperative MRI.The overall recurrence rate was 14.5% [CI: 12.1%-17.1%]. Lesion ≥10mm was associated with greater recurrence (OR: 1.83 [CI: 1.13-2.96]; p=0.015), as was greater duration of follow-up (OR: 1.53 (CI: 1.17-2.01); p=0.002). No imaging modality was associated with significant differences in recurrence.Despite significant improvements in detection rates over four decades, there were no significant changes in the reported remission or recurrence rates. CONCLUSION A lack of controlled comparative studies makes it difficult to draw definitive conclusions. Within this limitation, the results suggest that despite improvements in radiological detection rates of Cushing's disease over the last four decades, there were no changes in clinical outcomes. Advances in imaging alone may be insufficient to improve surgical outcomes. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42020187751.
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Affiliation(s)
- Chan Hee Koh
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
- Department of Neurosurgery, Royal Stoke University Hospital, Stoke, United Kingdom
- *Correspondence: Chan Hee Koh,
| | - Danyal Z. Khan
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Ronneil Digpal
- Department of Neurosurgery, University Hospital Southampton, Southampton, United Kingdom
| | - Hugo Layard Horsfall
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Ahmad M. S. Ali
- Department of Neurosurgery, The Walton Centre, Liverpool, United Kingdom
| | - Stephanie E. Baldeweg
- Department of Diabetes and Endocrinology, University College Hospital, London, United Kingdom
- Centre for Obesity & Metabolism, Department of Experimental & Translational Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Pierre-Marc Bouloux
- Centre for Neuroendocrinology University College London Medical School, London, United Kingdom
| | - Neil L. Dorward
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - William M. Drake
- Centre for Endocrinology, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Jane Evanson
- Department of Radiology, Barts Health NHS Trust, London, United Kingdom
| | - Joan Grieve
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Márta Korbonits
- Centre for Endocrinology, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Hani J. Marcus
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
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22
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Fleseriu M, Auchus R, Bancos I, Ben-Shlomo A, Bertherat J, Biermasz NR, Boguszewski CL, Bronstein MD, Buchfelder M, Carmichael JD, Casanueva FF, Castinetti F, Chanson P, Findling J, Gadelha M, Geer EB, Giustina A, Grossman A, Gurnell M, Ho K, Ioachimescu AG, Kaiser UB, Karavitaki N, Katznelson L, Kelly DF, Lacroix A, McCormack A, Melmed S, Molitch M, Mortini P, Newell-Price J, Nieman L, Pereira AM, Petersenn S, Pivonello R, Raff H, Reincke M, Salvatori R, Scaroni C, Shimon I, Stratakis CA, Swearingen B, Tabarin A, Takahashi Y, Theodoropoulou M, Tsagarakis S, Valassi E, Varlamov EV, Vila G, Wass J, Webb SM, Zatelli MC, Biller BMK. Consensus on diagnosis and management of Cushing's disease: a guideline update. Lancet Diabetes Endocrinol 2021; 9:847-875. [PMID: 34687601 PMCID: PMC8743006 DOI: 10.1016/s2213-8587(21)00235-7] [Citation(s) in RCA: 454] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 12/19/2022]
Abstract
Cushing's disease requires accurate diagnosis, careful treatment selection, and long-term management to optimise patient outcomes. The Pituitary Society convened a consensus workshop comprising more than 50 academic researchers and clinical experts to discuss the application of recent evidence to clinical practice. In advance of the virtual meeting, data from 2015 to present about screening and diagnosis; surgery, medical, and radiation therapy; and disease-related and treatment-related complications of Cushing's disease summarised in recorded lectures were reviewed by all participants. During the meeting, concise summaries of the recorded lectures were presented, followed by small group breakout discussions. Consensus opinions from each group were collated into a draft document, which was reviewed and approved by all participants. Recommendations regarding use of laboratory tests, imaging, and treatment options are presented, along with algorithms for diagnosis of Cushing's syndrome and management of Cushing's disease. Topics considered most important to address in future research are also identified.
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Affiliation(s)
| | | | | | | | - Jerome Bertherat
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares de la Surrénale, Service d'Endocrinologie, Hôpital Cochin, Paris, France
| | - Nienke R Biermasz
- Leiden University Medical Center and European Reference Center for Rare Endocrine Conditions (Endo-ERN), Leiden, Netherlands
| | | | | | | | - John D Carmichael
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Felipe F Casanueva
- Santiago de Compostela University and Ciber OBN, Santiago de Compostela, Spain
| | - Frederic Castinetti
- Aix Marseille Université, Marseille Medical Genetics, INSERM, Marseille, France; Assistance Publique Hopitaux de Marseille, Marseille, France; Department of Endocrinology, La Conception Hospital, Marseille, France
| | - Philippe Chanson
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Mônica Gadelha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eliza B Geer
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Ashley Grossman
- University of London, London, UK; University of Oxford, Oxford, UK
| | - Mark Gurnell
- University of Cambridge, Cambridge, UK; NIHR Cambridge Biomedical Research Center, Cambridge, UK; Addenbrooke's Hospital, Cambridge, UK
| | - Ken Ho
- The Garvan Institute of Medical Research, Sydney, NSW, Australia
| | | | - Ursula B Kaiser
- Brigham & Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - André Lacroix
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Ann McCormack
- The Garvan Institute of Medical Research, Sydney, NSW, Australia
| | | | - Mark Molitch
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Alberto M Pereira
- Leiden University Medical Center and European Reference Center for Rare Endocrine Conditions (Endo-ERN), Leiden, Netherlands
| | - Stephan Petersenn
- ENDOC Center for Endocrine Tumors, Hamburg, Germany and University of Duisburg-Essen, Essen, Germany
| | | | - Hershel Raff
- Medical College of Wisconsin, Milwaukee, WI, USA; Advocate Aurora Research Institute, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Martin Reincke
- Department of Medicine IV, University Hospital of LMU, Ludwig-Maximilians-Universität, Munich, Germany
| | | | | | - Ilan Shimon
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | | | | | - Antoine Tabarin
- CHU de Bordeaux, Hôpital Haut Lévêque, University of Bordeaux, Bordeaux, France
| | | | - Marily Theodoropoulou
- Department of Medicine IV, University Hospital of LMU, Ludwig-Maximilians-Universität, Munich, Germany
| | | | - Elena Valassi
- Endocrinology Unit, Hospital General de Catalunya, Barcelona, Spain; Research Center for Pituitary Diseases (CIBERER Unit 747), Hospital Sant Pau, Barcelona, Spain
| | | | - Greisa Vila
- Medical University of Vienna, Vienna, Austria
| | - John Wass
- Churchill Hospital, Oxford, United Kingdom
| | - Susan M Webb
- Research Center for Pituitary Diseases (CIBERER Unit 747), Hospital Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
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23
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Senanayake R, Gillett D, MacFarlane J, Van de Meulen M, Powlson A, Koulouri O, Casey R, Bashari W, Gurnell M. New types of localization methods for adrenocorticotropic hormone-dependent Cushing's syndrome. Best Pract Res Clin Endocrinol Metab 2021; 35:101513. [PMID: 34045044 DOI: 10.1016/j.beem.2021.101513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The management of endogenous Cushing's syndrome (CS) typically involves two key steps: (i) confirmation of autonomous hypercortisolism and (ii) localization of the cause to guide treatment. Adrenocorticotropic hormone (ACTH)-dependent CS is most commonly due to a pituitary corticotrope tumor which may be so small as to evade detection on conventional magnetic resonance imaging (MRI). Although biochemical testing (e.g., corticotropin stimulation; dexamethasone suppression) can provide an indication of the likely origin of ACTH excess, bilateral inferior petrosal sinus catheterization offers greater accuracy to distinguish pituitary-driven CS [Cushing's Disease (CD)] from the ectopic ACTH syndrome [EAS, e.g., due to a bronchial or pancreatic neuroendocrine tumor (NET)]. In patients with CD, 40-50% may not have a pituitary adenoma (PA) readily visualized on standard clinical MRI. In these subjects, alternative MR sequences (e.g., dynamic, volumetric, fluid attenuation inversion recovery) and higher magnetic field strength (7T > 3T > 1.5T) may aid tumor localization but carry a risk of identifying coincidental (non-causative) pituitary lesions. Molecular imaging is therefore increasingly being deployed to detect small ACTH-secreting PA, with hybrid imaging [e.g., positron emission tomography (PET) combined with MRI] allowing precise anatomical localization of sites of radiotracer (e.g., 11C-methionine) uptake. Similarly, small ACTH-secreting NETs, missed on initial cross-sectional imaging, may be detected using PET tracers targeting abnormal glucose metabolism (e.g., 18F-fluorodeoxyglucose), somatostatin receptor (SSTR) expression (e.g., 68Ga-DOTATATE), amine precursor (e.g., 18F-DOPA) or amino acid (e.g., 11C-methionine) uptake. Therefore, modern management of ACTH-dependent CS should ideally be undertaken in specialist centers which have an array of cross-sectional and functional imaging techniques at their disposal.
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Affiliation(s)
- Russell Senanayake
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Daniel Gillett
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - James MacFarlane
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Merel Van de Meulen
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Andrew Powlson
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Olympia Koulouri
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Ruth Casey
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Waiel Bashari
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Mark Gurnell
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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24
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van Furth WR, de Vries F, Lobatto DJ, Kleijwegt MC, Schutte PJ, Pereira AM, Biermasz NR, Verstegen MJT. Endoscopic Surgery for Pituitary Tumors. Endocrinol Metab Clin North Am 2020; 49:487-503. [PMID: 32741484 DOI: 10.1016/j.ecl.2020.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endoscopic transsphenoidal surgery for pituitary adenoma is a safe and highly effective first-line treatment that is well tolerated by patients. Potential complications are plenty, and there is a large variation in complexity of surgery. This article presents the philosophy, surgical techniques, and outcomes of a high-volume pituitary adenoma center. Three surgical videos illustrate some procedures. The experience has reinforced the authors' belief that experience and surgical volume are key to high quality of care.
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Affiliation(s)
- Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center J11-86, Center for Endocrine Tumors Leiden, PO-Box 9600, Leiden 2300 RC, the Netherlands.
| | - Friso de Vries
- Department of Endocrinology, Leiden University Medical Center, PO-Box 9600, Leiden 2300 RC, the Netherlands
| | - Daniel J Lobatto
- Department of Neurosurgery, Leiden University Medical Center J11-86, Center for Endocrine Tumors Leiden, PO-Box 9600, Leiden 2300 RC, the Netherlands
| | - Maarten C Kleijwegt
- Department of Ear Nose and Throat - Head and Neck Cancer, Leiden University Medical Center, PO-Box 9600, Leiden 2300 RC, the Netherlands
| | - Pieter J Schutte
- Department of Neurosurgery, Leiden University Medical Center J11-86, Center for Endocrine Tumors Leiden, PO-Box 9600, Leiden 2300 RC, the Netherlands
| | - Alberto M Pereira
- Department of Endocrinology, Leiden University Medical Center, PO-Box 9600, Leiden 2300 RC, the Netherlands
| | - Nienke R Biermasz
- Department of Endocrinology, Leiden University Medical Center, PO-Box 9600, Leiden 2300 RC, the Netherlands
| | - Marco J T Verstegen
- Department of Neurosurgery, Leiden University Medical Center J11-86, Center for Endocrine Tumors Leiden, PO-Box 9600, Leiden 2300 RC, the Netherlands
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