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Seki A, Henmi F, Ito S, Uruga H, Arisawa K, Uesaka Y. [A case of primary central nervous system lymphoma of the sellar region presented with panhypopituitarism]. Rinsho Shinkeigaku 2024:cn-001941. [PMID: 38658327 DOI: 10.5692/clinicalneurol.cn-001941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The patient is a 41-year-old woman. She presented with vomiting and lightheadedness, and blood tests showed a generalized decrease in pituitary hormones and hyperprolactinemia. A head MRI showed increased signal intensity lesions on FLAIR image in the pituitary stalk, corpus callosum, periventricular area of the fourth ventricle, and superior cerebellar peduncle. The lesions were homogeneously enhanced, and a brain biopsy confirmed the diagnosis of primary diffuse large B-cell lymphoma of the central nervous system, and chemotherapy was started. Although the suprasellar region is a rare site for primary central nervous system lymphoma (PCNSL), it should be diagnosed early by biopsy.
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Affiliation(s)
- Ayaka Seki
- Department of Neurology, Toranomon Hospital
| | | | - Shinji Ito
- Department of Diagnostic Pathology, Toranomon Hospital
| | | | - Kei Arisawa
- Department of Neurosurgery, Toranomon Hospital
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Bobeff EJ, Mathios D, Mistry AA, Dobri GA, Souweidane MM, Anand VK, Tabaee A, Kacker A, Greenfield JP, Schwartz TH. Predictors of extent of resection and recurrence following endoscopic endonasal resection of craniopharyngioma. J Neurosurg 2023; 139:1235-1246. [PMID: 37119110 DOI: 10.3171/2023.3.jns222607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/16/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Craniopharyngioma is a benign but surgically challenging brain tumor. Controversies exist regarding its ideal treatment strategy, goals of surgery, efficacy of radiation, and the long-term outcomes of these decisions. The authors of this study performed a detailed analysis of factors predictive of the extent of resection and recurrence in large series of craniopharyngiomas removed via an endoscopic endonasal approach (EEA) with long-term follow-up. METHODS From a prospective database of all EEAs done at Weill Cornell Medical College by the senior author from 2004 to 2022, a consecutive series of histologically proven craniopharyngiomas were identified. Gross-total resection (GTR) was generally the goal of surgery. Radiation was often given if GTR had not been achieved. The stalk was preserved if not infiltrated with tumor but was sacrificed to achieve GTR. Intentional subtotal resection (STR) was performed in select cases to avoid hypothalamic injury. RESULTS Among the 111 identified cases were 88 adults and 23 children. Newly diagnosed cases comprised 58.6% of the series. GTR was attempted in 77.5% of the patients and among those cases was achieved in 89.5% of treatment-naive tumors and 72.4% of recurrent tumors. An inability to achieve GTR was predicted by prior surgical treatment (OR 0.13, 95% CI 0.03-0.6, p = 0.009), tumor diameter ≥ 3.5 cm (OR 0.11, 95% CI 0.02-0.53, p = 0.006), and encasement of the optic nerve or a major artery (OR 0.11, 95% CI 0.01-0.8, p = 0.03). GTR with stalk preservation maintained some anterior pituitary function in 64.5% of cases and prevented diabetes insipidus in 25.8%. After a median follow-up of 51 months (IQR 17-80 months), the recurrence rate after GTR was 12.5% compared with 38.5% after non-GTR. The median recurrence-free survival was 5.5 years after STR, 8.3 years after near-total resection (≥ 98%), and not reached after GTR (p = 0.004, log-rank test). GTR was the strongest predictor of recurrence-free survival (OR 0.09, 95% CI 0.02-0.42, p = 0.002), whereas radiation did not show a statistically significant impact (OR 1.17, 95% CI 0.45-3.08). In GTR cases, the recurrence rate was higher if the stalk had been preserved (22.6%) as opposed to a sacrificed stalk (4.9%; OR 5.69, 95% CI 1.09-29.67). CONCLUSIONS The study data show that GTR should be the goal of surgery in craniopharyngiomas if it can be achieved safely. Although stalk preservation can maintain some endocrine function, the risk of recurrence is higher in such cases. Radiation may not be as effective as previously reported.
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Affiliation(s)
- Ernest J Bobeff
- Departments of1Neurological Surgery
- 5Department of Neurosurgery, Barlicki University Hospital, Lodz, Poland; and
- 6Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | | | | | | | | | | | | | | | | | - Theodore H Schwartz
- Departments of1Neurological Surgery
- 4Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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Yehouenou Tessi RT, Adeyemi B, El Msaadi S, El Haddad S, Allali N, Chat L. Pituitary stalk interruption syndrome on MRI: Case report. Clin Case Rep 2023; 11:e7899. [PMID: 37692160 PMCID: PMC10483495 DOI: 10.1002/ccr3.7899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/27/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023] Open
Abstract
Key clinical message Pituitary stalk interruption syndrome (PSIS) is an antenatal anatomical defect characterized by pituitary insufficiency with symptomatology depending on associated hormonal deficits. Diagnosis is often delayed because many clinical findings. The gold standard for detection is pituitary MRI showing absence of pituitary stalk, anterior pituitary hypoplasia, and postpituitary ectopy. The treatment remains polyhormonal substitution. Abstract Pituitary stalk interruption syndrome (PSIS) is an antenatal anatomical defect. It is characterized by pituitary insufficiency with symptomatology depending on associated hormonal deficits. Diagnosis of PSIS is often delayed probably because of various clinical characteristics findings. Pituitary imaging abnormality is a specific indicator of hypopituitarism. The symptomatological triad associates a very thin or interrupted pituitary stalk, an ectopic or absent pituitary gland and hypoplasia of the anterior pituitary gland. The gold standard for detection is pituitary MRI. Some genetic factors are associated with the disease. The treatment remains polyhormonal substitution depending on the associated deficits. We reported the case of a 14-year-old child with growth retardation in whom the biological work-up and pituitary MRI concluded that the diagnosis was PSIS with growth hormone deficiency. The treatment implemented was a recombinant growth hormone treatment. The immediate outcome was marked by a regression of symptoms.
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Affiliation(s)
| | - Boris Adeyemi
- Radiology DepartmentIbn Sina Paediatric Teaching Hospital, Mohammed V UniversityRabatMorocco
| | - Sihame El Msaadi
- Radiology DepartmentIbn Sina Paediatric Teaching Hospital, Mohammed V UniversityRabatMorocco
| | - Siham El Haddad
- Radiology DepartmentIbn Sina Paediatric Teaching Hospital, Mohammed V UniversityRabatMorocco
| | - Nazik Allali
- Radiology DepartmentIbn Sina Paediatric Teaching Hospital, Mohammed V UniversityRabatMorocco
| | - Latifa Chat
- Radiology DepartmentIbn Sina Paediatric Teaching Hospital, Mohammed V UniversityRabatMorocco
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Lopez DC, Almeida JP, Momin AA, Andrade EJD, Soni P, Yogi-Morren D, Kshettry VR, Recinos PF. Triphasic response after endoscopic craniopharyngioma resection and its dependency on infundibular preservation or sacrifice. J Neurosurg 2023; 139:790-797. [PMID: 36738460 DOI: 10.3171/2022.12.jns221137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 12/09/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Surgery is the primary treatment for craniopharyngioma with the preservation of hypothalamic function of paramount importance. Infundibular preservation is debated, as maximal resection decreases recurrence rates but causes hypopituitarism. A triphasic response of diabetes insipidus (DI), syndrome of inappropriate antidiuretic hormone secretion (SIADH), and recurrent DI has been described after pituitary surgery, but the impact of infundibular preservation on the triphasic response following craniopharyngioma resection has not been well established. The authors' objective was to assess postoperative fluid and sodium balance and differences in ADH imbalance management following endonasal craniopharyngioma resection based on infundibular transection status. METHODS This is a retrospective cohort study of 19 patients with craniopharyngioma treated with endoscopic endonasal resection between 2014 and 2021. Resection was dichotomized into infundibular transection or preservation. Postoperative triphasic response, time to DI, and time to ADH replacement were compared using Fisher's exact test and Kaplan-Meier analysis. RESULTS Based on surgeon impression, 10 patients had infundibular transection and 9 had infundibular preservation. Overall, 16 patients experienced DI, 12 experienced persistent DI, and 6 experienced SIADH. A postoperative triphasic response occurred in 40% (n = 4) of transection patients without preoperative DI and 11% (n = 1) of preservation patients without preoperative DI. The median time to postoperative DI (0.5 vs 18.0 hours, p = 0.022) and median time to ADH replacement therapy (4.5 vs 24 hours, p = 0.0004) were significantly shorter in the transection group than in the preservation group. CONCLUSIONS Following endonasal craniopharyngioma resection, the triphasic response occurs in nearly half of infundibular transection cases. DI begins earlier with infundibular transection. On the basis of the study findings in which no patients met the criteria for SIADH or were endocrinologically unstable after postoperative day 6, it is reasonable to suggest that otherwise stable patients can be discharged at or before postoperative day 6 when ADH fluctuations have normalized and endocrinopathy is appropriately managed with oral desmopressin. Infundibular transection status may impact postoperative hormonal replacement strategies, but additional studies should evaluate their efficacies.
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Affiliation(s)
- Diana C Lopez
- 1Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland
- 2Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - João Paulo Almeida
- 2Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
- 3Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | - Arbaz A Momin
- 1Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland
- 2Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Erion Júnior de Andrade
- 1Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland
| | - Pranay Soni
- 1Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland
| | - Divya Yogi-Morren
- 2Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
- 4Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland; and
| | - Varun R Kshettry
- 1Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland
- 2Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Pablo F Recinos
- 1Department of Neurological Surgery and Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland
- 2Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
- 5Department of Otolaryngology-Head & Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
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Yamada H, Yagi R, Kambara A, Katayama Y, Tsuji Y, Hiramatsu R, Ikeda N, Kameda M, Nonoguchi N, Furuse M, Kawabata S, Takami T, Wanibuchi M. Occult neurohypophyseal germinoma discovered during the course of long-term diabetes insipidus: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23113. [PMID: 37728283 PMCID: PMC10555647 DOI: 10.3171/case23113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/09/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The authors report a case of occult neurohypophyseal germinoma detected in a patient with long-term diabetes insipidus. Central diabetes insipidus is the initial symptom in 95% of cases of neurohypophyseal germinoma. In occult neurohypophyseal germinomas, no abnormalities are seen on magnetic resonance imaging (MRI) at the onset of symptoms. It can take several months or even years for these changes to be detected on MRI. OBSERVATIONS A 20-year-old male was diagnosed with central diabetes insipidus at the age of 17 years, and gonadal and adrenal corticosteroid insufficiency was noted at the age of 19 years. Head MRI showed an enlarged and enhanced pituitary stalk. He was referred to our department for a suspected neoplastic lesion. Endoscopic transsphenoidal biopsy indicated a pure germinoma. He was treated with chemotherapy and radiotherapy and then was discharged. LESSONS In this case, new imaging findings appeared 19 months after the onset of diabetes insipidus, and the pathological diagnosis was made after almost 24 months. Because the patient had a history of growth hormone deficiency and had a positive test result for diabetes insipidus, occult neurohypophyseal germinoma was suspected, and periodic contrast-enhanced MRI monitoring was deemed essential.
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Affiliation(s)
- Hironori Yamada
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Ryokichi Yagi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Akihiro Kambara
- Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan; and
| | | | - Yuichiro Tsuji
- Department of Neurosurgery, Kano General Hospital, Osaka, Japan
| | - Ryo Hiramatsu
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Naokado Ikeda
- Department of Neurosurgery, Takeda General Hospital, Kyoto, Japan
| | - Masahiro Kameda
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Naosuke Nonoguchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Motomasa Furuse
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Xiao D, Zhang S, Lin K, Zhao L, Wei L, Wang S. Pre- and Postoperative Magnetic Resonance Imaging Comparative Studies of Pituitary Tissues Following Transsphenoidal Resection of Pituitary Macroadenomas. J Integr Neurosci 2023; 22:107. [PMID: 37735115 DOI: 10.31083/j.jin2205107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has become the most important radiological procedure for diagnosing and following pituitary tumors. But previous MRI studies on pituitary adenomas are mainly focused on the posterior pituitary. Few research has been done on residual normal pituitary tissue before and after transsphenoidal surgery. This retrospective cohort study investigates the pre- and postoperative magnetic resonance imaging characteristics of normal pituitary tissues regarding transsphenoidal resection of pituitary macroadenomas. METHODS Pre- and postoperative magnetic resonance imaging scanning of 112 consecutive pituitary macroadenoma patients who underwent tumor resection via transsphenoidal approach was performed, and their medical records were studied. RESULTS On preoperative MRI, 66 cases of pituitary stalks were identifiable, 9 of them were roughly in the middle, and 57 cases showed left or right deviation, with the angle between pituitary stalks and the sagittal plane was 5.32°-64.05° (average 21.65°). Among the 57 patients with preoperative pituitary stalk deviation, 55 of the pituitary stalk deviations improved in 1 week after surgery, and 30 cases were almost in the middle in 4-6 months after operation, with the other cases get better in varying degrees. The diameter of pituitary stalk was 1.08-3.89 mm (mean 2.36 mm) in pre-operation, and 1.29-3.43 mm (mean 2.30 mm) in 4-6 months after operation. The length of pituitary stalk was 1.41-11.74 mm (mean 6.12 mm) preoperatively, 3.61-11.63 mm (mean 6.93 mm) early postoperatively, and 5.37-17.57 mm (mean 8.83 mm) in 4-6 months after operation. Pituitary stalk was thickened or compressed on preoperative MR images, and gradually recovered to normal during postoperative period. It tended to be in the middle position and its length increased gradually until 4-6 months after operation. On preoperative MRI, 69 out of 112 patients showed residual pituitary tissues (RPT)(+) on enhanced MRI. RPT were likely located above the adenomas in somatotroph adenoma patients. Morphological restitution of postoperative normal pituitary tissues was better in lateral displacement than in superior or superolateral patterns on preoperative magnetic resonance imaging. Postoperative normal pituitary tissues usually subsided directly in superior displacement pattern on preoperative MRI, while were likely to be confined in the lateral side in lateral and superolateral displacement patients. Postoperative morphologic remodeling grade of RPT was positively correlated with the maximum diameter of pituitary adenoma (p = 0.000), but not with age. CONCLUSIONS The larger the tumor diameter, the worse the pituitary morphological recovery after tumor resection. Relative locations of normal pituitary and adenoma tissues may be related to adenoma type and may affect postoperative reconstruction of residual normal pituitary tissues. These findings enable surgeons to distinguish pituitary tissue from residual or recurring tumor tissue on postoperative magnetic resonance imaging.
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Affiliation(s)
- Deyong Xiao
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, 361005 Xiamen, Fujian, China
- Department of Neurosurgery, Fuzhou 900th Hospital, Fujian Medical University Fuzong Clinical College, 350025 Fuzhou, Fujian, China
| | - Shuai Zhang
- Department of Neurosurgery, Fuzhou 900th Hospital, Fujian Medical University Fuzong Clinical College, 350025 Fuzhou, Fujian, China
| | - Kunzhe Lin
- Department of Neurosurgery, Fuzhou 900th Hospital, Fujian Medical University Fuzong Clinical College, 350025 Fuzhou, Fujian, China
| | - Lin Zhao
- Department of Neurosurgery, Fuzhou 900th Hospital, Fujian Medical University Fuzong Clinical College, 350025 Fuzhou, Fujian, China
| | - Liangfeng Wei
- Department of Neurosurgery, Fuzhou 900th Hospital, Fujian Medical University Fuzong Clinical College, 350025 Fuzhou, Fujian, China
| | - Shousen Wang
- Department of Neurosurgery, Fuzhou 900th Hospital, Fujian Medical University Fuzong Clinical College, 350025 Fuzhou, Fujian, China
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Hasebe M, Shibue K, Honjo S, Hamasaki A. A Case of Lymphocytic Infundibulo-neurohypophysitis Exhibiting Spontaneous Regression. JCEM Case Rep 2023; 1:luad020. [PMID: 37908468 PMCID: PMC10580413 DOI: 10.1210/jcemcr/luad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Indexed: 11/02/2023]
Abstract
Lymphocytic infundibulo-neurohypophysitis (LINH) is a rare autoimmune inflammatory process that selectively affects the neurohypophysis and the pituitary stalk, typically presenting with central diabetes insipidus (CDI). LINH is considered underdiagnosed because the definitive diagnosis requires invasive pituitary surgery with a high risk of complications. We present a case of CDI resulting from LINH, which was treated with conservative management, eschewing both glucocorticoid treatment and pituitary surgery. At presentation, the hormonal assessment indicated the presence of CDI without anterior pituitary dysfunction. Magnetic resonance imaging revealed stalk thickening without a posterior pituitary bright spot, and anti-rabphilin-3A antibodies were positive in serum. Collectively, we made a diagnosis of LINH. Considering that the patient did not exhibit any symptoms of mass effect, we chose conservative treatment with desmopressin acetate. One year later, the stalk thickening regressed spontaneously without surgical or glucocorticoid treatment, although the posterior pituitary bright spot remained absent, and CDI did not improve. The inflammatory process of LINH is mostly self-limited and recovers spontaneously, whereas life-long desmopressin treatment may be required because of pituitary stalk fibrosis and atrophy. Our case highlights the importance of noninvasive diagnosis and careful follow-up in preventing unnecessary interventions for patients with LINH.
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Affiliation(s)
- Masashi Hasebe
- Department of Diabetes and Endocrinology, Medical Research Institute, Kitano Hospital, PIIF Tazuke-Kofukai, Kita-ku, Osaka 530-8480, Japan
| | - Kimitaka Shibue
- Department of Diabetes and Endocrinology, Medical Research Institute, Kitano Hospital, PIIF Tazuke-Kofukai, Kita-ku, Osaka 530-8480, Japan
| | - Sachiko Honjo
- Department of Diabetes and Endocrinology, Medical Research Institute, Kitano Hospital, PIIF Tazuke-Kofukai, Kita-ku, Osaka 530-8480, Japan
| | - Akihiro Hamasaki
- Department of Diabetes and Endocrinology, Medical Research Institute, Kitano Hospital, PIIF Tazuke-Kofukai, Kita-ku, Osaka 530-8480, Japan
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Zhang H, Zhang S, Shang M, Wang J, Wei L, Wang S. Pituitary stalk changes on magnetic resonance imaging following pituitary adenoma resection using a transsphenoidal approach. Front Neurol 2023; 14:1049577. [PMID: 36779061 PMCID: PMC9911825 DOI: 10.3389/fneur.2023.1049577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
Objective We aimed to investigate the magnetic resonance imaging (MRI) findings and clinical significance of position and changes in morphology of the pituitary stalk following pituitary adenoma (PA) resection using a transsphenoidal approach. Methods We collected clinical and MRI data of 108 patients with PA after transsphenoidal surgery. Diameter, length, and coronal deviation of the pituitary stalk were measured pre-, post-, and mid-term post-operatively, to observe pituitary stalk morphology. Results Of 108 patients, 53 pituitary stalks were recognisable pre-operatively. The angle between the pituitary stalk and the median line was 7.22°-50.20° (average, 25.85°) in 22 patients with left-sided pituitary stalks and 5.32°-64.05° (average, 21.63°) in 20 patients with right-sided pituitary stalks. Of 42 patients with preoperative pituitary stalk deviation, 41 had an early postoperative recovery and 1 had increased deviation. In the mid-term postoperative period, 21 of 42 patients had pituitary stalks located centrally. In 53 patients, the pituitary stalk length was 1.41-11.74 mm (mean, 6.12 mm) pre-operatively, 3.61-11.63 mm (mean, 6.93 mm) in the early postoperative period, and 5.37-17.57 mm (mean, 8.83 mm) in the mid-term postoperative period. In the early postoperative period, 58 (53.70%) patients had posterior pituitary bright spots (PPBS) and 28 (25.92%) had diabetes insipidus (DI). Conclusion Pre-operatively, the pituitary stalk was compressed and thinned. Post-operatively, it could be stretched to a "normal state", and its position showed a gradual centring trend. Post-operatively, the length of the pituitary stalk gradually increased. The PPBS in the early postoperative period negatively correlated with postoperative DI.
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Affiliation(s)
- Huijian Zhang
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| | - Shuai Zhang
- Department of Neurosurgery, Huanggang Central Hospital, Huanggang, Hubei, China
| | - Mingchao Shang
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| | - Jiaxing Wang
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| | - Liangfeng Wei
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| | - Shousen Wang
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China,Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China,*Correspondence: Shousen Wang ✉
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Xue L, Wu J, Chen J, Yang Y. Change in the pituitary stalk deviation angle after transsphenoidal surgery can predict the development of diabetes insipidus for pituitary adenomas. Endocr Connect 2022; 11:e220187. [PMID: 36103145 PMCID: PMC9641766 DOI: 10.1530/ec-22-0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/14/2022] [Indexed: 11/08/2022]
Abstract
Purpose We aimed to assess the factors influencing the development of diabetes insipidus after transsphenoidal surgery for pituitary adenomas. Methods A retrospective analysis was conducted on the clinical data of patients with pituitary adenomas who underwent transsphenoidal surgery. The predictors of postoperative diabetes insipidus were determined using statistical analysis. Results Of the 415 patients who underwent microscopic transsphenoidal surgery for pituitary adenomas, 196 experienced postoperative diabetes insipidus. The sinking depth of the diaphragma sellae and the difference between the preoperative and postoperative pituitary stalk deviation angles in the diabetes insipidus group were greater than those in the non-diabetes insipidus group. Logistic regression analysis showed that the risk of diabetes insipidus after transsphenoidal surgery was higher in patients with a larger difference in their pituitary stalk deviation angles (odds ratio = 2.407, 95% CI = 1.335-4.342; P = 0.004). Conclusion The difference in the pituitary stalk deviation angle could predict the onset of diabetes insipidus after transsphenoidal surgery for pituitary adenomas.
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Affiliation(s)
- Liang Xue
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, 900TH Hospital of the Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Jianwu Wu
- Department of Neurosurgery, 900TH Hospital of the Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Jie Chen
- Department of Radiology, 900TH Hospital of the Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Yongkai Yang
- Department of Neurosurgery, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, Fujian, China
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Wu J, Wu X, Yang L, Xie S, Tang B, Tong Z, Wu B, Yang Y, Ding H, Bao Y, Zhou L, Hong T. Nomograms to Predict Endocrinological Deficiency in Patients With Surgically Treated Craniopharyngioma. Front Oncol 2022; 12:840572. [PMID: 35664729 PMCID: PMC9161152 DOI: 10.3389/fonc.2022.840572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/15/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Postoperative hypopituitarism associated with increased risks of premature mobility and mortality is often encountered in craniopharyngioma patients. The aim of our study is to construct nomograms related to injury types of the hypothalamus-pituitary axis (HPA) to predict hypopituitarism 1 year after surgery. Methods Craniopharyngioma patients undergoing initial endoscopic endonasal surgery between December 2012 and March 2021 in our center were retrospectively reviewed, and injury types of the HPA were categorized according to intraoperative endoscopic observation. Included patients were randomly divided into a training group and a validation group. Nomograms were established based on the results of multivariate logistic analysis. The predictive performance of the nomograms was evaluated in the training and validation groups. Results A total of 183 patients with craniopharyngioma were enrolled, and seven injury types of the HPA were summarized. Relative to intact HPA, exclusive hypothalamus injury significantly increased the risk of anterior (OR, 194.174; 95% CI, 21.311-1769.253; p < 0.001) and posterior pituitary dysfunction (OR, 31.393; 95% CI, 6.319-155.964; p < 0.001) 1 year after surgery, while exclusively sacrificing stalk infiltrated by tumors did not significantly increase the risk of anterior (OR, 5.633; 95% CI, 0.753-42.133; p = 0.092) and posterior pituitary dysfunction (OR, 1.580; 95% CI, 0.257-9.707; p = 0.621) 1 year after surgery. In the training group, the AUCs of nomograms predicting anterior and posterior pituitary dysfunction 1 year after surgery were 0.921 and 0.885, respectively, compared with 0.921 and 0.880 in the validation group. Conclusions Intact hypothalamus structure is critical in maintaining pituitary function. Moreover, our preliminary study suggests that the pituitary stalk infiltrated by craniopharyngioma could be sacrificed to achieve radical resection, without substantially rendering significantly worse endocrinological efficiency 1 year after surgery. The user-friendly nomograms can be used to predict hypopituitarism 1 year after surgery.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Tao Hong
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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11
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Abstract
CONTEXT Pituitary stalk thickening (PST) is often identified on magnetic resonance imaging (MRI), either incidentally or during diagnostic workup of hypopituitarism. However, the neoplastic etiology and natural course of PST are not fully understood, although this knowledge is required to establish diagnostic and surveillance strategies. OBJECTIVE This work aimed to investigate the neoplastic etiology and natural course of PST. METHODS MEDLINE/PubMed and EMBASE databases were searched up to February 2021 to identify original research investigating the etiologies of PST. The proportion of neoplastic etiology in patients with PST was meta-analytically pooled. Supplementary analysis exploring factors suggesting neoplasm was also performed. For initially indeterminate cases without confirmed diagnosis, the proportion of patients showing progression of PST during follow-up was evaluated. RESULTS Eighteen studies covering 1368 patients with PST were included. The pooled proportion of neoplasm was 45.2% (95% CI, 33.3%-57.8%), with substantial heterogeneity across studies (I2 = 93%). The most common neoplasm was germ cell tumor (14.0% of study population), followed by Langerhans cell histiocytosis (10.2%) and metastasis (4.7%). The studies on pediatric populations and those with more than 50% of patients having at least one pituitary hormone deficiency tended to show a higher proportion of neoplasm. The pituitary stalk was thicker in neoplasms, but the difference was not significant (pooled mean difference, 2.08 mm; P = .08). In initially indeterminate cases, 18.5% (95% CI, 7.6%-38.3%) showed progression of PST during follow-up. CONCLUSION PST was commonly confirmed to be neoplastic, especially in pediatric populations. As isolated PST frequently progresses, follow-up imaging is essential in initially indeterminate cases.
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Affiliation(s)
- Dong Yeong Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jin-Ho Choi
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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12
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Chen Z, Ma Z, He W, Shou X, Ye Z, Zhang Y, Zhang Q, Qiao N, Zhou X, Cao X, He M, Zhang Z, Ye H, Li Y, Li S, Zhao Y, Shen M, Wang Y. Impact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas. Front Neurol 2021; 12:753944. [PMID: 34803890 PMCID: PMC8601158 DOI: 10.3389/fneur.2021.753944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the factors associated with recurrence/progression after endoscopic endonasal resection of suprasellar craniopharyngiomas. Special attention was paid to assess the impact of pituitary stalk preservation on tumor recurrence/progression and endocrinological outcomes. Methods: We retrospectively recruited 73 patients with suprasellar craniopharyngiomas undergone endoscopic endonasal approach (EEA) surgery from September 2014 to May 2019 and assessed their clinical characteristics, surgical outcomes, and recurrence/progression. Stalk preservation or sacrifice was determined by reviewing operative records, videos, and post-operative magnetic resonance imaging. Results: Gross total resection (GTR) was achieved in 51 cases (69.9%). Tumor recurrence was seen in 5 cases (9.8%) and progression was seen in 8 cases (36.4%), respectively. GTR (OR = 0.248 CI 0.081-0.759; p = 0.015) was the only independent factor influencing recurrence/progression. Kaplan-Meier survival analysis showed that the mean recurrence/progression-free survival were 53 (95% CI 48-59) and 39 (95% CI 28-50) months, respectively, in patients with and without GTR (p = 0.011). Pituitary stalk preservation was more common in cases with peripheral type tumors (83% vs. 30%, p < 0.01). Preserving the pituitary stalk does not appear to decrease the percentage of GTR (75.5% vs. 55.0%, p = 0.089), or increase the rate of tumor recurrence (12.5% vs. 0%, p = 0.508) or progression (46.2% vs. 22.2%, p = 0.486). However, surgically induced hypothyroidism (60.5% vs. 100%, p = 0.041) and diabetes insipidus (35.1% vs. 81.8%, p = 0.017) were significantly lower in patients with stalk preservation. For patients who had hypopituitarism before EEA, there was no difference between those with and without stalk preservation regarding post-operative hypopituitarism (p > 0.05). Conclusion: GTR is the only independent predictor of recurrence/progression after EEA surgery for suprasellar craniopharyngiomas. Preserving the pituitary stalk does not appear to increase the risk of non-GTR and tumor recurrence/progression and might help reduce the risk of surgically induced hypothyroidism and diabetes insipidus. We recommend preserving the pituitary stalk in peripheral type suprasellar craniopharyngiomas with normal pituitary function, especially in cases without hypothyroidism or diabetes insipidus. On the other hand, stalk sacrifice could be considered in central type tumors with severe pre-operative endocrinopathy.
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Affiliation(s)
- Zhengyuan Chen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Zengyi Ma
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Wenqiang He
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Xuefei Shou
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Zhao Ye
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Yichao Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Qilin Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Nidan Qiao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Xiang Zhou
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Xiaoyun Cao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Min He
- National Center for Neurological Disorder, Shanghai, China.,Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhaoyun Zhang
- National Center for Neurological Disorder, Shanghai, China.,Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongying Ye
- National Center for Neurological Disorder, Shanghai, China.,Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yiming Li
- National Center for Neurological Disorder, Shanghai, China.,Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shiqi Li
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Yao Zhao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Ming Shen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China
| | - Yongfei Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.,Shanghai Pituitary Tumor Center, Shanghai, China.,National Center for Neurological Disorder, Shanghai, China.,Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences, Beijing, China
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13
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Badmaeva IN, Astafieva LI, Kalinin PL, Kadashev BA, Kutin MA. [Central diabetes insipidus after resection of sellar-suprasellar tumors: prevalence and predictors of manifestation]. Zh Vopr Neirokhir Im N N Burdenko 2021; 85:111-118. [PMID: 34951768 DOI: 10.17116/neiro202185051111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Central diabetes insipidus is a neuroendocrine disorder caused by disturbances in antidiuretic hormone release. The last one is responsible for fluid and electrolyte balance regulation. The most common cause of diabetes insipidus is resection of sellar-suprasellar tumors followed by damage to hypothalamic nuclei responsible for antidiuretic hormone release, disruption of antidiuretic hormone transportation from hypothalamus or its release by neurohypophysis. According to various data, postoperative diabetes insipidus occurs in 13-30% of cases. The highest risk of diabetes insipidus is observed after resection of craniopharyngioma, Rathke's cleft cyst and ACTH-releasing pituitary microadenoma. This review is devoted to prevalence and predictors of diabetes insipidus after resection of sellar-suprasellar tumors.
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Affiliation(s)
| | | | - P L Kalinin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - M A Kutin
- Burdenko Neurosurgical Center, Moscow, Russia
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14
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Bianco D, Napoli F, Morana G, Pistorio A, Allegri AEM, Fava D, Schiavone M, Thiabat HF, Crocco M, Camia T, Lezzi M, Calandrino A, Tortora D, Severino M, Patti G, Ibba A, Rossi A, Di Iorgi N, Maghnie M. Endocrine Outcomes In Central Diabetes Insipidus: the Predictive Value of Neuroimaging "Mismatch Pattern". J Clin Endocrinol Metab 2020; 105:5892808. [PMID: 32797230 DOI: 10.1210/clinem/dgaa540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/11/2020] [Indexed: 01/21/2023]
Abstract
CONTEXT The etiology of central diabetes insipidus (CDI) in children is often unknown. Clinical and radiological features at disease onset do not allow discrimination between idiopathic forms and other conditions or to predict anterior pituitary dysfunction. OBJECTIVE To evaluate the evolution of pituitary stalk (PS) thickening and the pattern of contrast-enhancement in relation with etiological diagnosis and pituitary function. METHODS We enrolled 39 children with CDI, 29 idiopathic and 10 with Langerhans cell histiocytosis (LCH). Brain magnetic resonance images taken at admission and during follow-up (332 studies) were examined, focusing on PS thickness, contrast-enhancement pattern, and pituitary gland size; T2-DRIVE and postcontrast T1-weighted images were analyzed. RESULTS Seventeen of 29 patients (58.6%) with idiopathic CDI displayed "mismatch pattern," consisting in a discrepancy between PS thickness in T2-DRIVE and postcontrast T1-weighted images; neuroimaging findings became stable after its appearance, while "mismatch" appeared in LCH patients after chemotherapy. Patients with larger PS displayed mismatch more frequently (P = 0.003); in these patients, reduction of proximal and middle PS size was documented over time (P = 0.045 and P = 0.006). The pituitary gland was smaller in patients with mismatch (P < 0.0001). Patients with mismatch presented more frequently with at least one pituitary hormone defect, more often growth hormone deficiency (P = 0.033). CONCLUSIONS The PS mismatch pattern characterizes patients with CDI, reduced pituitary gland size, and anterior pituitary dysfunction. The association of mismatch pattern with specific underlying conditions needs further investigation. As patients with mismatch show stabilization of PS size, we assume a prognostic role of this peculiar pattern, which could be used to lead follow-up.
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Affiliation(s)
- Deborah Bianco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Angela Pistorio
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Daniela Fava
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maurizio Schiavone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Hanan F Thiabat
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marco Crocco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Tiziana Camia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marilea Lezzi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrea Calandrino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Domenico Tortora
- Pediatric Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Giuseppa Patti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Anastasia Ibba
- SSD Endocrinologia Pediatrica, Azienda Ospedaliera Brotzu, SSD Endocrinologia Pediatrica, Ospedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
| | - Andrea Rossi
- Pediatric Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Natascia Di Iorgi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
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15
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Kasapas K, Malli A, Sfikas S, Georgakoulias N. Sporadic Pituitary Stalk Hemangioblastoma: A Rare Case Report and Review of the Literature. Cureus 2020; 12:e9107. [PMID: 32789052 PMCID: PMC7417129 DOI: 10.7759/cureus.9107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Supratentorial hemangioblastomas have rarely been described in the literature. Pituitary stalk hemangioblastomas are extremely rare and almost always are associated with von Hippel Lindau disease. Herein, we report a sporadic case of pituitary stalk hemangioblastoma in a 36-year-old male and review the current literature regarding this pathology. In our case, complete resection of the lesion was achieved using the transglabellar approach.
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Affiliation(s)
| | - Antonia Malli
- Neurosurgery, The National and Kapodistrian University of Athens School of Health Sciences, Athens, GRC
| | - Spyros Sfikas
- Neurosurgery, 251 Air Force General Hospital, Athens, GRC
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16
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Faje A. Chronic lymphocytic leukemia, a rare cause of pituitary stalk thickening. Clin Case Rep 2020; 8:1319-1320. [PMID: 32695388 PMCID: PMC7364060 DOI: 10.1002/ccr3.2875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/08/2020] [Accepted: 03/24/2020] [Indexed: 11/25/2022] Open
Abstract
This case highlights a rare presentation of chronic lymphocytic leukemia (CLL). CNS involvement by CLL is rare, and only 5 cases with pituitary or hypothalamic involvement have previously been reported. Unfamiliarity with this disease complication may lead to a delay in diagnosis and treatment.This case highlights a rare presentation of chronic lymphocytic leukemia (CLL). CNS involvement by CLL is rare, and only 5 cases with pituitary or hypothalamic involvement have previously been reported. Unfamiliarity with this disease complication may lead to a delay in diagnosis and treatment.
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Affiliation(s)
- Alexander Faje
- Neuroendocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
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17
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Kakehi E, Adachi S, Fukuyasu Y, Hashimoto Y, Sakurai S, Hirotani A, Danbara H, Shimizu K, Fujita R, Teraura H, Kotani K, Matsumura M. Magnetic resonance imaging and symptoms in patients with neurosarcoidosis and central diabetes insipidus. Endokrynol Pol 2019; 70:430-437. [PMID: 31681969 DOI: 10.5603/ep.a2019.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/30/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In the clinical setting, the diagnosis of neurosarcoidosis in patients with central diabetes insipidus (CDI) is typically based both on symptoms (i.e. polydipsia or polyuria) and brain magnetic resonance imaging (MRI) findings (e.g. pituitary abnormality). However, inconsistent changes in the patient's symptoms and brain MRI findings may occur during the clinical course of the disease. This review was performed to summarise the relationship between symptoms and brain MRI findings in previously reported cases of neurosarcoidosis with CDI. MATERIAL AND METHODS Case studies of patients diagnosed with neurosarcoidosis with CDI were collected via a PubMed search of studies published through 30 June 2018. RESULTS Thirteen eligible studies were reviewed (20 patients; 12 men, 8 women; mean age 33 years). Polydipsia or polyuria was the first symptom in 13 patients. The mean duration from disease onset to diagnosis was 3.4 months. Brain MRIs showed abnormal findings in the hypothalamus and pituitary for 17 patients. Immunosuppressive drugs were used in 17 patients. For 14 patients, MRI findings improved, while symptoms did not. CONCLUSION Patients with both neurosarcoidosis and CDI symptoms often do not improve, despite the fact that brain MRI findings often improve following treatment. More studies involving detailed pathological analyses and longer follow-up periods are necessary.
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Affiliation(s)
- Eiichi Kakehi
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan.
| | - Seiji Adachi
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Yusuke Fukuyasu
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Yasuhiro Hashimoto
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Shigehisa Sakurai
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Akane Hirotani
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Hisanori Danbara
- Department of Internal Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Kaduyo Shimizu
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Ryosuke Fujita
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Hiroyuki Teraura
- Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Kazuhiko Kotani
- Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Masami Matsumura
- Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
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18
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Wang F, Zhang J, Wang P, Zhou T, Meng X, Jiang J. Prediction of pituitary stalk position in pituitary adenomas by visualization of the hypothalamo-hypophyseal tract using diffusion tensor imaging tractography. Medicine (Baltimore) 2018; 97:e0052. [PMID: 29517662 PMCID: PMC5882425 DOI: 10.1097/md.0000000000010052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The preservation of pituitary stalk during surgery is very important for neurosurgeons. Sometimes, it is hard to identify the pituitary stalk in the operation. The hypothalamo-hypophyseal tract (HHT) projects through the pituitary stalk to the posterior pituitary gland. If the HHT can be identified, the position of pituitary stalk will be visualized. The diffusion tensor imaging (DTI) fiber tracking technique has been widely used for the quantitative assessment of the white matter integrity and thus may be suitable for the evaluation of the HHT.DTI was used to track the HHT in 11 patients with pituitary adenoma, and the location of the tract was compared with the pituitary stalk of postoperative image in those patients.The fiber tracking and 3D visualization of the HHT were successfully carried out in all 11 patients. Comparison between the tract and pituitary stalk of postoperative magnetic resonance imaging (MRI) was carried out in 9 patients. The results revealed that the position of tract was consistent with the pituitary stalk of postoperative MRI image in 8 patients (88.9%). The properties of tract showed that the median number of tract was 5.18 ± 7.00, the median fractional anisotropy (FA) was 0.14 ± 0.04, and the median length was 28.81 ± 7.94 mm.HHT can be tracked and visualized with the DTI-FT technique. It will be helpful to identify the location of pituitary stalk preoperatively.
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Lundgren JA, Oldfield EH, Marshall JC. The longest stalk: preserved pituitary function after regression of a giant prolactinoma. Pituitary 2017; 20:485-487. [PMID: 28210909 PMCID: PMC5844470 DOI: 10.1007/s11102-017-0796-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Edward H Oldfield
- University of Virginia Health System, Charlottesville, VA, 22908, USA
| | - John C Marshall
- University of Virginia Health System, Charlottesville, VA, 22908, USA
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20
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Nakassa ACI, Chabot JD, Snyderman CH, Wang EW, Gardner PA, Fernandez-Miranda JC. Complete endoscopic resection of a pituitary stalk epidermoid cyst using a combined infrasellar interpituitary and suprasellar endonasal approach: case report. J Neurosurg 2017; 128:437-443. [PMID: 28409722 DOI: 10.3171/2016.11.jns161605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial epidermoid cysts are benign lesions of epithelial origin that most frequently present with symptoms of mass effect. Although they are often associated with a high rate of residual tumor and recurrence, maximal safe resection usually leads to good outcomes. The authors report a complete resection of an uncommon pituitary stalk epidermoid cyst with intrasellar extension using a combined suprasellar and infrasellar interpituitary, endoscopic endonasal transsphenoidal approach. The patient, a 54-year-old woman, presented with headache, visual disturbance, and diabetes insipidus. Postoperatively, she reported improvement in her visual symptoms and well-controlled diabetes insipidus using 0.1 mg of desmopressin at bedtime and normal anterior pituitary gland function. One year later, she continues to receive the same dosage of desmopressin and is also taking 50 mcg of levothyroxine daily after developing primary hypothyroidism unrelated to the surgical procedure. A combined infrasellar interpituitary and suprasellar approach to this rare location for an epidermoid cyst can lead to a safe and complete resection with good clinical outcomes.
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Affiliation(s)
- Ana C I Nakassa
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Joseph D Chabot
- 2Department of Neurosciences, St. Cloud Hospital, St. Cloud, Minnesota
| | - Carl H Snyderman
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Eric W Wang
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Paul A Gardner
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Juan C Fernandez-Miranda
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
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Li HY, Feng CY, Zhang C, Su J, Yuan J, Xie Y, Liao Y, Yuan X, Liu Q. Microscopic surgery for pituitary adenomas to preserve the pituitary gland and stalk. Exp Ther Med 2017; 13:1011-1016. [PMID: 28450934 PMCID: PMC5403720 DOI: 10.3892/etm.2017.4063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/13/2016] [Indexed: 11/05/2022] Open
Abstract
Surgery is the primary treatment of choice for all symptomatic pituitary adenomas except prolactinomas. Common postoperative complications include endocrinopathies, vision impairment and cerebrospinal fluid leak. The present study assessed 153 continuous microscopic surgeries for pituitary adenomas performed by an author of the present study between 2010 to 2014. Patients underwent either transphenoidal or transcranial surgery depending on their individual tumor characteristics. Five typical cases are presented in the present study and intraoperative identification and preservation of the gland and stalk were discussed. Postoperative complications were analyzed and compared with the literature. In the present analysis, 90.2% patients received transphenoidal surgery, and the rest underwent transcranial operation. Gross total resection was achieved in 81.2% patients in the transphenoidal group and 46.7% patients in the transcranial group. No new hypopituitarism or worsening of the pre-existing pituitary dysfunctions was detected. The most common postoperative endocrinopathy was diabetes insipidus (transphenoidal group, 4.3%; transcranial group, 26.7%). All patients were fully recovered prior to discharge. The findings indicated the importance of pituitary gland and stalk preservation during the microscopic surgery to minimize postoperative morbidity and mortality, without compromising the extent of tumor resection. Based on preoperative imaging characteristics and intraoperative observations, surgeons should try all possible means to preserve the pituitary stalk and gland during surgery in order to minimize postoperative endocrinopathies and improve quality of life.
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Affiliation(s)
- Hao-Yu Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
- The Institute of Skull Base Surgery & Neurooncology at Hunan, Neurosurgery Institute of Central South University, Changsha, Hunan 410008, P.R. China
| | - Cheng-Yuan Feng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
- The Institute of Skull Base Surgery & Neurooncology at Hunan, Neurosurgery Institute of Central South University, Changsha, Hunan 410008, P.R. China
| | - Chi Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
- The Institute of Skull Base Surgery & Neurooncology at Hunan, Neurosurgery Institute of Central South University, Changsha, Hunan 410008, P.R. China
| | - Jun Su
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
- The Institute of Skull Base Surgery & Neurooncology at Hunan, Neurosurgery Institute of Central South University, Changsha, Hunan 410008, P.R. China
| | - Jian Yuan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
- The Institute of Skull Base Surgery & Neurooncology at Hunan, Neurosurgery Institute of Central South University, Changsha, Hunan 410008, P.R. China
| | - Yuanyang Xie
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
- The Institute of Skull Base Surgery & Neurooncology at Hunan, Neurosurgery Institute of Central South University, Changsha, Hunan 410008, P.R. China
| | - Yiwei Liao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
- The Institute of Skull Base Surgery & Neurooncology at Hunan, Neurosurgery Institute of Central South University, Changsha, Hunan 410008, P.R. China
| | - Xianrui Yuan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
- The Institute of Skull Base Surgery & Neurooncology at Hunan, Neurosurgery Institute of Central South University, Changsha, Hunan 410008, P.R. China
| | - Qing Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
- The Institute of Skull Base Surgery & Neurooncology at Hunan, Neurosurgery Institute of Central South University, Changsha, Hunan 410008, P.R. China
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Tanaka Y, Tanaka A, Hashimoto A, Shinzato I. Isolated Pituitary Stalk Relapse of Primary Penile Lymphoma. Intern Med 2017; 56:835-839. [PMID: 28381752 PMCID: PMC5457929 DOI: 10.2169/internalmedicine.56.7788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 76-year-old Japanese man was admitted to our hospital because of the occurrence of multiple nodules on the shaft of his penis. He was diagnosed with diffuse large B cell lymphoma (DLBCL). His lymphoma was located only in his penis. He received immunochemotherapy and involved-field radiotherapy, and achieved complete response (CR). About two years later, he complained of a poor appetite. Magnetic resonance imaging showed a mass lesion in the pituitary stalk. Biopsy of this mass revealed the recurrence of DLBCL. He received whole-brain radiotherapy, and achieved CR. This is the first case of an isolated pituitary stalk relapse of primary penile lymphoma.
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Affiliation(s)
- Yasuhiro Tanaka
- Department of Hematology and Clinical Immunology, Nishi-Kobe Medical Center, Japan
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Di Iorgi N, Morana G, Allegri AEM, Napoli F, Gastaldi R, Calcagno A, Patti G, Loche S, Maghnie M. Classical and non-classical causes of GH deficiency in the paediatric age. Best Pract Res Clin Endocrinol Metab 2016; 30:705-736. [PMID: 27974186 DOI: 10.1016/j.beem.2016.11.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Growth hormone deficiency (GHD) may result from a failure of hypothalamic GHRH production or release, from congenital disorders of pituitary development, or from central nervous system insults including tumors, surgery, trauma, radiation or infiltration from inflammatory diseases. Idiopathic, isolated GHD is the most common sporadic form of hypopituitarism. GHD may also occur in combination with other pituitary hormone deficiencies, and is often referred to as hypopituitarism, combined pituitary hormone deficiency (CPHD), multiple pituitary hormone deficiency (MPHD) or panhypopituitarism. Children without any identifiable cause of their GHD are commonly labeled as having idiopathic hypopituitarism. MRI imaging is the technique of choice in the diagnosis of children with hypopituitarism. Marked differences in MRI pituitary gland morphology suggest different etiologies of GHD and different prognoses. Pituitary stalk agenesis and ectopic posterior pituitary (EPP) are specific markers of permanent GHD, and patients with these MRI findings show a different clinical and endocrine outcome compared to those with normal pituitary anatomy or hypoplastic pituitary alone. Furthermore, the classic triad of ectopic posterior pituitary gland, pituitary stalk hypoplasia/agenesis, and anterior pituitary gland hypoplasia is generally associated with permanent GHD. T2 DRIVE images aid in the identification of pituitary stalk without the use of contrast medium administration. Future developments in imaging techniques will undoubtedly reveal additional insights. Mutations in a number of genes encoding transcription factors - such as HESX1, SOX2, SOX3, LHX3, LHX4, PROP1, POU1F1, PITX, GLI3, GLI2, OTX2, ARNT2, IGSF1, FGF8, FGFR1, PROKR2, PROK2, CHD7, WDR11, NFKB2, PAX6, TCF7L1, IFT72, GPR161 and CDON - have been associated with pituitary dysfunction and abnormal pituitary gland development; the correlation of genetic mutations to endocrine and MRI phenotypes has improved our knowledge of pituitary development and management of patients with hypopituitarism, both in terms of possible genetic counseling, and of early diagnosis of evolving anterior pituitary hormone deficiencies.
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Affiliation(s)
- Natascia Di Iorgi
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Anna Elsa Maria Allegri
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Roberto Gastaldi
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Annalisa Calcagno
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Giuseppa Patti
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Sandro Loche
- SSD Endocrinologia Pediatrica, Ospedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy; Department of Endocrine Unit, Istituto Giannina Gaslini, University of Genova, Genova, Italy.
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Abstract
The effectiveness and safety of fronto-basal interhemispheric approach in treating craniopharyngioma were evaluated. In this retrospective study, the safety and effectiveness of fronto-basal interhemispheric approach for surgical resection of craniopharyngioma in 20 patients was analyzed. Of the 20 patients, 12 were men and 8 were women, aged 15–65 years, with an average age of 42.5 years. The course of disease ranged from 1 to 36 months. The craniopharyngioma tumor was completely removed through surgical resection in 18 patients (90%) and partially removed in 2 patients. The pituitary stalk was preserved in 18 patients and 1 patient succumbed during the study period due to large area pulmonary embolism. In conclusion, fronto-basal interhemispheric approach provides better access to the tumor that grows in the sella-hypothalamus and anterior third ventricle region. Using this approach, tumors can be resected while preserving the vital structures such as the pituitary stalk and hypothalamus.
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Affiliation(s)
- Hongshun Xing
- Department of Neurosurgery, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Hongbo Xing
- Department of Stomatology, Weihai Municipal Hospital, Weihai, Shandong 264200, P.R. China
| | - Peiquan Hui
- Department of Neurosurgery, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Bin Yang
- Department of Neurosurgery, Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
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Abstract
OBJECT Craniopharyngiomas (CPs) are rare epithelial tumors that are often associated with an enigmatic and unpredictable growth pattern. Understanding the growth patterns of these tumors has a direct impact on surgical planning and may enhance the safety of radical tumor removal. The aim of this study was to analyze the growth patterns and surgical treatment of CPs with a focus on the involvement of the hypothalamopituitary axis and the relationship of the tumor to the arachnoid membrane and surrounding structures. METHODS Clinical data from 226 consecutive patients with primary CP were retrospectively reviewed. Tumor location and the relationship of the tumor to the third ventricle floor and the pituitary stalk were evaluated using preoperative MRI and intraoperative findings. A topographic classification scheme was proposed based on the site of tumor origin and tumor development. The clinical relevance of this classification on patient presentation and outcomes was also analyzed. RESULTS The growth of CPs can be broadly divided into 3 groups based on the site of tumor origin and on tumor-meningeal relationships: Group I, infrasellar/infradiaphragmatic CPs (Id-CPs), which mainly occurred in children; Group II, suprasellar subarachnoid extraventricular CPs (Sa-CPs), which were mainly observed in adults and rarely occurred in children; and Group III, suprasellar subpial ventricular CPs (Sp-CPs), which commonly occurred in both adults and children. Tumors in each group may develop complex growth patterns during vertical expansion along the pituitary stalk. Tumor growth patterns were closely related to both clinical presentation and outcomes. Patients with Sp-CPs had more prevalent weight gain than patients with Id-CPs or Sa-CPs; the rates of significant weight gain were 41.7% for children and 16.7% for adults with Sp-CPs, 2.2% and 7.1% for those with Id-CPs, and 12.5% and 2.6% for those with Sa-CPs (p < 0.001). Moreover, patients with Sp-CPs had increased hypothalamic dysfunction after radical removal; 39% of patients with Sp-CPs, 14.5% with Id-CPs, and 17.4% with Sa-CPs had high-grade hypothalamic dysfunction in the first 2 postoperative years (p < 0.001). CONCLUSIONS The classification of CPs based on growth pattern may elucidate the best course of treatment for this formidable tumor. More tailored, individualized surgical strategies based on tumor growth patterns are mandatory to provide long-term tumor control and to minimize damage to hypothalamic structures. Differences in the distribution of growth patterns between children and adults imply that hierarchical comparison is necessary when investigating outcomes and survival across treatment paradigms in patients with CP.
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Affiliation(s)
| | | | - Yi Liu
- Departments of 1 Neurosurgery
| | | | | | | | - YiKai Xu
- Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | | | - Jun Fan
- Departments of 1 Neurosurgery
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Metwali H, Gerganov V, Fahlbusch R. Optic nerve mobilization to enhance the exposure of the pituitary stalk during craniopharyngioma resection: early experience. J Neurosurg 2015; 125:683-8. [PMID: 26684781 DOI: 10.3171/2015.6.jns141847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Preservation of the pituitary stalk and its vasculature is a key step in good postoperative endocrinological outcome in patients with craniopharyngiomas. In this article, the authors describe the surgical technique of medial optic nerve mobilization for better inspection and preservation of the pituitary stalk. METHODS This operative technique has been applied in 3 patients. Following tumor exposure via a frontolateral approach, the pituitary stalk could be seen partially hidden under the optic nerve and the optic chiasm. The subchiasmatic and opticocarotid spaces were narrow, and tumor dissection from the pituitary stalk under direct vision was not possible. The optic canal was therefore unroofed, the falciform ligament was incised, and the lateral part of the tuberculum sellae was drilled medial to the optic nerve. The optic nerve could be mobilized medially to widen the opticocarotid triangle, which enhanced visualization of and access to the pituitary stalk. RESULTS By using the optic nerve mobilization technique, the tumor could be removed completely, and the pituitary stalk and its vasculature were preserved in all patients. In 2 patients, vision improved after surgery, while in 1 patient it remained normal, as it was before surgery. The hormonal status remained normal after surgery in 2 patients. In the patient with preoperative hormonal deficiencies, improvement occurred early after surgery and hormonal levels were normal after 3 months. No approach-related complications occurred. CONCLUSIONS This early experience shows that this technique is safe and could be used as a complementary step during microsurgery of craniopharyngiomas. It allows for tumor dissection from the pituitary stalk under direct vision. The pituitary stalk can thus be preserved without jeopardizing the optic nerve.
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Affiliation(s)
- Hussam Metwali
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany
| | - Venelin Gerganov
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany
| | - Rudolf Fahlbusch
- Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany
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Abstract
Central diabetes insipidus (CDI) is a complex and heterogeneous clinical syndrome affecting the hypothalamic-neurohypophyseal network and water balance. A recent national surveillance in Denmark showed a prevalence rate of twenty-three CDI patients per 100,000 inhabitants in five years. The differential diagnosis between several presenting conditions with polyuria and polydipsia is puzzling, and the etiological diagnosis of CDI remains a challenge before the identification of an underlying cause. For clinical practice, a timely diagnosis for initiating specific treatment in order to avoid central nervous system damage, additional pituitary defects and the risk of dissemination of germ cell tumor is advisable. Proper etiological diagnosis can be achieved via a series of steps that start with careful clinical observation of several signs and endocrine symptoms and then progress to more sophisticated imaging tools. This review summarizes the best practice and approach for the diagnosis and treatment of patients with CDI.
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Affiliation(s)
- Natascia Di Iorgi
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Giovanni Morana
- Department of Pediatric Neuroradiology, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Flavia Napoli
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | | | - Andrea Rossi
- Department of Pediatric Neuroradiology, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy.
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Xiao G, Yuan X, Yuan J, Krumtally NA, Li Y, Feng C, Liu Q, Peng Z, Li X, Ding X. Pituitary stalk management during the microsurgery of craniopharyngiomas. Exp Ther Med 2014; 7:1055-1064. [PMID: 24940387 PMCID: PMC3991534 DOI: 10.3892/etm.2014.1561] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 02/07/2014] [Indexed: 11/06/2022] Open
Abstract
In the present study, 203 patients that had previously undergone microsurgery for craniopharyngiomas (CPs) between 1992 and 2012 were analyzed retrospectively on a long-term follow-up basis to investigate the differences in the recurrence rate and endocrine function between patients with preserved and resected pituitary stalks. To summarize the possible outcomes of microsurgery, the 203 patients were divided into 2 groups: Group A that had preserved pituitary stalks and Group B that had undergone resections of the pituitary stalk. Tumor origins and the involvement of the pituitary stalk during surgery were observed. From 2010 onwards, an ultra-electron microscope was used postoperatively to detect whether pituitary stalk specimens were infiltrated or invaded with tumor cells. Long-term follow-up observations of the patients included tumor recurrence, postoperative endocrine dysfunction and visual acuity and field. Among the 203 patients, 175 patients received gross-total resection (GTR) (175/203, 86.2%), 28 patients underwent subtotal resection (28/203, 13.8%) and 34 patients had surgery that preserved the pituitary stalk (34/203, 16.7%). There was no significant difference in the recurrence rate between Group A (4/34, 11.8%) and the patients in Group B (10/123, 8.1%) who underwent GTR and also received follow-ups. Of the 157 patients who were followed up, 91 individuals underwent endocrine evaluation and the outcome was divided into normal, satisfactory and poor grades. The results for Group A were 5, 18 and 0, respectively, while the results for Group B were 1, 60 and 7, respectively, which showed a statistically significant difference between the groups. Pituitary stalk specimens of 15 patients were studied postoperatively using an ultra-electron microscope and all samples showed tumor cells had invaded the pituitary stalk (15/15, 100%). Total resections of CPs with the pituitary stalk were recommended if the pituitary stalk was intraoperatively invaded. In cases where the pituitary stalk was not involved, microsurgical excisions preserving the pituitary stalk were preferred, as there was no significant increase in the recurrence rate and the patients experienced less endocrine dysfunction.
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Affiliation(s)
- Gelei Xiao
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xianrui Yuan
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Jian Yuan
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Nadeem Akhtar Krumtally
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yifeng Li
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Chengyuan Feng
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Qing Liu
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Zefeng Peng
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xuejun Li
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xiping Ding
- Institute of Skull Base Surgery and Neurooncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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29
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Ikeda H, Gotoh H, Watanabe K. Outcome of endoscopy-assisted microscopic extended transsphenoidal surgery for suprasellar adult craniopharyngiomas. Front Endocrinol (Lausanne) 2012; 3:25. [PMID: 22654858 PMCID: PMC3356029 DOI: 10.3389/fendo.2012.00025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 02/01/2012] [Indexed: 11/13/2022] Open
Abstract
Craniopharyngiomas are difficult to treat. The extended transsphenoidal approach has recently been described in several small series. We describe the usefulness of microscopy-assisted angled endoscopy for visualizing vital structures such as tumor attachment or tumor invasion to the pituitary stalk to achieve confident radical tumor removal. Between 2006 and 2010, 15 patients underwent the microscopy-assisted extended transsphenoidal approach for resection of entirely suprasellar craniopharyngiomas. Fourteen patients had the transinfundibular type, and one had the transinfundibular type with extension to the third ventricle. We observed color change within the pituitary stalk by endoscopy. The pituitary stalk was cut intentionally in 10 patients because of suspected tumor invasion surrounding the stalk. Total removal was accomplished in nine patients. Pathological specimens from the pituitary stalk showed tumor invasion spreading over the surface of the pituitary stalk, shown by a discolored pituitary stalk, and this was essential for confident radical tumor removal. Even after stalk resection, postoperative diabetes insipidus was minimal when a bright signal on T1 in the posterior lobe was not observed with preoperative magnetic resonance imaging. Confident radical tumor removal is possible with the introduction of the endoscopy-assisted microscopic extended transsphenoidal approach.
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Affiliation(s)
- Hidetoshi Ikeda
- Research Institute for Pituitary Disease, Southern Tohoku General HospitalKoriyama, Japan
| | - Hiromi Gotoh
- Department of Neurosurgery, Southern Tohoku General HospitalKoriyama, Japan
| | - Kazuo Watanabe
- Research Institute for Neuroscience, Southern Tohoku General HospitalKoriyama, Japan
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30
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Abstract
Hypopituitarism is not a common cause of delayed puberty. A 22 year old man was referred to our clinic because of the absence of the development of secondary sexual characteristics. The patient had no complaints of physical discomfort. Random serum testosterone and luteinizing hormone level were obtained and found to be low. The combined pituitary function stimulation test revealed a partial hypopituitarism. A pituitary magnetic resonance imaging (MRI) was obtained and showed decreased pituitary stalk enhancement and ectopic neurohypophysis. Therefore, we conclude that the delayed puberty was a result of hypopituitarism due to pituitary stalk dysgenesis and ectopic neurohypophysis. The patient was started on hormone replacement therapy and gradually developed secondary sexual characteristics.
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Affiliation(s)
- Hye Jin Yoo
- Department of Internal Medicine. Korea University College of Medicine, Seoul, Korea
| | - Kyung Mook Choi
- Department of Internal Medicine. Korea University College of Medicine, Seoul, Korea
| | - Ohk Hyun Ryu
- Department of Internal Medicine. Korea University College of Medicine, Seoul, Korea
| | - Sang Il Suh
- Department of Diagnostic Radiology, Korea University College of Medicine, Seoul, Korea
| | - Nan Hee Kim
- Department of Internal Medicine. Korea University College of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Department of Internal Medicine. Korea University College of Medicine, Seoul, Korea
| | - Dong Seop Choi
- Department of Internal Medicine. Korea University College of Medicine, Seoul, Korea
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