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Endocrinology and Metabolism Clinics of... Sep 2020Pituitary adenomas are usually nonmalignant, but have a heavy burden on patients and health care systems. Increased availability of MRI has led to an increase in... (Review)
Review
Pituitary adenomas are usually nonmalignant, but have a heavy burden on patients and health care systems. Increased availability of MRI has led to an increase in incidentally found pituitary lesions and clinically relevant pituitary adenomas. Epidemiologic studies show that pituitary adenomas are increasing in incidence (between 3.9 and 7.4 cases per 100,000 per year) and prevalence (76 to 116 cases per 100,000 population) in the general population (approximately 1 case per 1000 of the general population). Most new cases diagnosed are prolactinomas and nonsecreting pituitary adenomas. Most clinically relevant pituitary adenomas occur in females, but pituitary adenomas are clinically heterogeneous.
Topics: Adenoma; Humans; Incidence; Pituitary Neoplasms; Prevalence
PubMed: 32741475
DOI: 10.1016/j.ecl.2020.04.002 -
Ugeskrift For Laeger May 2019In this review, we discuss pituitary adenomas (PA), which account for 10-25% of the intracranial tumours. Despite their benign nature, PA often show invasive growth.... (Review)
Review
In this review, we discuss pituitary adenomas (PA), which account for 10-25% of the intracranial tumours. Despite their benign nature, PA often show invasive growth. Pressure on neighbouring structures may cause hypopituitarism or vision field impairment. For PA, except prolactinomas, surgical treatment is first choice. The primary surgical technique is transsphenoidal surgery. Pituitary function, vision and post-operative magnetic resonance imaging scan is evaluated in a multidisciplinary team of neurosurgeons and endocrinologist 6-8 weeks post-operatively. Follow-up and treatment of pituitary adenomas is highly specialised and requires a team of dedicated endocrinologists and neurosurgeons.
Topics: Adenoma; Humans; Magnetic Resonance Imaging; Pituitary Neoplasms; Treatment Outcome
PubMed: 31124446
DOI: No ID Found -
Annales D'endocrinologie Jul 2015Clinically NFPA is currently the preferred term for designing all the pituitary adenomas which are not hormonally active (in other words, not associated with clinical... (Review)
Review
Clinically NFPA is currently the preferred term for designing all the pituitary adenomas which are not hormonally active (in other words, not associated with clinical syndromes such as amenorrhea-galactorrhea in the context of prolactinomas, acromegaly, Cushing's disease or hyperthyroidism secondary to TSH-secreting adenomas). They account for 15-30% of pituitary adenomas. Diagnosis is usually made either in the context of mass effect due to a macroadenoma or, increasingly, fortuitously during imaging performed for some unrelated purpose; the latter case is known as pituitary incidentaloma. Surgery is indisputably indicated in case of tumoral syndrome, but other aspects of NFPA (hormonal work-up, follow-up, and especially postoperative follow-up, management of remnant or recurrence, the special case of incidentaloma, or apoplexy) remain controversial. The French Endocrinology Society (SFE) therefore set up an expert working group of endocrinologists, neurosurgeons, ophthalmologists, neuroradiologists, pathologists and biologists to draw up guidelines, at the 2012 SFE Congress in Toulouse, France. The present article presents the guidelines suggested by this group of French-speaking experts.
Topics: Adenoma; Consensus; Humans; Pituitary Apoplexy; Pituitary Neoplasms
PubMed: 26072284
DOI: 10.1016/j.ando.2015.04.002 -
Endocrine Practice : Official Journal... Jan 2023Pituitary Incidentalomas (PI) are pituitary lesions serendipitously identified on imaging. PIs have become common in clinical practice because of increased use of... (Review)
Review
Pituitary Incidentalomas (PI) are pituitary lesions serendipitously identified on imaging. PIs have become common in clinical practice because of increased use of imaging and radiologic advances. The most frequently incidentally detected lesions in adults are pituitary adenomas, followed by cystic lesions, and rarely other types of tumors and infiltrative and inflammatory disorders. Biochemical screening for hyperprolactinemia and acromegaly is needed in all patients with PI, whereas testing for hyposecretion is recommended for lesions larger than 6.0 mm. Most PIs are small nonfunctioning adenomas or cysts, which can be conservatively managed. For larger lesions, a multidisciplinary approach including endocrinology, neurosurgery, and neuro-ophthalmology is required. For incidentally detected lactotroph, somatotroph, and corticotroph adenomas, disease-specific management guidelines apply. Prospective studies are needed to enhance our understanding of the long-term course and response to treatment.
Topics: Adult; Humans; Pituitary Neoplasms; Adenoma; Pituitary Gland; ACTH-Secreting Pituitary Adenoma; Acromegaly
PubMed: 36270609
DOI: 10.1016/j.eprac.2022.10.004 -
Veterinary Journal (London, England :... Apr 2021Pituitary tumours are common in dogs and are being increasingly recognized in cats. Pituitary tumours are usually classified as adenomas and should only be classified as... (Review)
Review
Pituitary tumours are common in dogs and are being increasingly recognized in cats. Pituitary tumours are usually classified as adenomas and should only be classified as carcinomas when there is evidence of metastatic spread of the tumour, which is rare. Despite the benign nature of most pituitary tumours, they can still compress or invade neighbouring tissues. Pituitary tumours can be functional (hormonally active) or non-functional (hormonally silent). The aim of this review was to provide an overview of the different pituitary tumour types in dogs and cats that have been reported in the literature. In dogs, the most common pituitary tumour type is the corticotroph adenoma, which can cause pituitary-dependent hypercortisolism. In cats, the most common pituitary tumour is the somatotroph adenoma, which can cause hypersomatotropism, and the second-most common is the corticotroph adenoma. A lactotroph adenoma has been described in one dog, while gonadotroph, thyrotroph and null cell adenomas have not been described in dogs or cats. Hormonally silent adenomas are likely underdiagnosed because they do not result in an endocrine syndrome. Tools used to classify pituitary tumours in humans, particularly immunohistochemistry for lineage-specific transcription factors, are likely to be useful to classify canine and feline pituitary tumours of unknown origin. Future studies are required to better understand the full range of pituitary adenoma pathology in dogs and cats and to determine whether certain adenoma subtypes behave more aggressively than others. Currently, the mechanisms that underlie pituitary tumorigenesis in dogs and cats are still largely unknown. A better understanding of the molecular background of these tumours could help to identify improved pituitary-targeted therapeutics.
Topics: ACTH-Secreting Pituitary Adenoma; Adenoma; Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Growth Hormone-Secreting Pituitary Adenoma; Humans; Immunohistochemistry; Pituitary Neoplasms
PubMed: 33641809
DOI: 10.1016/j.tvjl.2021.105623 -
Neurology India 2020Pituitary apoplexy (PA) is a rare, usually vision-threatening and occasionally life-threatening entity. The exact incidence of PA in large series of pituitary adenomas... (Review)
Review
Pituitary apoplexy (PA) is a rare, usually vision-threatening and occasionally life-threatening entity. The exact incidence of PA in large series of pituitary adenomas is variable; however, it is more common in macroadenomas and nonfunctioning adenomas though it has been reported rarely in microadenomas. There are several well-known precipitating factors for PA including the use of anticoagulants, surgery, head trauma, pregnancy, etc. The typical clinical presentation is characterized by the near universal presence of headache with or without the following: visual disturbances, extraocular palsies, altered sensorium. MRI is the imaging modality of choice. Most patients have hormonal and/or electrolyte disturbances at the time of presentation which needs to be quickly corrected. Both conservative and surgical treatment modalities have been advised for the management of this condition. However, on the basis of the evidence available in the literature, the treatment should be individualized for each patient with PA. If conservative management is chosen, close clinical monitoring is necessary for early identification of deterioration. Surgery generally is through the trans-sphenoidal route. Most patients have a good recovery in visual function and extraocular palsy. There is some evidence in the literature that surgical intervention, when necessary, should be undertaken early as it is associated with better visual outcome. The majority of the patients will have residual hormonal deficits which will require prolonged hormone replacement therapy. There is a small but significant risk of recurrent PA in patients with residual tumors, especially, in those with large tumor residues. There is also a small risk of tumor recurrence following PA and hence all patients should undergo surveillance imaging periodically to detect the possible recurrence of tumor. In recent years, the mortality from PA has decreased significantly. A high index of suspicion and prompt multidisciplinary management will often lead to an overall good outcome.
Topics: Adenoma; Humans; Magnetic Resonance Imaging; Neurosurgical Procedures; Pituitary Apoplexy; Pituitary Neoplasms
PubMed: 32611895
DOI: 10.4103/0028-3886.287669 -
The New England Journal of Medicine Mar 2020
Review
Topics: Adenoma; Age Factors; Endocrine System Diseases; Female; Growth Hormone-Secreting Pituitary Adenoma; Humans; Hyperprolactinemia; Male; Pituitary ACTH Hypersecretion; Pituitary Neoplasms; Prolactin
PubMed: 32130815
DOI: 10.1056/NEJMra1810772 -
Otolaryngologic Clinics of North America Apr 2022Nonfunctioning pituitary lesions represent a subset of pituitary adenomas that do not manifest with clinical features of hormone hypersecretion. Because of their... (Review)
Review
Nonfunctioning pituitary lesions represent a subset of pituitary adenomas that do not manifest with clinical features of hormone hypersecretion. Because of their indolent nature, their diagnosis is elusive, often resulting in presentation after the tumors have grown large enough to cause compressive symptoms. Although they are clinically silent, the various subtypes correspond to the predominant cell line of origin and therefore are biochemically distinct from one another. This article reviews the biochemical, clinical, and histopathologic features of each of these subtypes. A rubric is provided for diagnostic work-up of these lesions and the management options available to the treating clinician.
Topics: Adenoma; Humans; Pituitary Neoplasms
PubMed: 35365312
DOI: 10.1016/j.otc.2021.12.015 -
World Neurosurgery Apr 2023Tension pneumosella has been recognized as a very rare complication of pituitary transsphenoidal surgery. To the best of our knowledge, we report the second case of a...
Tension pneumosella has been recognized as a very rare complication of pituitary transsphenoidal surgery. To the best of our knowledge, we report the second case of a pituitary adenoma "pneumo-apoplexy", which is characterized by findings consistent with tension pneumosella in the context of apoplexy of a pituitary adenoma; although it is an extremely rare diagnosis, it should be considered in patients with compatible clinical and radiological findings, particularly with a previous history of transsphenoidal pituitary surgery.
Topics: Humans; Pituitary Neoplasms; Pituitary Apoplexy; Adenoma; Pituitary Gland
PubMed: 36682526
DOI: 10.1016/j.wneu.2023.01.052 -
Child's Nervous System : ChNS :... Nov 2019Pediatric pituitary adenomas are a rare medical entity that makes up a small portion of intracranial tumors in children and adolescents. Although benign, the majority of... (Review)
Review
BACKGROUND
Pediatric pituitary adenomas are a rare medical entity that makes up a small portion of intracranial tumors in children and adolescents. Although benign, the majority of these lesions are secreting functional tumors with the potential for physiological sequela that can profoundly affect a child's development.
FOCUS OF REVIEW
In this review, we discuss the medical and surgical management of these tumors with a focus on clinical presentation, diagnostic identification, surgical approach, and associated adjuvant therapies. We will also discuss our current treatment paradigm using endoscopic, open, and combined approaches to treat these tumors. The management of pituitary tumors requires a multidisciplinary team of surgeons, endocrinologists, and neuroanesthesiologists as well as neurocritical care specialists to deliver comprehensive care.
Topics: ACTH-Secreting Pituitary Adenoma; Adenoma; Adolescent; Child; Child, Preschool; Craniotomy; Dopamine Agonists; Growth Hormone-Secreting Pituitary Adenoma; Humans; Microsurgery; Nasal Cavity; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Pituitary Neoplasms; Prolactinoma; Sphenoid Bone
PubMed: 31302729
DOI: 10.1007/s00381-019-04293-y