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Problemy Endokrinologii Sep 2023Hyperprolactinemia accompanies growth hormone hypersecretion in approximately 25-39% of cases. There is a recommendation to determine the level of prolactin in clinical... (Observational Study)
Observational Study
BACKGROUND
Hyperprolactinemia accompanies growth hormone hypersecretion in approximately 25-39% of cases. There is a recommendation to determine the level of prolactin in clinical guidelines for diagnosis and treatment of acromegaly. However, there is no understanding of the necessity to investigate the IGF-1 level in patients with hyperprolactinemia and a pituitary adenoma.
AIM
Determining the proportion of patients with hyperprolactinemia and pituitary adenoma, who were examined for IGF-1 levels, and identifying the proportion of patients with acromegaly among this cohort.
MATERIALS AND METHODS
Between December 2019 and December 2022 a single-center observational single-stage single-sample uncontrolled study was conducted. At the first stage of the study, the proportion of patients with pituitary adenoma and hyperprolactinemia with studied IGF-1 levels was determined, according to medical records. At the second stage of the study, patients without known indicators of IGF-1 were determined. The concentration of growth hormone was studied during the oral glucose load in the case of increased IGF-1 levels.
RESULTS
At the first stage, 105 patients were included in the study. The level of IGF-1 was determined in 41/105 (39%) cases. There were 22/41 (53.7%) cases in the subgroup with pituitary incidentalomas and 19/64 (29.7%) cases in the subgroup with hyperprolactinemia among them. At the second stage, the IGF-1 level was additionally determined in 53 patients with hyperprolactinemia and pituitary adenoma (total 94 patients). The level of IGF-1 was elevated in 11/94 patients, further acromegaly was confirmed in 3/94 patients (3.2%).
CONCLUSION
In real clinical practice the level of IGF-1 is studied only in 39% of cases in patients with pituitary adenoma and hyperprolactinemia. The disease was detected in 3 cases (3.2%) out of 94 people with hyperprolactinemia and pituitary adenoma without clinical manifestations of acromegaly. We consider the study of IGF-1 levels justified as a screening for acromegaly in patients with hyperprolactinemia and pituitary adenoma.
Topics: Humans; Hyperprolactinemia; Female; Acromegaly; Male; Pituitary Neoplasms; Adult; Insulin-Like Growth Factor I; Middle Aged; Adenoma; Human Growth Hormone
PubMed: 38796756
DOI: 10.14341/probl13344 -
Medicina (Kaunas, Lithuania) Apr 2024: A magnetic resonance imaging (MRI) scan is part of the diagnostic protocol in pituitary adenoma patients. The goal of the present study is to present and analyse the...
: A magnetic resonance imaging (MRI) scan is part of the diagnostic protocol in pituitary adenoma patients. The goal of the present study is to present and analyse the MRI appearances of the sphenoid sinus (SS) in patients with non-functioning pituitary adenoma (NFPA). : This is a retrospective case-control study conducted between January 2015 and December 2023 in a tertiary referral hospital. Forty NFPA patients were included in the study group, while the control group consisted of 30 age- and gender-matched cases. : The sellar type of SS pneumatization was the most frequently encountered pattern among both groups. The presence of the lateral recess of the SS, mucosal cysts, and sphenoethmoidal cells was similar in both patient groups. The proportion of patients with SS mucosal thickness greater than 3 mm was 42.5% in NFPA group and 3% in the control group, and this difference was statistically significant ( < 0.001). The space between the two optic nerves was significantly larger in the NFPA group as compared to the control group ( < 0.001). : Our study was able to establish a statistically significant association between the presence of NFPA and both the thickening of the SS mucosa and increased space between optic nerves.
Topics: Humans; Sphenoid Sinus; Male; Female; Pituitary Neoplasms; Retrospective Studies; Magnetic Resonance Imaging; Middle Aged; Case-Control Studies; Adult; Adenoma; Aged
PubMed: 38792891
DOI: 10.3390/medicina60050708 -
The Immune Microenvironment Landscape of Pituitary NeuroEndocrine Tumors, a Transcriptomic Approach.Genes Apr 2024Pituitary neuroendocrine tumors (PitNET) are known to be variably infiltrated by different immune cells. Nonetheless, their role in pituitary oncogenesis has only begun...
Pituitary neuroendocrine tumors (PitNET) are known to be variably infiltrated by different immune cells. Nonetheless, their role in pituitary oncogenesis has only begun to be unveiled. The immune microenvironment could determine the biological and clinical behavior of a neoplasm and may have prognostic implications. To evaluate the expression of immune-related genes and to correlate such expression with the presence of infiltrating immune cells in forty-two PitNETs of different lineages, we performed whole transcriptome analysis and RT-qPCR. Deconvolution analysis was carried out to infer the immune cell types present in each tumor and the presence of immune cells was confirmed by immunofluorescence. We found characteristic expression profiles of immune-related genes including those encoding interleukins and chemokines for each tumor lineage. Genes such as , , , , and were upregulated in all PitNETS, whereas , , and characterize the , -, and -derived tumors, respectively. Transcriptome deconvolution analysis showed that M2 macrophages, CD4+ T cells, CD8+ T cells, NK cells, and neutrophils can potentially infiltrate PitNET. Furthermore, CD4+ and CD8+ T cells and NK cells infiltration was validated by immunofluorescence. Expression of , and as well as macrophage tumor infiltration could identify patients who can potentially benefit from treatment with immune checkpoint inhibitors.
Topics: Humans; Pituitary Neoplasms; Tumor Microenvironment; Neuroendocrine Tumors; Transcriptome; Gene Expression Regulation, Neoplastic; Gene Expression Profiling; Male; Female; Lymphocytes, Tumor-Infiltrating; Middle Aged; Adult
PubMed: 38790160
DOI: 10.3390/genes15050531 -
World Journal of Surgical Oncology May 2024Craniopharyngiomas (CPs) are generally derived from the craniopharyngeal duct epithelium, accounting for 38% and 24.5% of mortality in pediatric and adult patients,... (Meta-Analysis)
Meta-Analysis Review
Endoscopic endonasal transsphenoidal approach improves endocrine function and surgical outcome in primary craniopharyngioma resection: a systematic review and meta-analysis.
BACKGROUND
Craniopharyngiomas (CPs) are generally derived from the craniopharyngeal duct epithelium, accounting for 38% and 24.5% of mortality in pediatric and adult patients, respectively. At present, the widespread application of the endoscopic endonasal transsphenoidal approach (EEA) has led to controversy between the traditional microscopic transcranial approach (TCA) and EEA in relation to the surgical management of CPs.
OBJECT AND METHOD
We performed a systematic review and meta-analysis comparing the complications, surgical outcomes, and endocrine functions of patients with CPs to provide evidence-based decision-making in their surgical management.
RESULT
Overall, 11 observational studies with 12,212 participants were included in the meta-analysis, in which five of them only included an adult population, three of them only included a child population, and the other three studies included a mixed population (adult and child). In pediatric patients, the EEA achieved a higher gross total resection (GTR) rate (odds ratio (OR) = 5.25, 95%CI: 1.21-22.74), lower recurrence rate (OR = 0.54, 95%CI: 0.31-0.94, p = 0.030), and less hypopituitarism (OR = 0.34, 95%CI: 0.12-0.97, p = 0.043). In adult patients, EEA significantly improved mortality (OR = 0.09, 95%CI: 0.06-0.15, p < 0.001) and visual outcomes (visual improvement: OR = 3.42, 95%CI: 1.24-9.40, p = 0.017; visual deficit: OR = 0.30, 95%CI: 0.26-0.35) with decreases in postoperative stroke (OR = 0.58, 95%CI: 0.51-0.66, p < 0.001), hydrocephalus, and infections (OR = 0.32, 95%CI: 0.24-0.42, p < 0.001).
CONCLUSION
Compared with the traditional TCA in primary CP resection, the development and wide application of EEA optimistically decreased the recurrence rate of CP, alleviated hypopituitarism with improvement in the GTR rate of pediatric patients, and significantly improved the visual outcomes, hydrocephalus, postoperative stroke, survival, and infection rates of the patients. Therefore, EEA is an optimal approach for primary CP resection.
Topics: Humans; Craniopharyngioma; Pituitary Neoplasms; Postoperative Complications; Prognosis; Treatment Outcome; Neoplasm Recurrence, Local; Endoscopy
PubMed: 38790064
DOI: 10.1186/s12957-024-03411-8 -
BMC Cancer May 2024Brachytherapy has been indicated as an alternative option for treating cystic craniopharyngiomas (CPs). The potential benefits of brachytherapy for CPs have not yet been... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Brachytherapy has been indicated as an alternative option for treating cystic craniopharyngiomas (CPs). The potential benefits of brachytherapy for CPs have not yet been clarified. The purpose of this work was to conduct a meta-analysis to analyze the long-term efficacy and adverse reactions profile of brachytherapy for CPs.
MATERIALS AND METHODS
The relevant databases were searched to collect the clinical trials on brachytherapy in patients with CPs. Included studies were limited to publications in full manuscript form with at least 5-year median follow-up, and adequate reporting of treatment outcomes and adverse reactions data. Stata 12.0 was used for data analysis.
RESULTS
According to the inclusion and exclusion criteria, a total of 6 clinical trials involving 266 patients with CPs were included in this meta-analysis. The minimum average follow-up was 5 years. The results of the meta-analysis showed that 1-year, 2-3 years and 5 years progression free survival rates (PFS) are 75% (95%CI: 66-84%), 62% (95%CI: 52-72%) and 57% (95%CI: 22-92%), respectively. At the last follow-up, less than 16% of patients with visual outcomes worser than baseline in all included studies. While, for endocrine outcomes, less than 32% of patients worser than baseline level.
CONCLUSION
In general, based on the above results, brachytherapy should be considered as a good choice for the treatment of CP.
Topics: Humans; Brachytherapy; Craniopharyngioma; Follow-Up Studies; Pituitary Neoplasms; Progression-Free Survival; Treatment Outcome
PubMed: 38790011
DOI: 10.1186/s12885-024-12397-1 -
No Shinkei Geka. Neurological Surgery May 2024In the World Health Organization 2022 classification, a nomenclature change from pituitary adenoma to pituitary neuroendocrine tumor(PitNET)was introduced to indicate... (Review)
Review
In the World Health Organization 2022 classification, a nomenclature change from pituitary adenoma to pituitary neuroendocrine tumor(PitNET)was introduced to indicate rare but potentially malignant behavior. No grading system is available for PitNETs; therefore, the establishment of a system that corresponds to their clinical behavior is an urgent issue. Presently, this change has no direct influence on therapeutic strategies. Recently, the therapeutic outcomes of most patients with PitNETs have significantly improved owing to marked advancements in both surgical and medical treatments. The former includes the evolution of endoscopic surgery and technical refinements, whereas the latter includes the introduction of new effective drugs and increased knowledge and experience regarding their use, leading to personalized and/or precision medicine. Consequently, the treatment goals have advanced, encompassing endocrinological remission, successful management of comorbidities, increased health-related quality of life, and a normalized mortality rate. However, management of some aggressive and metastatic PitNETs remains difficult. Although temozolomide(TMZ)is considered a promising sole therapeutic option, recent reports have shown that TMZ does not provide long-term control in many cases. A multidisciplinary approach is necessary for the reliable prediction and successful management of aggressive tumors.
Topics: Humans; Pituitary Neoplasms; Neuroendocrine Tumors
PubMed: 38783506
DOI: 10.11477/mf.1436204957 -
European Journal of Endocrinology Jun 2024Unravel the potential mechanism(s) of the on- and off-target actions of dopamine agonist therapy in both human prolactinoma tumors and neighboring stromal and immune...
OBJECTIVE
Unravel the potential mechanism(s) of the on- and off-target actions of dopamine agonist therapy in both human prolactinoma tumors and neighboring stromal and immune cells.
DESIGN AND METHODS
Five surgically resected prolactinomas (PRLomas) from 3 cabergoline (CBG)-treated patients and 2 treatment-naive patients were analyzed by using single-cell RNA sequencing (scRNA-seq) to compare the cellular composition and transcriptional landscape.
RESULTS
Six major cell populations, namely tumor (88.2%), immune (5.6%), stromal (4.9%), progenitor cells (0.6%), proliferating cells (0.4%), and erythrocytes (0.2%), were observed. Tumor cells from CBG-treated patients expressed lower levels of genes that regulated hormone secretion, such as SCG2, VGF, TIMP1, NNAT, and CALD1, consistent with the inhibitory effects of CBG on hormone processing and secretion. Interestingly, we also observed an increased number of CD8+ T cells in the CBG-treated tissues. These cytotoxic CD8+ T cells expressed killing granule components such as perforin and the granzymes GZMB, GNLY, and KLRD1 as well as the inflammatory cytokine CCL5. Immune cell activation of these CD8+ T cells was further analyzed in a compartment-specific manner, and increased CD25 (IL2R) expression was noted in the CD8+ T cells from the CBG-treated samples. Additionally, and confirming prior reports, we noted a higher stromal cell population in the CBG-treated samples.
CONCLUSIONS
Our scRNA-seq studies revealed key differences in the transcriptomic features of CBG-treated and CBG-untreated PRLomas in both tumor and microenvironment cellular constituents, and for the first time, describe the previously unknown activation of CD8+ T cells following CBG treatment, which may play a role in the tumoricidal actions of CBG.
Topics: Humans; Cabergoline; Prolactinoma; Male; Female; Pituitary Neoplasms; Adult; Middle Aged; Fibrosis; Prolactin; Dopamine Agonists; CD8-Positive T-Lymphocytes; Stromal Cells; Young Adult; Tumor Microenvironment
PubMed: 38781434
DOI: 10.1093/ejendo/lvae055 -
Pediatrics International : Official... 2024
Topics: Humans; Diagnosis, Differential; Sella Turcica; Magnetic Resonance Imaging; Human Growth Hormone; Pituitary Neoplasms; Male; Child; Female
PubMed: 38780229
DOI: 10.1111/ped.15776 -
Journal of Neuropathology and... Jun 2024Corticotroph adenomas/pituitary neuroendocrine tumors (PitNETs) are associated with significant morbidity and mortality. Predictors of tumor behavior have not shown high...
Corticotroph adenomas/pituitary neuroendocrine tumors (PitNETs) are associated with significant morbidity and mortality. Predictors of tumor behavior have not shown high prognostic accuracy. For somatotroph adenomas/PitNETs, E-cadherin expression correlates strongly with prognosis. E-cadherin expression has not been investigated in other PitNETs. A retrospective chart review of adults with corticotroph adenomas/PitNETs was conducted to assess correlation between E-cadherin expression and tumor characteristics. In addition, gene expression microarray was performed in subset of tumors (n = 16). Seventy-seven patients were identified; 71% were female, with median age of cohort 45.2 years. Seventy-five percent had macroadenomas, of which 22% were hormonally active. Ninety-five percent of microadenomas were hormonally active. Adrenocorticotropic hormone granulation pattern by IHC identified 63% as densely granulated (DG) and 34% as sparsely granulated (SG). All microadenomas were DG (p < .001); 50% of macroadenomas were DG associated with increased tumor invasion compared to SG. E-cadherin IHC was positive in 80%, diminished in 17%, and absent in 20% and did not correlate with corticotroph PitNETs subtype, size, or prognosis. In contrast to the distinct transcriptomes of corticotroph PitNETs and normal pituitaries, a comparison of clinically active and silent corticotroph PitNETs demonstrated similar molecular signatures indicating their common origin, but with unique differences related to their secretory status.
Topics: Humans; Female; Male; Middle Aged; Cadherins; Adult; Neuroendocrine Tumors; Retrospective Studies; ACTH-Secreting Pituitary Adenoma; Aged; Transcriptome; Pituitary Neoplasms; Young Adult; Gene Expression Profiling; Gene Expression Regulation, Neoplastic
PubMed: 38777808
DOI: 10.1093/jnen/nlae034 -
Acta Neurochirurgica May 2024To identify differences in the presentation and surgical outcomes between very large (30-39 mm) and giant (≥ 40 mm) (LARGE group) pituitary adenomas (PAs) compared...
PURPOSE
To identify differences in the presentation and surgical outcomes between very large (30-39 mm) and giant (≥ 40 mm) (LARGE group) pituitary adenomas (PAs) compared to the smaller group (< 30 mm) (non-LARGE group).
METHODS
Eighty patients with very large (n = 44) or giant (n = 36) PAs and 226 patients in the non-LARGE group who underwent tumor resection by pituitary surgery between 2008 and 2023 were studied. Hormonal, radiological, ophthalmological, and pathological data, and surgical outcomes were evaluated.
RESULTS
Preoperatively, patients of the LARGE group presented more frequently with visual impairment (82.5% vs. 22.1%, P < 0.001) and with pituitary apoplexy (15.0% vs. 2.7%, P < 0.001) than the non-LARGE group. Moreover, the LARGE group were more commonly associated with preoperative panhypopituitarism (28.8% vs. 6.2%, P < 0.001). This group presented cavernous sinus invasion more frequently (71.3% vs. 23.9%, P < 0.001). The non-LARGE group achieved surgical cure more often than the LARGE group (79.7% vs. 50.0%, P < 0.001), and the rate of major complications was higher in the latest (8.8% vs. 1.3%, P < 0.004).
CONCLUSIONS
PAs ≥ 30 mm are most frequently accompanied by hormonal dysfunction, cavernous sinus invasion, and visual impairment. All this implies lower resection rates and higher postoperative complications than the smaller adenomas, posing a real surgical challenge.
Topics: Humans; Pituitary Neoplasms; Adenoma; Male; Female; Middle Aged; Adult; Treatment Outcome; Aged; Cohort Studies; Vision Disorders; Postoperative Complications; Hypopituitarism; Retrospective Studies; Tumor Burden
PubMed: 38772927
DOI: 10.1007/s00701-024-06107-w