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Journal of Veterinary Internal Medicine 2015Transsphenoidal hypophysectomy is an effective treatment for dogs with pituitary-dependent hypercortisolism (PDH). However, long-term recurrence of hypercortisolism is a...
BACKGROUND
Transsphenoidal hypophysectomy is an effective treatment for dogs with pituitary-dependent hypercortisolism (PDH). However, long-term recurrence of hypercortisolism is a well-recognized problem, indicating the need for reliable prognostic indicators.
OBJECTIVES
The aim of this study was to evaluate the prognostic value of perioperative plasma ACTH and cortisol concentrations for identifying recurrence of hypercortisolism after transsphenoidal hypophysectomy.
ANIMALS
A total of 112 dogs with PDH that underwent transsphenoidal hypophysectomy met the inclusion criteria of the study.
METHODS
Hormone concentrations were measured preoperatively and 1-5 hours after surgery. Both absolute hormone concentrations and postoperative concentrations normalized to preoperative concentrations were included in analyses. The prognostic value of hormone concentrations was studied with Cox's proportional hazard analysis.
RESULTS
Median follow-up and disease-free period were 1096 days and 896 days, respectively. Twenty-eight percent of patients had recurrence, with a median disease-free period of 588 days. Both absolute and normalized postoperative cortisol concentrations were significantly higher in dogs with recurrence than in dogs without recurrence. High ACTH 5 hours after surgery, high cortisol 1 and 4 hours after surgery, high normalized ACTH 3 hours after surgery, high normalized cortisol 4 hours after surgery and the random slope of cortisol were associated with a shorter disease-free period.
CONCLUSIONS AND CLINICAL IMPORTANCE
Individual perioperative hormone curves provide valuable information about the risk of recurrence after hypophysectomy. However, because no single cutoff point could be identified, combination with other variables, such as the pituitary height/brain area (P/B) ratio, is still needed to obtain a good estimate of the risk for recurrence of hypercortisolism after hypophysectomy.
Topics: ACTH-Secreting Pituitary Adenoma; Adenoma; Adrenocorticotropic Hormone; Animals; Dog Diseases; Dogs; Female; Hydrocortisone; Hypophysectomy; Male; Preoperative Period; Prognosis; Recurrence
PubMed: 25959680
DOI: 10.1111/jvim.12601 -
American Journal of Veterinary Research Feb 2022To assess the accuracy of transsphenoidal hypophysectomy using 3-D printed patient-specific guides (3D-PSGs) in small-breed dogs.
OBJECTIVE
To assess the accuracy of transsphenoidal hypophysectomy using 3-D printed patient-specific guides (3D-PSGs) in small-breed dogs.
ANIMALS
Heads obtained from the cadavers of 19 small-breed dogs (ex vivo portion of study) and 3 healthy adult (3 to 4 years) purpose-bred Beagles with a median body weight of 9.2 kg.
PROCEDURES
In the ex vivo study, CT images of the cadavers were collected. The position, width, and length of the pituitary fossa and the pilot hole (insertion angle and place) were measured. Using PSGs, 19 pilot holes were made for the pituitary gland fossa, and CT was performed to assess the position accuracy. In the in vivo study, 3 surgical windows from the pilot holes were made using PSGs. Repeated CT and MRI were performed to evaluate the safeness and effectiveness of PSGs, followed by necropsy.
RESULTS
In the ex vivo study, the median (interquartile range) difference between the pre- and postoperative insertion angles was 2° (0° to 3.5°) and the median deviation of the pilot hole was 0.46 mm (0 to 1.58 mm). In the in vivo study, the surrounding structures were not damaged, and favorable outcomes were evident in terms of the shape, size, and position of the surgical window.
CLINICAL RELEVANCE
3D-PSGs provided a safe and effective surgical window for transsphenoidal hypophysectomy. Our findings emphasized the applicability of PSGs in brain surgery, in terms of accuracy and effectiveness.
Topics: Animals; Cadaver; Dog Diseases; Dogs; Hypophysectomy; Pituitary Gland; Printing, Three-Dimensional
PubMed: 35175933
DOI: 10.2460/ajvr.21.09.0154 -
Postgraduate Medical Journal Aug 1964
Review
Topics: Carbohydrate Metabolism; Diabetes Mellitus; Diabetic Retinopathy; Dwarfism; Dwarfism, Pituitary; Gigantism; Growth; Growth Hormone; Humans; Hypophysectomy; Lipid Metabolism; Pituitary Gland; Proteins
PubMed: 14184231
DOI: 10.1136/pgmj.40.466.470 -
The Journal of Biological Chemistry Jun 1977The effects of hypophysectomy on albumin and total protein synthesis in rat liver were investigated in vivo, in perfused liver, and in isolated hepatocytes. In all...
The effects of hypophysectomy on albumin and total protein synthesis in rat liver were investigated in vivo, in perfused liver, and in isolated hepatocytes. In all systems, hypophysectomy resulted in about a 50% decrease in the rate of total protein synthesis and a 30 to 50% decrease in the relative rate of albumin synthesis. Albumin synthesis accounted for 11 to 13% of total protein synthesis in all normal systems, but represented only 5 to 8% of the total in all systems derived from hypophysectomized rats. Growth hormone, administered subcutaneously to hypophysectomized rats for 5 days, restored the relative rate of albumin synthesis to normal in vivo; however, only partial restoration was demonstrated in the in vitro systems. Perfused livers and isolated hepatocytes exhibited linear rates of total protein and albumin secretion for 3 h. The rate of albumin secretion by normal perfused livers was 3 times that of perfused livers from hypophysectomized animals, being 0.54 and 0.17 mg/g of liver/h, respectively. Isolated hepatocytes synthesized total protein and albumin at nearly the same rate as perfused livers. The amount of albumin secreted by cells derived from normal and hypophysectomized rats was 0.38 and 0.10 mg/ml of packed cells/h, respectively. Ribosome half-transit times for albumin and total liver protein were 1.6 to 1.7 min in isolated liver cells derived from both normal and hypophysectomized rats. Analysis by polyacrylamide gel electrophoresis showed no difference in the qualitative distribution of the proteins secreted by perfused livers and isolated hepatocytes.
Topics: Albumins; Animals; Growth Hormone; Hypophysectomy; Leucine; Liver; Male; Perfusion; Protein Biosynthesis; Rats; Ribosomes
PubMed: 863898
DOI: No ID Found -
Kidney International Dec 1975The mechanism whereby an increase in left atrial pressure (LAP) causes a water diuresis in the anesthetized dog remains controversial. In the present study LAP was... (Review)
Review
The mechanism whereby an increase in left atrial pressure (LAP) causes a water diuresis in the anesthetized dog remains controversial. In the present study LAP was increased by inflation of an atrial balloon in two groups of animals. In the first group of eight intact dogs, mean LAP was increased from 3.4 to 17.6 mm Hg (P less than 0.001). The rise in LAP was associated with a mean increase in urine flow (V) from 0.70 to 1.29 ml/min (P less than 0.001), a decrease in urinary osmolality (Uosm) from 808 to 490 mOsm/kg of H2O (P less than 0.001) and an increase in free water clearance (CH2O) from -0.684 to -0.200 ml/min (P less than 0.025). This diuresis was associated with a mean decrease in antidiuretic hormone concentrations in plasma as measured by radioimmunoassay from 27.6 to 12.3 pg/ml (P less than 0.02). The changes in the urinary indexes and in the antidiuretic hormone concentrations were reversible and returned to control levels when the LAP was allowed to return to normal. A second group of dogs was acutely hypophysectomized, steroid replaced and given a constant infusion of vasopressin. In these animals, mean LAP was increased from 3.0 to 16.0 mm Hg (P less than 0.001) but no significant change in V (0.49 to 0.56 ml/min), Uosm (878 to 845 mOsm/kg of H2O) or CH2O (-0.750 to -0.620 ml/min) occurred. Cardiac output, renal arterial pressure, glomerular filtration rate and solute excretion were comparable in the two groups. We therefore conclude that suppression of antidiuretic hormone release is the primary mechanism whereby increased LAP causes a water diuresis in the anesthetized dog.
Topics: Animals; Atrial Function; Cautery; Diuresis; Dogs; Female; Heart; Heart Atria; Hypophysectomy; Male; Pressure; Radioimmunoassay; Urine; Vasopressins
PubMed: 1107639
DOI: 10.1038/ki.1975.127 -
Journal of Endocrinological... Mar 2022Dynamic testing represents the mainstay in the differential diagnosis of ACTH-dependent Cushing's syndrome. However, in case of undetectable or detectable...
PURPOSE
Dynamic testing represents the mainstay in the differential diagnosis of ACTH-dependent Cushing's syndrome. However, in case of undetectable or detectable lesion < 6 mm on MRI, bilateral inferior petrosal sinus sampling (BIPSS) is suggested by current guidelines. Aim of this study was to analyze the performance of CRH, desmopressin and high-dose dexamethasone suppression test (HDDST) in the differential diagnosis of ACTH-dependent Cushing's syndrome as well as the impact of invasive and noninvasive tests on surgical outcome in patients affected by Cushing's disease (CD).
METHODS
Retrospective analysis on 148 patients with CD and 26 patients with ectopic ACTH syndrome.
RESULTS
Among CD patients, negative MRI/lesion < 6 mm was detected in 97 patients (Group A); 29 had a 6-10 mm lesion (Group B) and 22 a macroadenoma (Group C). A positive response to CRH test, HDSST and desmopressin test was recorded in 89.4%, 91·4% and 70.1% of cases, respectively. Concordant positive response to both CRH/HDDST and CRH/desmopressin tests showed a positive predictive value of 100% for the diagnosis of CD. Among Group A patients with concordant CRH test and HDDST, no difference in surgical outcome was found between patients who performed BIPSS and those who did not (66.6% vs 70.4%, p = 0.78).
CONCLUSIONS
CRH, desmopressin test and HDDST have high accuracy in the differential diagnosis of ACTH-dependent CS. In patients with microadenoma < 6 mm or non-visible lesion, a concordant positive response to noninvasive tests seems sufficient to diagnose CD, irrespective of MRI finding. In these patients, BIPSS should be reserved to discordant tests.
Topics: Adrenocorticotropic Hormone; Adult; Cushing Syndrome; Diagnosis, Differential; Diagnostic Techniques, Endocrine; Female; Humans; Hypophysectomy; Italy; Magnetic Resonance Imaging; Male; Petrosal Sinus Sampling; Pituitary ACTH Hypersecretion; Pituitary Function Tests; Pituitary Neoplasms; Retrospective Studies
PubMed: 34699044
DOI: 10.1007/s40618-021-01695-1 -
Veterinary Surgery : VS Jan 2023To characterize the clinical features, neurological examination findings, diagnostic imaging results, histopathological findings, and outcome following transsphenoidal...
OBJECTIVE
To characterize the clinical features, neurological examination findings, diagnostic imaging results, histopathological findings, and outcome following transsphenoidal hypophysectomy (TSH) in dogs with nonfunctional sellar masses (NFSM).
STUDY DESIGN
Multi-institutional retrospective study.
METHODS
Medical records of dogs that underwent TSH for a NFSM were reviewed for clinical signs, physical and neurological examination findings, diagnostic imaging results, endocrine testing, surgery reports, and outcome. Magnetic resonance (MR) imaging was rereviewed, and tumors were classified using the previously described system according to pituitary tumor extension and vascular involvement. Owners of dogs that survived to discharge were contacted.
RESULTS
The majority of dogs presented for mentation change (12/15). The mean pituitary to brain ratio (P/B ratio) was 1.05 (0.6-1.4). Eight dogs had a tumor imaging classification of 5B. Eleven dogs were diagnosed with a nonfunctional pituitary adenoma (NFPA). Perioperative mortality was 33% (5/15). The median survival for all dogs was 232 days (0-1658). When dogs that did not survive to discharge were excluded, the median survival time was 708 days. Seven of 10 dogs that survived the perioperative period received adjunctive therapy. Owner assessment of outcome was excellent (6/7) to good (1/7).
CONCLUSION
The common presenting complaint for dogs with large NFSM causing mass effect was mentation changes. Dogs with NFPA that survived to discharge and received adjunctive therapy had good to excellent outcomes.
CLINICAL SIGNIFICANCE
Transsphenoidal debulking with adjunctive therapy can be considered for the treatment of NFSM causing clinical signs of mass effect in dogs. Successful long-term outcomes are possible.
Topics: Dogs; Animals; Hypophysectomy; Retrospective Studies; Dog Diseases; Pituitary Gland; Pituitary Neoplasms; Thyrotropin; Treatment Outcome
PubMed: 36416123
DOI: 10.1111/vsu.13917 -
California Medicine Aug 1970Hypophysectomy can be advised for diabetic patients whose vision is threatened by neovascular changes characterizing proliferative retinopathy. In the management of...
Hypophysectomy can be advised for diabetic patients whose vision is threatened by neovascular changes characterizing proliferative retinopathy. In the management of advancing breast cancer, hypophysectomy is recommended in postmenopausal (natural or induced) patients who have received two trials of hormonal therapy. We advocate wider application of hypophysectomy for advancing prostate cancer, where, when used in sequence after castration and administration of hormonal therapy, it will relieve pain and produce tumor regression in some patients unresponsive to other forms of treatment. Transsphenoidal cryohypophysectomy is a safe and effective means of pituitary ablation.
Topics: Breast Neoplasms; Cryosurgery; Diabetic Retinopathy; Female; Humans; Hypophysectomy; Male; Prognosis; Prostatic Neoplasms
PubMed: 5527884
DOI: No ID Found -
Acta Neurochirurgica Jul 2011While large-to-giant pituitary adenomas (PAs) may be safely removed by experienced surgeons through a single route, the procedure is technically challenging. We present...
BACKGROUND
While large-to-giant pituitary adenomas (PAs) may be safely removed by experienced surgeons through a single route, the procedure is technically challenging. We present the outcome of a simultaneous combined transcranial and transsphenoidal approach and discuss its applications.
METHODS
A retrospective review was conducted on 12 consecutive patients. Surgical complications, visual and endocrinological functions, and tumour control were reviewed.
RESULTS
There were four men and eight women, with a mean age of 47.6 years. All but one patient had non-functioning PAs. The mean tumour height was 4.1 cm (range: 2.3-5.5). The predominant presenting symptoms were visual field loss in eight patients, headache in three patients and mental confusion in one patient. There was no operative mortality. Post-operative cerebrospinal fluid leakage occurred in one patient. Five of the eight patients who presented with visual field loss achieved full recovery, and three had partial improvement. Two patients developed permanent diabetes insipidus after surgery. Panhypopituitarism occurred in one patient. Gross total removal (GTR) was achieved in five, and subtotal removal (STR) in seven patients. Seven patients received post-operative external irradiation. All patients who had GTR remained tumour-free and all those with STR had stable diseases after a mean follow-up period of 53.1 months (range: 14.1-92.1).
CONCLUSION
The simultaneous 'above and below' approach is a safe and effective surgical strategy for large-to-giant PAs, particularly when expertise in endoscopic transsphenoidal surgery is unavailable. Its use, however, should be limited to a carefully selected group of patients, and tailored to individual user's expertise and experience.
Topics: Adult; Aged; Cerebrospinal Fluid Rhinorrhea; Craniotomy; Endoscopy; Female; Follow-Up Studies; Humans; Hypophysectomy; Hypopituitarism; Male; Middle Aged; Neoplasm Recurrence, Local; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Sphenoid Bone; Treatment Outcome; Vision Disorders
PubMed: 21533660
DOI: 10.1007/s00701-011-1029-y -
Physiological Reviews Jan 1964
Review
Topics: Anions; Antimetabolites; Biological Transport; Cardiac Glycosides; Cold Temperature; Cyanates; Halogens; Hydrogen-Ion Concentration; Hypophysectomy; Iodides; Iodine; Ion Exchange; Manganese; Metabolism; Nitrates; Phospholipids; Potassium; Proteins; Sodium; Sulfhydryl Compounds; Thyroid Gland; Thyrotropin
PubMed: 14105583
DOI: 10.1152/physrev.1964.44.1.45