Abstract:
:Acromegaly is associated with serious morbidity and mortality, if not well controlled. Approved somatostatin receptor ligands (SRLs) are a mainstay of medical therapy and exhibit preferential affinity for somatostatin receptor (SSTR) subtype 2. Our objective was to assess whether characteristic features of individual growth hormone (GH)-secreting adenomas at diagnosis, correlated with SRL sensitivity, using defined tumor markers. A retrospective review of 86 consecutive acromegaly surgeries (70 patients) performed between January 2006 and December 2011 was undertaken. Patients with any preoperative medical treatment were excluded. Response to SRL therapy was defined as normalization of insulin-like growth factor 1 (IGF1) and random GH < 1.0 ng/dl. Immunohistochemical staining pattern: sparsely granulated, densely granulated, mixed growth hormone-prolactin (GH/PRL) and SSRT2 positivity (+) were correlated with clinicopathologic features, adenoma recurrence, and SRL treatment response. Two-tailed t test, univariate ANOVA, Kruskal-Wallis and bivariate correlation were performed using PAWS 18. The cohort eligible for analysis comprised 59 patients (41 female and 18 male). Based on pre-surgery adenoma imaging dimensions, 81.3% (48) were macroadenomas and average maximum tumor diameter was 18.1 ± 9.9 mm. Patients on SRLs were followed for 13.4 ± 15.8 (mean ± SD) months. Sparsely granulated adenomas were significantly larger at diagnosis, exhibited lower SSTR2 positivity and had a lower rate of biochemical normalization to SRLs. Densely granulated adenomas were highly responsive to SRLs. Overall, patients with SSTR2A+ adenomas responded more favorably to SRL treatment than those with SSTR2A- adenomas. Eighty-one percent of patients with SSTR2A+ adenomas were biochemically controlled (both GH and IGF1) on SRL treatment, e.g. a much higher normalization rate than that reported in the unselected acromegaly population (20-30%). Detailed knowledge of adenoma GH granularity and the immunohistochemical SSTR2A+ status is a predictor of SRL response. These immunoreactive markers should be assessed routinely on surgical specimens to assess subsequent SRL responsiveness and potential need for adjunctive therapy after surgery.
journal_name
Pituitaryjournal_title
Pituitaryauthors
Brzana J,Yedinak CG,Gultekin SH,Delashaw JB,Fleseriu Mdoi
10.1007/s11102-012-0445-1subject
Has Abstractpub_date
2013-12-01 00:00:00pages
490-8issue
4eissn
1386-341Xissn
1573-7403journal_volume
16pub_type
杂志文章相关文献
Pituitary文献大全abstract:PURPOSE:Survivin is an apoptosis inhibitor, expressed in almost all types of human malignancies, but rarely in differentiated normal tissues. Recently, survivin gene splice variants with different anti-apoptotic activities have been reported. The current study was undertaken to examine the expression of survivin and it...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-014-0590-9
更新日期:2015-06-01 00:00:00
abstract::Clinically inapparent adrenal masses, or adrenal incidentalomas, are discovered inadvertently in the course of workup or treatment of unrelated disorders. Cortical adenoma is the most frequent type of adrenal incidentaloma accounting for approximately 50% of cases in surgical series and even greater shares in medical ...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-005-4024-6
更新日期:2004-01-01 00:00:00
abstract::We describe two young men with cystic pituitary enlargement on magnetic resonance imaging (MRI) causing hypopituitarism. The first patient presented acutely unwell with headache and vomiting associated with anterior and posterior pituitary dysfunction. The second patient presented with hypopituitarism after a long his...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1023/b:pitu.0000011177.43408.56
更新日期:2003-01-01 00:00:00
abstract::The pituitary is the master endocrine gland of the body. It undergoes many changes after birth, and these changes may be mediated by the differentiation of pituitary stem cells. Stem cells in any tissue source must display (1) pluripotent capacity, (2) capacity for indefinite self-renewal, and (3) a lack of specializa...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-013-0470-8
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVE:Lymphocytic hypophysitis (LH) is a rare chronic inflammatory disorder characterized by lymphocytic infiltration of the pituitary gland commonly affecting women during pregnancy or post-partum period. The pathogenesis remains uncertain, however an autoimmune process is frequently implicated. There is limited d...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-008-0119-1
更新日期:2009-01-01 00:00:00
abstract::Non-functioning pituitary carcinomas (NFPC) are defined as tumours of adenophyseal origin with craniospinal or systemic dissemination, with the absence of a hormonal hypersecretion syndrome. These are a histologically heterogenous group of tumours, comprising gonadotroph, null cell, "silent" tumours of corticotroph, s...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-017-0857-z
更新日期:2018-04-01 00:00:00
abstract::Most patients with acromegaly have some degree of insulin resistance. The principal mediator of insulin resistance in acromegaly is hypersecretion of growth hormone. Growth hormone acts at several levels to block insulin actions including inhibiting phosphorylation of the insulin receptor and one of its principal sign...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1023/a:1023321421760
更新日期:2002-01-01 00:00:00
abstract::We report a case of hepatolithiasis (intrahepatic stone) complicated by gram-negative sepsis in a 37 year old male with acromegaly being treated with octreotide. As a child, he had suffered a traumatic injury to his liver requiring the surgical repair of a laceration. This is the first reported case of hepatolithiasis...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1023/a:1012880113759
更新日期:2000-12-01 00:00:00
abstract::Surgical cure cannot be achieved in most patients with invasive non-functioning pituitary macroadenoma (NFPA). Short-term residual tumor treatment with somatostatin analogs has produced disappointing results. This prospective case-control study assessed the efficacy of chronic treatment with long acting octreotide (oc...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-011-0370-8
更新日期:2012-12-01 00:00:00
abstract::Pituitary radiotherapy (RT) is an effective second-line treatment for paediatric Cushing's disease (CD). We report long-term efficacy and anterior pituitary function in a cohort of paediatric CD patients treated with RT. Between 1988 and 2008, from our cohort of 48 paediatric CD patients, eight paediatric CD patients ...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-010-0231-x
更新日期:2010-12-01 00:00:00
abstract::In this case report we describe a 38 year-old-female with galactorrhea several months after the birth of an anencephalic child. She had hyperpolactemia and imaging of the pituitary gland revealed a midline defect and a nasopharyngeal mass compatible with a meningo-(hypophyso-) encephalocele and possibly an ectopic ter...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-011-0320-5
更新日期:2012-12-01 00:00:00
abstract:PURPOSE:It is estimated that approximately 69 million individuals worldwide will sustain a TBI each year, which accounts for substantial morbidity and mortality in both children and adults. TBI may lead to significant neuroendocrine changes, if the delicate pituitary is ruptured. In this review, we focus on the anterio...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-019-00944-0
更新日期:2019-06-01 00:00:00
abstract:PURPOSE:In a 10-week proof-of-concept study (LINC 1), the potent oral 11β-hydroxylase inhibitor osilodrostat (LCI699) normalized urinary free cortisol (UFC) in 11/12 patients with Cushing's disease. The current 22-week study (LINC 2; NCT01331239) further evaluated osilodrostat in patients with Cushing's disease. METHO...
journal_title:Pituitary
pub_type: 杂志文章,多中心研究
doi:10.1007/s11102-015-0692-z
更新日期:2016-04-01 00:00:00
abstract:PURPOSE:Nelson's syndrome is a challenging condition that can develop following bilateral adrenalectomy for Cushing's disease, with high circulating ACTH levels, pigmentation and an invasive pituitary tumor. There is no established medical therapy. The aim of the study was to assess the effects of pasireotide on plasma...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-017-0853-3
更新日期:2018-06-01 00:00:00
abstract::The role of pituitary radiotherapy (RT) in the management of clinically non-functioning pituitary tumors (NFTs) remains controversial. Observational studies suggest that RT is effective in preventing the regrowth of NFT remnants following initial surgical debulking. However, not all tumor remnants will regrow in the a...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1023/b:pitu.0000004801.95086.e2
更新日期:2003-09-01 00:00:00
abstract::We aimed to study the occurrence of acute-onset symptoms at initial presentation in a national Danish cohort of patients with childhood- or adult-onset craniopharyngioma, and to investigate potential risk factors for acute presentation. Medical records of 189 consecutive patients (39 children, 150 adults) presenting w...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-012-0451-3
更新日期:2013-12-01 00:00:00
abstract::An unusual case of tubercular granulomatous hypophysitis is reported. A sellar mass diagnosed as pituitary adenoma in MRI, showed non-caseating granulomas, glandular destruction and fibrosis in histology. Stain for acid-fast bacilli (AFB) were negative and the case was misdiagnosed as Idiopathic Granulomatous hypophys...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-007-0068-0
更新日期:2008-01-01 00:00:00
abstract::MAP-2, a well characterized member of the microtubule associated protein (MAP) family, binds to and stabilizes microtubules and is involved in cell proliferation as well as neuronal differentiation. The aim of the present work was to study MAP-2 expression in human adenohypophyses and pituitary adenomas. To our knowle...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-005-1523-4
更新日期:2005-01-01 00:00:00
abstract:PURPOSE:Endogenous Cushing's syndrome (CS) is a rare disease that results from exposure to high levels of cortisol; Cushing's disease (CD) is the most frequent form of CS. Patients with CS suffer from a variety of comorbidities that increase the risk of mortality. Surgical resection of the disease-causing lesion is gen...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-016-0742-1
更新日期:2016-12-01 00:00:00
abstract:INTRODUCTION:The sphenoid bone has a superior depression called the sella turcica, Latin for "Turkish saddle," where the pituitary gland is found. The availability of modern radiological imaging techniques has replaced plain radiography of the sella turcica in the investigation of hypothalamo-pituitary abnormalities. H...
journal_title:Pituitary
pub_type: 历史文章,杂志文章,评审
doi:10.1007/s11102-014-0609-2
更新日期:2015-08-01 00:00:00
abstract::Lymphoma involving the pituitary gland is very rare and usually results from metastatic spread of systemic lymphoma. We present a case of primary central nervous system (CNS) large B cell lymphoma that manifested as pituitary apoplexy. A 45-year-old woman presented with headache, and then rapidly developed a third ner...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-008-0084-8
更新日期:2009-01-01 00:00:00
abstract:CONTEXT:Outcome of acromegaly surgery is assessed by IGF-1 and glucose-suppressed GH, but whether the latter provides additional clinically relevant information when IGF-1 is normal is unclear. The role of GH suppression testing after surgery requires clarification. METHODS:We studied 97 acromegaly patients with norma...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-020-01094-4
更新日期:2020-10-30 00:00:00
abstract::Aggressive pituitary adenomas are notoriously difficult to manage due to their size, invasiveness, speed of growth and high frequency of recurrence. Except for prolactinomas, surgery (usually transsphenoidal but sometimes transcranial) is the first-line option, but re-growth of aggressive tumors is almost inevitable a...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-008-0153-z
更新日期:2009-01-01 00:00:00
abstract::A high incidence of venous thromboembolic (VTE) complications has been reported in Cushing's syndrome (CS), mostly post-operatively and attributable to hypercoagulability. The prevalence of symptomatic VTE was investigated retrospectively in 58 consecutive CS patients in relation to acquired and genetic thrombotic ris...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-012-0398-4
更新日期:2013-06-01 00:00:00
abstract::Familial neurohypophyseal diabetes insipidus (FNDI) is mostly an autosomal dominant inherited disorder presenting with severe polydipsia and polyuria typically in early childhood. To date, 69 different variations in the AVP gene encoding the AVP prohormone have been identified in autosomal dominant FNDI (adFNDI). In t...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-012-0392-x
更新日期:2013-06-01 00:00:00
abstract::Twenty years after the first description of combined hypopituitarism (CPHD) caused by PROP1 mutations, the phenotype of affected subjects is still challenging for clinicians. These patients suffer from pituitary hormone deficits ranging from IGHD to panhypopituitarism. ACTH deficiency usually develops later in life. P...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-020-01049-9
更新日期:2020-08-01 00:00:00
abstract::Non-functioning pituitary neuroendocrine tumors do not cause endocrine symptoms related to hypersecretion of adenohypophyseal hormones and are clinically characterized by symptoms due to growing sellar tumor mass. Histopathological classification of this tumor group has always been challenging due to their heterogenei...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-017-0855-1
更新日期:2018-04-01 00:00:00
abstract::Pituitary adenomas rarely originate outside the sella turcica. Ectopic locations include the suprasellar region, sphenoid sinus, cavernous sinus and clivus. We describe a 50-year-old female who presented with clinical signs and biochemical evidence of acromegaly. Pituitary MRI demonstrated a 2 mm hypointense lesion on...
journal_title:Pituitary
pub_type: 杂志文章,评审
doi:10.1007/s11102-011-0345-9
更新日期:2012-12-01 00:00:00
abstract:PURPOSE:To report the results of a consecutive series of patients who underwent an endoscopic endonasal approach (EEA) for resection of a pituitary adenoma and compare them to previous series of microscopic and endoscopic approaches. METHODS:A retrospective review of clinical and radiographic outcomes of a consecutive...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-013-0502-4
更新日期:2014-08-01 00:00:00
abstract::Postoperative serum cortisol is used as an indicator of Cushing's disease (CD) remission following transsphenoidal surgery (TSS) and guides (controversially) the need for immediate adjuvant treatment for CD. We investigated postoperative cortisol and adrenocorticotropic hormone (ACTH) levels as predictors of remission...
journal_title:Pituitary
pub_type: 杂志文章
doi:10.1007/s11102-012-0455-z
更新日期:2013-12-01 00:00:00