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Endocrine and Neuroendocrine Tumors
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Natasha Shrikrishnapalasuriyar, P.N. Plowman, Márta Korbonits, Ashley B. Grossman
Transsphenoidal surgery is remarkably successful for the removal and often cure of the majority of pituitary tumors. However, while medical therapy is also available for prolactin-, GH-, ACTH-, and TSH-secreting tumors, with varying degrees of success, apparently non-functioning tumors are largely unresponsive to medical therapy. Current research suggests such medical approaches will become available for all types of pituitary tumor in the future, allowing for effective and well-tolerated alternatives to surgery.
Dopamine and Tumorigenesis in Reproductive Tissues
Published in Nira Ben-Jonathan, Dopamine, 2020
The occurrence of nonfunctional pituitary adenomas varies from 20% to 30% of total pituitary tumors. These tumors are often composed of gonadotrophs, although they are devoid of humoral hypersecretory syndromes [24]. They are usually large at the time of diagnosis, presenting with headaches, visual field defects, and hypopituitarism. Transsphenoidal surgery remains the treatment of choice for a rapid decompression of neighboring structures, often improving visual and pituitary function. Patients need long-term follow-up for the detection and treatment of hypopituitarism, visual dysfunction and tumor growth that may develop over time. In a small study, D2R was expressed in 67% of nonfunctional pituitary adenomas, among which the long isoform was found in 50%, the short isoform in 17%, and both isoforms in 33% of cases; D4R was expressed in 17% of the cases [25]. After 1 year of cabergoline treatment, tumor shrinkage was evident in 56% of the patients and was associated with D2R expression. The role of DA in the promotion of tumorigenesis was reinforced by a recent report that D2R agonists reduced both migration and invasion of cultured pituitary cells obtained from patients with nonfunctional pituitary adenomas [26].
Neurosurgery: Neuroendocrine lesions
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Transsphenoidal surgery (TSS) can be performed safely in patients over the age of 70, particularly when perioperative risk is low. As the most common presenting feature in these patients is mass effect, surgery becomes the best option (18).
A case of atypical macroprolactinoma presenting with pituitary apoplexy during pregnancy and review of the literature
Published in Gynecological Endocrinology, 2020
Seda Hanife Oguz, Figen Soylemezoglu, Selcuk Dagdelen, Tomris Erbas
The patient was consulted to endocrinology, neurosurgery, obstetrics, and ophthalmology departments and it was decided that the follow-up of the patient should be continued as an inpatient. Given the visual deficit had not resolved spontaneously in 1 week of hospitalization and undeterminable history whether the adenoma was sensitive to dopamine agonist therapy or not, surgery was thought to be the most suitable treatment option. The patient underwent transsphenoidal surgery 8 days after admission. Histopathological examination established a pituitary adenoma with recent hemorrhage. Immunohistochemistry staining confirmed a prolactinoma consisted of dense granular lactotroph cells. Ki-67 index was 3.5% and positive nuclear immunostaining for p53 was detected in some of the neoplastic cells. In the light of these findings, atypical pituitary adenoma was diagnosed according to 2004 World Health Organization classification of pituitary tumors.
Endoscopic skull base neurosurgical practice in the United Kingdom
Published in British Journal of Neurosurgery, 2019
Andrew F. Alalade, Sara Venturini, Neil Dorward, Nick Thomas
Studies have shown a learning curve between 15 and 200 procedures,43 after which operative time and complications stabilise. Jho and Carrau were pioneers of the Neurosurgery-ENT collaboration for endoscopic pituitary surgery, and this has become more popular over the last decades.8,24 The dual-specialty collaboration has proven to be a predictor of better outcomes. Lofrese et al.43 showed that as more neurosurgeons worked with ENT colleagues in endoscopic skull base surgery, there was a reduction of the learning curve, minimization of complications during the training, and surgical and clinical outcomes continued to improved even after the curve has long since reached its plateau. With improving technological devices, the skill sets for endoscopic transsphenoidal surgery are gradually evolving from the surgical resection of intra-/suprasellar pituitary adenomas to that of more complex lesions infiltrating or involving the parasellar region. It is now becoming more obvious that there is a growing emergence of neurosurgeon-ENT groups, leading more operators to become familiar with extended endonasal endoscopic approaches and thus prospectively improving surgical proficiency and outcome even in such demanding procedures through this constant amalgamation of specialist expertise.
Incidental ethmoidal dural arteriovenous fistula coexisting with a pituitary adenoma exacerbating post-transsphenoidal epistaxis
Published in British Journal of Neurosurgery, 2019
Keisuke Yoshida, Raita Fukaya, Masahito Fukuchi, Yoshihiko Hiraga, Shinya Ichimura, Koji Fuji
Transsphenoidal surgery is a useful operative method for sellar and parasellar lesions, especially pituitary tumours. However, several cases of severe postoperative epistaxis after transsphenoidal surgery have been reported.1,2 Ethmoidal dural arteriovenous fistula (DAVF) is rare and asymptomatic DAVFs can remain unrecognised unless catheter angiography is done. We report a case of postoperative epistaxis that required massive transfusion and endovascular embolisation after an uneventful endoscopic transsphenoidal surgery for pituitary tumour associated with preoperatively-unknown coexisting ethmoidal DAVF.