RESUMO
OBJECTIVE: Prolactinoma can increase the risk of cardiovascular diseases (CVDs), such as arterial stiffness, atherosclerosis, dysrhythmia and heart failure. This study aimed to evaluate and compare muscle function, exercise capacity, physical activity (PA) level, CVD risk factor knowledge level, sleep quality, fatigue and quality of life between prolactinoma patients and healthy controls. METHODS: Nineteen female patients with prolactinomas and 19 healthy women were included in this study. Quadriceps muscle strength (QMS) was measured using a hand dynamometer, and muscular endurance was evaluated via the squat test. The 6-minute walking test (6MWT) distance was also measured. CVD risk factor knowledge levels were evaluated with the Cardiovascular Diseases Risk Factors Knowledge Level Scale (CARRF-KL), PA levels were assessed with the International Physical Activity Questionnaire-short form (IPAQ), sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), fatigue was assessed with the Multidimensional Fatigue Rating Scale (MAF), and quality of life was assessed with the Short Form-36 questionnaire (SF-36). RESULTS: Patients with prolactinomas had significantly lower 6MWT distances; CARRF-KL total scores; SF-36 general health and physical limitation scores; and higher IPAQ-sitting scores than did healthy controls (p < 0.05). Moreover, there were no significant differences between the groups in terms of QMS score; number of squats; severity of IPAQ score; severity, moderate, or total walking score; total PSQI score; or total MAF score (p > 0.05). CONCLUSIONS: Exercise capacity and quality of life are adversely affected, and sedentary behavior is observed in prolactinomas. Patients with prolactinomas have less knowledge about CVD risk factors than healthy individuals. CVD incidence and knowledge and functional capacity should be improved in patients with prolactinomas by the use of a multidisciplinary team for cardiac rehabilitation. CLINICAL TRIAL REGISTRATION: This study is part of a larger clinical trial registered on ClinicalTrials.gov prior to participant enrollment (NCT05236829).
Assuntos
Doenças Cardiovasculares , Tolerância ao Exercício , Exercício Físico , Força Muscular , Neoplasias Hipofisárias , Prolactinoma , Qualidade de Vida , Humanos , Feminino , Adulto , Prolactinoma/fisiopatologia , Prolactinoma/complicações , Pessoa de Meia-Idade , Exercício Físico/fisiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/etiologia , Tolerância ao Exercício/fisiologia , Força Muscular/fisiologia , Neoplasias Hipofisárias/fisiopatologia , Neoplasias Hipofisárias/complicações , Fadiga/fisiopatologia , Fatores de Risco de Doenças Cardíacas , Qualidade do Sono , Conhecimentos, Atitudes e Prática em Saúde , Fatores de RiscoRESUMO
OBJECTIVE: Hyperprolactinemia has negative impacts on metabolism and musculoskeletal health. In this study, individuals with active prolactinoma were evaluated for nonalcoholic fatty liver disease (NAFLD) and musculoskeletal health, which are underemphasized in the literature. METHODS: Twelve active prolactinoma patients and twelve healthy controls matched by age, gender, and BMI were included. Magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was used to evaluate hepatic steatosis and magnetic resonance elastography (MRE) to evaluate liver stiffness measurement (LSM). Abdominal muscle mass, and vertebral MRI-PDFF was also evaluated with MRI. Body compositions were evaluated by dual energy X-ray absorptiometry (DXA). The skeletal muscle quality (SMQ) was classified as normal, low and weak by using "handgrip strength/appendicular skeletal muscle mass (HGS/ASM)" ratio based on the cut-off values previously stated in the literature. RESULTS: Prolactin, HbA1c and CRP levels were higher in prolactinoma patients (p<0.001, p=0.033 and p=0.035, respectively). The median MRI-PDFF and MRE-LSM were 3.0% (2.01-15.20) and 2.22 kPa (2.0-2.5) in the prolactinoma group and 2.5% (1.65-10.00) and 2.19 kPa (1.92-2.54) in the control group, respectively and similiar between groups. In prolactinoma patients, liver MRI-PDFF showed a positive and strong correlation with the duration of disease and traditional risk factors for NAFLD. Total, vertebral and pelvic bone mineral density was similar between groups, while vertebral MRI-PDFF tended to be higher in prolactinoma patients (p=0.075). Muscle mass and strength parameters were similar between groups, but HGS/ASM tended to be higher in prolactinoma patients (p=0.057). Muscle mass was low in 33.3% of prolactinoma patients and 66.6 of controls. According to SMQ, all prolactinoma patients had normal SMQ, whereas 66.6% of the controls had normal SMQ. CONCLUSION: Prolactinoma patients demonstrated similar liver MRI-PDFF and MRE-LSM to controls despite their impaired metabolic profile and lower gonadal hormone levels. Hyperprolactinemia may improve muscle quality in prolactinoma patients despite hypogonadism.
Assuntos
Absorciometria de Fóton , Imageamento por Ressonância Magnética , Músculo Esquelético , Hepatopatia Gordurosa não Alcoólica , Neoplasias Hipofisárias , Prolactinoma , Humanos , Projetos Piloto , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiopatologia , Estudos de Casos e Controles , Prolactinoma/diagnóstico por imagem , Prolactinoma/fisiopatologia , Prolactinoma/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/fisiopatologia , Técnicas de Imagem por Elasticidade , Força da Mão , Fígado/diagnóstico por imagem , Fígado/patologia , Hemoglobinas Glicadas , Densidade Óssea , Prolactina/sangue , Composição CorporalRESUMO
OBJECTIVE: To present the outcomes of endoscopic endonasal surgery for giant pituitary adenomas and discuss the extent of resection to minimize morbidity and mortality. METHODS: We retrospectively reviewed medical records of 44 patients with giant pituitary adenomas who underwent endoscopic endonasal surgery. Clinical presentation, laboratory results, imaging studies, clinical outcomes, extent of resection, and complications were collected and analyzed. Factors affecting long-term outcome according to surgical technique were identified and analyzed. RESULTS: Radical resection (RR) was defined as either gross total resection or near-total resection (90%-100% of the tumor). There were 28 patients (63.6%) who underwent RR, 10 patients (22.7%) who underwent subtotal resection, and 6 patients (13.6%) who underwent partial resection. Visual improvement was achieved in 27 patients (81.8%). Thirteen patients (72.2%) with pituitary dysfunction had improvement in at least 1 preoperative endocrinological dysfunction. RR rates for dumbbell and multilobular tumors were 44.4% and 28.6%, respectively. Surgical complications were observed in 14 (31.8%) patients. Major vascular injury occurred in 3 patients (6.8%). Mean follow-up period was 38.5 months (range, 1-70 months). No patients with RR had recurrence or residual tumor progression. Ten patients (22.7%) received adjuvant radiation therapy after resection. Two patients were reoperated on for tumor regrowth, and 3 patients (including the 2 patients with tumor regrowth) were lost to follow-up. CONCLUSIONS: Long-term follow-up results and low recurrence rate of tumors indicate that RR is effective to decrease morbidity and mortality.
Assuntos
Adenoma/cirurgia , Cirurgia Endoscópica por Orifício Natural , Neuroendoscopia , Neoplasias Hipofisárias/cirurgia , Adenoma/patologia , Adenoma/fisiopatologia , Adolescente , Adulto , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Quimioterapia Adjuvante , Doenças dos Nervos Cranianos/fisiopatologia , Progressão da Doença , Feminino , Adenoma Hipofisário Secretor de Hormônio do Crescimento/patologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/fisiopatologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Humanos , Hipopituitarismo/fisiopatologia , Complicações Intraoperatórias/epidemiologia , Pessoa de Meia-Idade , Cavidade Nasal , Recidiva Local de Neoplasia , Neoplasia Residual , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Prolactinoma/patologia , Prolactinoma/fisiopatologia , Prolactinoma/cirurgia , Radioterapia Adjuvante , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Carga Tumoral , Lesões do Sistema Vascular/epidemiologia , Transtornos da Visão/fisiopatologia , Adulto JovemRESUMO
PURPOSE: The aim of this study was to evaluate the somatotroph axis in a large series of patients with prolactinoma to verify the prevalence of silent acromegaly in this population. METHODS: A hundred and forty-four patients were enrolled in a multicenter study: 90 were already on cabergoline (CAB) and enrolled in a cross-sectional arm (group A) with random PRL, GH and IGF-I determination on treatment (≥ 3 months), whereas 54 untreated patients were enrolled at diagnosis in a prospective arm (group B) with PRL, GH and IGF-I measurement before and after 6 and 12 months of treatment. In the presence of high IGF-I, CAB was withdrawn for 3 months and GH, IGF-I, PRL and GH during an oral Glucose Tolerance Test (OGTT) were obtained. RESULTS: High IGF-I levels (ULN 1.01-1.56) were observed in 9 patients (6.25%, 5F). After CAB withdrawal, IGF-I levels normalized in 5/9 patients, GH was < 0.4 ng/ml after OGTT in 7/9 cases or at random GH determination in one case. After CAB re-introduction, IGF-I levels re-increased in a single case. Overall, a single young female patient harboring a macroadenoma in group A was diagnosed with silent acromegaly and underwent successful transsphenoidal removal of a GH/PRL-secreting adenoma. CONCLUSION: The prevalence of silent acromegaly in prolactinomas (0.7%) is lower than previously reported and OGTT is helpful to recognize silent acromegaly. We suggest that the somatotroph axis should be evaluated at diagnosis in all cases and not systematically during follow-up.
Assuntos
Acromegalia/epidemiologia , Prolactinoma/fisiopatologia , Acromegalia/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Prospectivos , Adulto JovemRESUMO
BACKGROUND: The prevalence of sellar masses (SMs) is reported in Europe and North America but only limited data are available from the Middle East and North Africa (MENA) region. OBJECTIVES: Assess the prevalence and characteristics of SMs in Al Ain city, United Arab Emirates. DESIGN: Retrospective, descriptive multicenter study. SETTING: Three endocrine centers in Al Ain. PATIENTS AND METHODS: All patients diagnosed with SMs in the city of Al Ain, Emirate of Abu Dhabi, between 2011 and 2016 were evaluated. Cases were identified using ICD 9 and 10 codes and demographic and clinical data were collected. The prevalence rate was calculated for patients alive and residing in Al Ain city until 31 December 2016. MAIN OUTCOME MEASURES: Clinical presentations and prevalence rate. SAMPLE SIZE: 272. RESULTS: The mean (SD) age on presentation was 40.8 (14.3) years (range: 6-114 years, median: 40.0). The 170 (61.8%) females and 128 (46.5%) were native citizens of the United Arab Emirates. Two hundred and forty five (90%) patients had pituitary adenomas (PAs) while 27 (10%) had non-pituitary sellar lesions. The four most common SMs were prolactinoma (n=139, 51.1%), nonfunctioning adenoma (NFA) (n= 69, 25.4%), somatotroph adenoma (n=32, 11.8%) and craniopharyngioma (n=15, 5.5%). Patients with prolactinoma, corticotroph adenoma, and Rathke's cleft cyst had small sellar masses (<1 centimeter) while the majority of patients with other SMs had macroadenomas. Hypogonadism and growth hormone deficiency was present in 41.8% and 20.5% of the patients, respectively. Of 268 patients with available data, 82 patients underwent surgery while 25 patients received radiotherapy. At the end of 2016, 197 patients were residing in Al Ain city. The overall prevalence of SMs was 25.7/100 000 with PAs constituting most of these masses (n=177) for a prevalence of 23.1/100 000. CONCLUSIONS: This is the first study of SMs in the United Arab Emirates and the MENA region. Prolactinoma and NFA were the two most common SMs. Further studies are needed to explore the reasons for the lower prevalence of SMs in our region compared with other countries. LIMITATIONS: Retrospective design, relatively small sample size. CONFLICT OF INTEREST: None.
Assuntos
Adenoma/epidemiologia , Cistos do Sistema Nervoso Central/epidemiologia , Craniofaringioma/epidemiologia , Neoplasias Hipofisárias/epidemiologia , Adenoma Hipofisário Secretor de ACT/epidemiologia , Adenoma Hipofisário Secretor de ACT/patologia , Adenoma Hipofisário Secretor de ACT/fisiopatologia , Adenoma Hipofisário Secretor de ACT/terapia , Adenoma/patologia , Adenoma/fisiopatologia , Adenoma/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos do Sistema Nervoso Central/patologia , Cistos do Sistema Nervoso Central/fisiopatologia , Cistos do Sistema Nervoso Central/terapia , Criança , Craniofaringioma/patologia , Craniofaringioma/fisiopatologia , Craniofaringioma/terapia , Feminino , Hormônio do Crescimento/deficiência , Adenoma Hipofisário Secretor de Hormônio do Crescimento/epidemiologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/patologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/fisiopatologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/terapia , Humanos , Hipogonadismo/fisiopatologia , Hipopituitarismo/epidemiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/fisiopatologia , Neoplasias Hipofisárias/terapia , Prevalência , Prolactinoma/epidemiologia , Prolactinoma/patologia , Prolactinoma/fisiopatologia , Prolactinoma/terapia , Radioterapia , Sela Túrcica , Carga Tumoral , Emirados Árabes Unidos/epidemiologia , Adulto JovemAssuntos
Neoplasias Hipofisárias/diagnóstico , Prolactinoma/diagnóstico , Adolescente , Diagnóstico Tardio , Humanos , Masculino , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/fisiopatologia , Prolactinoma/complicações , Prolactinoma/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
Although effective treatment regimens (surgical resection, drug treatment with dopamine agonists or somatostatin analogues, radiotherapy) have been established for the therapy of most pituitary tumours, a considerable proportion of affected patients cannot completely cured due to incomplete resection or drug resistance. Moreover, even if hormone levels have been normalized, patients with hormone-secreting tumours still show persistent pathophysiological alterations in metabolic, cardiovascular or neuropsychiatric parameters and have an impaired quality of life. In this review reasons for the discrepancy between biochemical cure and incomplete recovery from tumour-associated comorbidities are discussed and the clinical management is delineated exemplarily for patients with acromegaly and Cushing's disease. In view of the development of additional treatment concepts for the treatment of pituitary adenomas we speculate about the relevance of RSUME as a potential target for the development of an anti-angiogenic therapy. Moreover, the role of BMP-4 which stimulates prolactinoma development through the Smad signalling cascade is described and its role as putative drug target for the treatment of prolactinomas is discussed. Regarding the well-known resistance of a part of somatotropinomas to somatostatin analogue treatment, recently identified mechanisms responsible for the drug resistance are summarized and ways to overcome them in future treatment concepts are presented. Concerning novel therapeutic options for patients with Cushing's disease the impact of retinoic acid, which is currently tested in clinical studies, is shown, and the action and putative therapeutic impact of silibinin to resolve glucocorticoid resistance in these patients is critically discussed.
Assuntos
Neoplasias Hipofisárias/tratamento farmacológico , Pesquisa Translacional Biomédica/métodos , Animais , Humanos , Hipersecreção Hipofisária de ACTH/tratamento farmacológico , Hipersecreção Hipofisária de ACTH/fisiopatologia , Neoplasias Hipofisárias/fisiopatologia , Prolactinoma/tratamento farmacológico , Prolactinoma/fisiopatologia , Qualidade de Vida , Somatostatina/análogos & derivados , Somatostatina/uso terapêuticoRESUMO
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.
Assuntos
Adenoma Hipofisário Secretor de ACT/cirurgia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Microcirurgia/métodos , Neuroendoscopia/métodos , Neoplasias Hipofisárias/terapia , Prolactinoma/terapia , Adenoma Hipofisário Secretor de ACT/diagnóstico por imagem , Adenoma Hipofisário Secretor de ACT/metabolismo , Adenoma Hipofisário Secretor de ACT/fisiopatologia , Adenoma/diagnóstico por imagem , Adenoma/metabolismo , Adenoma/fisiopatologia , Adenoma/cirurgia , Adolescente , Criança , Pré-Escolar , Craniotomia , Agonistas de Dopamina/uso terapêutico , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico por imagem , Adenoma Hipofisário Secretor de Hormônio do Crescimento/metabolismo , Adenoma Hipofisário Secretor de Hormônio do Crescimento/fisiopatologia , Humanos , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/fisiopatologia , Prolactinoma/diagnóstico por imagem , Prolactinoma/fisiopatologia , Osso EsfenoideRESUMO
BACKGROUND: Dopamine agonists are the standard first-line medical therapy for prolactinoma. We report a rare case of giant prolactinoma with a first epileptic seizure due to rapid reduction of the tumor as a complication of dopamine agonist therapy. CASE PRESENTATION: A 27-year-old Japanese man presented to our institution with a history of visual disturbance for 1 year and general fatigue for 3 months. Magnetic resonance imaging showed a tumor that arose from the pituitary and extended to the bilateral anterior skull base, the clivus, and the cavernous sinus, with compression of the optic chiasm and the bilateral frontal and temporal lobes. On the basis of the patient's serum concentration of prolactin, we diagnosed a prolactinoma and started dopamine agonist therapy with cabergoline. The patient had a general seizure immediately after starting dopamine agonist therapy and required general anesthetic treatment following the rapid reduction of the tumor. We speculated that the rapid reduction of the tumor resulted in the retraction of the surrounding brain structure, and the epileptic seizure was then induced by dopamine agonist therapy. CONCLUSIONS: We report a rare case of giant prolactinoma with a first epileptic seizure immediately after the initiation of dopamine agonist therapy. Clinicians need to be aware that the rapid reduction of a giant prolactinoma by dopamine agonist therapy may cause an epileptic seizure.
Assuntos
Cabergolina/administração & dosagem , Agonistas de Dopamina/administração & dosagem , Lobo Frontal/patologia , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Estado Epiléptico/induzido quimicamente , Adulto , Anticonvulsivantes/uso terapêutico , Cabergolina/efeitos adversos , Agonistas de Dopamina/efeitos adversos , Fadiga , Lobo Frontal/efeitos dos fármacos , Humanos , Hidrocortisona/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/fisiopatologia , Prolactinoma/diagnóstico por imagem , Prolactinoma/fisiopatologia , Tiroxina/uso terapêutico , Resultado do Tratamento , Transtornos da VisãoRESUMO
BACKGROUND: Prolactin may exert immunological effects. Over the years, a higher prevalence of autoimmune thyroid diseases (ATD) has been reported in patients with prolactinomas (PRLs) in areas with sufficient iodine intake. PURPOSE: The aim of our study was to evaluate the prevalence of ATD [Graves' disease (GD) and chronic autoimmune thyroiditis (AIT)] in a retrospective cohort of Italian patients with PRLs compared to a sex-matched control group, represented by subjects with non-functioning pituitary adenoma (NFPA) or empty sella (ES). MATERIALS AND METHODS: We enrolled 149 patients (108 F/41 M) with PRLs (110 micro/39 macro) and 143 subjects (100 F/43 M) with NFPA (n = 96, 56 micro/40 macro) or ES (n = 47), with normal serum prolactin. Neck ultrasound and thyroid function tests (anti-thyroid antibodies, TSH, FT3 and FT4) were performed in all patients. RESULTS: In PRLs, median serum prolactin was significantly higher (98.3 vs. 8.9 ng/ml, p ≤ 0.0001), while age was lower (34 vs. 46 years, p ≤ 0.001) compared to controls. The prevalence of ATD was 13.4% (20/149) in PRLs (1 GD and 19 AIT) compared to 6.3% (9/143) in the controls (p = 0.042). At the multivariate analysis, serum prolactin was the only independent factor predicting ATD. Thyroid volume (12.5 ± 5.9 ml vs. 12.8 ± 10 ml, p = 0.47) and the presence of uni- or multinodular goiter (29.5% vs. 35%, p = 0.35) did not differ between PRLs and control groups. CONCLUSIONS: Our data in an area with mild iodine deficiency confirm a higher prevalence of ATD in patients with prolactinomas.
Assuntos
Prolactinoma/fisiopatologia , Doenças da Glândula Tireoide/epidemiologia , Tireoidite Autoimune/epidemiologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Testes de Função Tireóidea , Adulto JovemAssuntos
Cabergolina/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Lobo Frontal/diagnóstico por imagem , Imageamento por Ressonância Magnética , Transtornos da Memória/diagnóstico por imagem , Neoplasias Hipofisárias/fisiopatologia , Prolactinoma/fisiopatologia , Idoso , Confusão , Feminino , Lobo Frontal/fisiopatologia , Neuroimagem Funcional , Humanos , Transtornos da Memória/fisiopatologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/complicações , Prolactinoma/diagnóstico por imagem , Prolactinoma/tratamento farmacológico , Resultado do TratamentoRESUMO
INTRODUCTION: Pituitary adenomas are benign brain tumours arising from the adenohypophysis; representing 10-15% of all intra-cranial tumours. Despite improved management, they are still related to high morbidity. Visual impairment is a common presentation and visual field defects representing 37-96%. We aimed at describing the clinical presentation of operated patients and their visual outcome. METHODS: We conducted a cross-sectional study for 6 months at the Yaoundé Central Hospital's Neurosurgery, Endocrinology and Ophthalmology departments. We included all patients with histopathological confirmation, having pre-operative visual assessment and operated from January 2010 to June 2016. RESULTS: Twenty-five participants (50 eyes) were enrolled. Three subtypes of pituitary adenomas were identified: Non-functional pituitary adenomas (64%) > Somatotropinomas (20%) > Prolactinomas (16%). All cases were macroadenomas. The median duration of symptoms was 14 months. All participants presented with vision impairment and 80% with headaches. Craniotomy was used in 88% of cases. The temporal hemifield was the most quantitatively affected; 76% of eyes presented with visual acuity (VA) < 6/12 and 24% of eyes a visual acuity ≥6/12. Thirty percent of eyes presented with optic atrophy; cranial nerve III palsy was the most observed. The Mean deviation (MD), an automated visual field index, improved though non-significant and 16% of eyes had a normal visual field printout after surgery. Left eye mean deviation improved significantly (p = 0.04). After surgery, there was a mild improvement of VA with 62% of eyes having a VA< 6/12 and 38% a VA ≥6/12. There was no ophthalmoplaegia after surgery. Long delay before diagnosis significantly jeopardizes pre-operative and post-operative visual acuity (r = 0.5; p = 0.01). CONCLUSION: Quantitative vision parameters comparison are suggestive of a potential improvement of vision. This conclusion will be better ascertained on a large-scale sample size. Long delay before diagnosis is associated to poor visual outcome.
Assuntos
Adenoma/cirurgia , Neoplasias Hipofisárias/cirurgia , Transtornos da Visão/cirurgia , Adenoma/fisiopatologia , Adolescente , Adulto , Idoso , Camarões , Craniotomia/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/fisiopatologia , Prolactinoma/fisiopatologia , Prolactinoma/cirurgia , Resultado do Tratamento , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologiaRESUMO
Peroxisome proliferator-activated receptor alpha (PPARα) has been involved in the regulation of somatotroph tumour cells and may be targeted by different drugs, some of them are in current clinical use. The aim of this study was to investigate the expression of PPARα in additional phenotypes of pituitary adenomas (PA), the relationship between PPARα and its potential molecular partner aryl hydrocarbon receptor interacting protein (AIP) in these tumours, and the effects of PPARα agonists on lactotroph cells. Seventy-five human PA - 57 non-functioning (NFPA) and 18 prolactinomas (PRL-PA) - were characterised for PPARα and AIP expression by real time RT-PCR and/or immunohistochemistry (IHC), and the effects of fenofibrate and WY 14 643 on MMQ cells were studied in vitro. PPARα was expressed in a majority of PA. PPARα immunostaining was observed in 93.7% PRL-PA vs. 60.6% NFPA (p=0.016), the opposite being found for AIP (83.3% in NFPA vs. 43.7% in PRL-PA, p=0.003). PPARα expression was unrelated to gonadotroph differentiation in NFPA, but positively correlated with tumour volume in PRL-PA. Both drugs significantly reduced MMQ cell growth at high concentrations (100-200 µM). At the same time, despite modest stimulating effects on PRL secretion were observed, these were overcome by the reduction in cell number. In conclusion, PPARα is commonly expressed by PRL-PA and NFPA, regardless of AIP, and may represent a new target of PPARα agonists.
Assuntos
Fenofibrato/farmacologia , PPAR alfa/genética , Neoplasias Hipofisárias/genética , Pirimidinas/farmacologia , Adolescente , Adulto , Idoso , Proliferação de Células/efeitos dos fármacos , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Peptídeos e Proteínas de Sinalização Intracelular/genética , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Masculino , Pessoa de Meia-Idade , PPAR alfa/agonistas , PPAR alfa/metabolismo , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/fisiopatologia , Prolactinoma/genética , Prolactinoma/metabolismo , Prolactinoma/fisiopatologia , Somatotrofos/metabolismo , Adulto JovemRESUMO
The objective of this study was to investigate the effect of hyperprolactinemia and high levels of insulin-like growth factor-I (IGF-I) on bone resorption and their relation with receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) in patients with prolactinoma and acromegaly. Thirty-one patients with acromegaly, 28 patients with prolactinoma, and 33 healthy individuals were included in the study. Serum concentrations of RANKL, OPG, bone alkaline phosphatase (bone ALP), osteocalcin (OC), C-terminal telopeptide of type 1 collagen (CTX), procollagen type 1 N-terminal propeptide (P1NP) and urine deoxypyridinoline (DPD) levels were detected and bone mineral density (BMD) was measured. Groups were not statistically different from each other with regard to serum levels of RANKL and OPG. The RANKL/OPG ratio was higher in the prolactinoma group than in the control group (p=0.046). A positive correlation between OPG and increasing age was detected in both the prolactinoma and control groups (r=0.524, p=0.004 and r=0.380, p=0.029, respectively). An inverse correlation was observed between IGF-I and OPG after excluding age in the prolactinoma group (r=-0.412, p=0.046). OC and bone ALP were negatively associated with RANKL in the acromegaly group (r=-0.384, p=0.036 and r=-0.528, p=0.003, respectively). There was an inverse correlation between OPG and BMD at the femoral neck in the acromegaly group (r=-0.422, p=0.02). The effect of IGF-I on bone remodeling may be partly mediated by RANKL and OPG. The RANKL/OPG ratio plays an important role in prolactinoma. A positive correlation of OPG with age and an inverse correlation with IGF-I favor the compensatory response of OPG against bone loss in the aging skeleton.
Assuntos
Acromegalia/fisiopatologia , Biomarcadores/sangue , Reabsorção Óssea/sangue , Osteoprotegerina/sangue , Prolactinoma/fisiopatologia , Ligante RANK/sangue , Acromegalia/sangue , Adolescente , Adulto , Idoso , Reabsorção Óssea/epidemiologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Prolactinoma/sangue , Adulto JovemRESUMO
PURPOSE: Pituitary tumours are slowly progressing tumours, mostly benign, with a reported global prevalence of 16.7% (22.5% in radiologic studies and 14.4% in autopsy studies). Clinical and epidemiological data on pituitary adenomas in Saudi Arabia are lacking. We aimed to utilise our database variables to determine clinical and epidemiological characteristics as well as treatment outcomes of pituitary tumours among Saudi patients. METHODS: This retrospective study was conducted in King Fahad Medical City, Riyadh, Saudi Arabia, in patients with pituitary tumours. Data were collected between 2006 and 2017. RESULTS: Overall, 284 patients (females: 38.1 ± 13.9 years; males: 44.1 ± 15.4 years) with pituitary tumours were included. Common pituitary tumours were prolactin-secreting adenomas (45%), non-functioning pituitary adenomas (NFPAs: 35.6%), growth hormone (GH)-secreting adenomas (10.6%), craniopharyngiomas (7%), and adrenocorticotropic hormone (ACTH)-secreting adenomas (1.8%). Prolactin-secreting adenomas were more frequently microadenomas and were common among females. Headaches and visual symptoms occurred commonly in NFPA patients (62.4 and 45.5%, respectively) than in those with prolactin-secreting adenomas (56.3 and 32.8%, respectively) or GH-secreting adenomas (40 and 16.6%, respectively). Medical treatment was the mainstay for prolactin-secreting adenoma patients (69%). Pituitary surgery was the primary therapy in NFPA patients (43.6%) and GH-secreting adenomas (86.7%). CONCLUSION: This study identified the pattern of pituitary tumours in Saudi patients and management strategies. Further, the study highlights the need for a nationwide registry to improve surveillance and physicians' knowledge in Saudi Arabia.
Assuntos
Adenoma/epidemiologia , Neoplasias Hipofisárias/epidemiologia , Prolactinoma/epidemiologia , Adenoma/tratamento farmacológico , Adenoma/fisiopatologia , Adenoma/cirurgia , Adulto , Idoso , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/fisiopatologia , Neoplasias Hipofisárias/cirurgia , Prolactinoma/tratamento farmacológico , Prolactinoma/fisiopatologia , Prolactinoma/cirurgia , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricosRESUMO
Prolactinomas account for about 40% of all pituitary adenomas. The main treatment for prolactinomas is undoubtedly therapy with dopamine agonists (DAs). However, prolonged conservative treatment (for many years or even throughout life) that is necessary for permanent control of the disease makes some patients refuse pharmacological treatment for various reasons. In addition, not all prolactinomas respond to DAs therapy. Sometimes, the patient is not able to continue treatment because of the severity of side effects. Along with tumor resistance to therapy and patient intolerance of DAs, complications (liquorrhea, hemorrhage in the tumor) may occur during conservative treatment. In these cases, surgery is necessary. The paper analyzes the modern literature on various treatment options for prolactin-secreting pituitary adenomas and defines the indications for surgical treatment.
Assuntos
Agonistas de Dopamina/efeitos adversos , Resistencia a Medicamentos Antineoplásicos , Procedimentos Neurocirúrgicos , Neoplasias Hipofisárias/terapia , Prolactinoma/terapia , Agonistas de Dopamina/uso terapêutico , Humanos , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/fisiopatologia , Prolactinoma/patologia , Prolactinoma/fisiopatologiaRESUMO
Background The majority of pituitary adenomas are sporadic, but about 5% of them occur in a familial setting, predominantly in multiple endocrine neoplasia type 1 and Carney complex. Familial isolated pituitary adenomas (FIPA), unrelated to the syndromes mentioned above, were also described. The clinical course of FIPA differs significantly from sporadic cases, and is characterized by a larger tumor size, more aggressive course and younger patients' age at the moment of recognition. Objectives The aim of this retrospective study is to present 4 families in which two closely related people were diagnosed with pituitary adenomas. Probably these cases are clinical manifestations of FIPA. Material and methods Eight patients within four families, presenting with anterior pituitary tumors were described. The authors analyzed medical and family histories of the patients, their imaging pictures (pituitary MRI/CT) and hormonal tests. Results Family 1.: two sisters with acromegaly in the course of macroadenoma. Family 2.: two brothers with clinically nonsecreting macroadenomas. Family 3.: father and daughter with clinically nonsecreting macroadenomas. Family 4.: young man with acromegaly caused by macroadenoma and a daughter of his mother`s sister with microprolactinoma. CONCLUSIONS: Familial isolated pituitary adenomas are more common than it was previously thought, therefore, specific questioning regarding family history should be a part of the workup of all patients with pituitary adenomas. Genetically induced pituitary tumors often have aggressive behavior in terms of tumor expansion and resistance to different treatment options and often involve a multidisciplinary approach that combines endocrine, neurosurgical, and radiological specialists.
Assuntos
Adenoma Hipofisário Secretor de Hormônio do Crescimento/metabolismo , Acromegalia/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Prolactinoma/complicações , Prolactinoma/metabolismo , Prolactinoma/fisiopatologia , Estudos RetrospectivosRESUMO
OBJECTIVE: Hyperprolactinemia has been associated with endothelial dysfunction and a wide range of cardiovascular risk factors, thus it can potentially lead to cardiac dysfunction. The present study was designed to interrogate our hypothesis that hyperprolactinemia can contribute to preclinical impaired left ventricular function. METHODS: Thirty-one prolactinoma patients and 60 healthy volunteers were prospectively recruited. Left ventricular function was evaluated using conventional two dimensions and M-mode echocardiography, as well as Doppler tissue imaging (DTI). RESULTS: The Tei index (0.45 ± 0.06 vs. 0.41 ± 0.03, P = .005) and ratio of transmitral and myocardial early diastolic velocities (E/Em; 6.30 ± 1.45 vs. 5.64 ± 0.69, P = .045) were significantly higher, and septal systolic velocity (Sm; 9.88 ± 1.45 vs. 11.58 ± 1.28 cm/s, P<.001) was significantly lower in prolactinoma patients. Furthermore, significant motional abnormalities were detected in regional segments of prolactinoma patients. Pearson's correlation analysis revealed that prolactin level was inversely associated with Sm (r = -0.373, P = .009) and late diastolic phase (Am; r = -0.293, P = .043). Moreover, inverse correlations between prolactin and partial left ventricular segment wall motion were found, including the basal (r = -0.363, P = .014), middle (r = -0.418, P = .004), and apical segment (r = -0.574, P<.001) of the posterior ventricular septum. Multivariate linear regression analysis revealed that prolactin (ß = -0.28, 95% confidence interval -0.011 to 0, P = .035), as a single factor, can significantly predict decreased Sm, independent of traditional vascular risk factors. CONCLUSION: Our results suggest that subclinical cardiac dysfunction occurs in untreated prolactinoma patients and is characterized by impaired systolic and diastolic function of the left ventricle, as well as regional segment motional abnormality. ABBREVIATIONS: A = transmitral late diastolic velocity Am = late diastolic phase Apo = apolipoprotein DTI = Doppler tissue imaging E = transmitral early diastolic velocity Em = myocardial early diastolic velocity FMD = flow-mediated dilation HOMA-IR = homeostasis model assessment of insulin resistance hsCRP = high-sensitivity C-reactive protein IMT = intima media thickness LDL-C = low-density lipoprotein cholesterol LV = left ventricular PPCM = postpartum cardiomyopathy Sm = septal systolic velocity.
Assuntos
Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/fisiopatologia , Prolactinoma/complicações , Prolactinoma/fisiopatologia , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Ecocardiografia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico , Prolactinoma/diagnóstico , Fatores de Risco , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
BACKGROUND: The potent immunomodulatory action of prolactin has been demonstrated in many experimental in vitro studies. In accordance with these data, our retrospective analyses revealed higher prevalence of autoimmune thyroid diseases in prolactinoma patients compared to general population. PURPOSE: A cross-sectional case-control study was carried out in a single tertiary referral centre. The main aim was to assess the frequency of newly diagnosed autoimmune thyroid diseases in female patients with prolactinomas. METHODS: The study population consisted of 260 females (154 patients and 106 sex-matched, ethnicity-matched, and age-matched healthy controls) enroled in a prospective manner. Physical exam, thyroid ultrasound, and laboratory testing (measurement of antibodies to thyroglobulin, thyroid peroxidase, TSH-receptor, serum TSH and FT4 levels) were performed in all study participants. RESULTS: Autoimmune thyroid diseases were diagnosed in 29.9% of the patients and 10.4% of the healthy subjects (p = 0.0002). Subclinical hypothyroidism was found in 9.7% of the patients versus 2.8% of the controls (p = 0.044). Autoimmune hyperthyroidism was observed in 1.3% of all patients. CONCLUSIONS: The prevalence of newly diagnosed autoimmune thyroid diseases, and especially the subclinical hypothyroidism, was significantly higher in our female prolactinoma patients in comparison to age-matched healthy women. Based on our results, we suggest routine screening for autoimmune thyroid diseases (thyroid function, immunology and ultrasound examination) in all female patients with prolactinoma at the time of diagnosis. We also recommend a close follow-up of thyroid function in these women in case of pregnancy and after delivery.