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1.
Neurol India ; 69(5): 1414-1420, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747828

RESUMO

Primary pituitary tuberculosis (PTA) is a very rare disease. The clinical diagnosis is difficult as it is clinically radiologically indistinguishable from other sellar lesions. We present a case of PTA without any predisposing etiology and radiologically mimicking a pituitary macroadenoma. The patient underwent endoscopic transsphenoidal resection where pus admixed with mucoid was seen coming out of the lesion intraoperatively. Histology of the cyst wall was suspective of tuberculous etiology and QuantiFERON Tb Gold done for confirmation was positive. Postoperatively patient showed obvious improvement in visual symptoms. Patient developed diabetes insipidus and was put on desmopressin and was started with anti-tuberculosis medication for 18 months. Timely surgical intervention followed by anti-tubercular therapy and hormone replacement is the mainstay of treatment in these cases. For intraoperative management, we advise thorough wash with antibiotic and saline rather than curetting the walls of the abscess to decrease the postoperative incidence of endocrine abnormalities.


Assuntos
Adenoma , Abscesso Encefálico , Diabetes Insípido , Doenças da Hipófise , Neoplasias Hipofisárias , Adenoma/diagnóstico , Adenoma/cirurgia , Humanos , Doenças da Hipófise/diagnóstico , Neoplasias Hipofisárias/diagnóstico
2.
Ceska Gynekol ; 86(5): 331-334, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34736331

RESUMO

OBJECTIVE: The description of a rare case of Cushings syndrome caused by an adrenal adenoma in pregnancy with successful treatment. CASE PRESENTATION: 30-ear-old Gravida 3 female was admitted to our hospital with hypertension at the 18th week of gestation. Hormonal analyses revealed primary Cushings syndrome with high plasma cortisol levels and low levels of adrenocorticotropic hormone. Magnetic resonance imaging demonstrated a mass on the right-side of the adrenal gland. Adrenalectomy was performed in the 28th week of gestation and the following histopathology revealed an adrenocortical adenoma. Pregnancy continued until the 38th week of gestation with glucocorticoid replacement therapy and the patient gave birth vaginally to a healthy boy in the 38th week of gestation. CONCLUSION: Cushings syndrome in pregnancy rarely occurs; dia-gnosis may be dismissed or determined after birth in most cases. Misdia-gnosis of Cushings syndrome is common because of physiological increase of corticotropin hormones and cortisol levels and overlapping symptoms that can occur even during physiological pregnancy. Cushings syndrome should have a place in the differential dia-gnosis of hypertension in pregnancy (especially before the 20th week of gestation). Analysis of the urinary free cortisol level and circadian rhythm blood cortisol can provide a reasonable strategy to dia-gnose Cushings syndrome in pregnant women. Early dia-gnosis and surgical treatment can significantly reduce maternal and fetal complications.


Assuntos
Adenoma , Adenoma Adrenocortical , Síndrome de Cushing , Adenoma/cirurgia , Adrenalectomia , Adenoma Adrenocortical/complicações , Adenoma Adrenocortical/diagnóstico , Adenoma Adrenocortical/cirurgia , Hormônio Adrenocorticotrópico , Síndrome de Cushing/etiologia , Síndrome de Cushing/cirurgia , Feminino , Humanos , Masculino , Gravidez
3.
Cir Cir ; 89(S1): 37-42, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762622

RESUMO

Undescended parathyroid adenoma is a rare cause of primary hyperparathyroidism that happens < 1% of cases. If not suspected, it can lead to a negative bilateral parathyroid exploration and extensive iatrogenic trauma. We propose that with proper imaging the correct diagnosis can be established to simplify surgical management. We describe two cases of patients who underwent a targeted neck exploration due to an undescended parathyroid adenoma diagnosed with an appropriate preoperative imaging protocol. With an appropriate imaging protocol for primary hyperparathyroidism and parathyroid hormone aspirates, an undescended parathyroid adenoma can be primarily diagnosed to guide a focused parathyroidectomy.


Assuntos
Adenoma , Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Adenoma/complicações , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Humanos , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/cirurgia , Glândulas Paratireoides , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia
4.
Anticancer Res ; 41(10): 5249-5254, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593478

RESUMO

BACKGROUND: Bile duct adenomas (BDA) may be precursor lesions of small duct-type, including mass-forming type intrahepatic cholangiocarcinoma (ICC). CASE REPORT: A 68-year-old woman was transferred to our facility for the treatment of a liver tumor, possibly metastasized from a pancreatic neuroendocrine tumor. Finally, two liver tumors were resected and histopathologically diagnosed as "BDA" and "ICC with a BDA-like component". In the BDA-like component, the MUC6 positive rate was notably lower and the Ki-67 positive rate was higher than the other BDAs and ICC component, respectively. The doubling time of the tumor volume in BDA was very long but was shortened (1,510 and 719 days). Distinct enlargement of the tumor and appearance of enhancement through diagnostic imaging was useful in diagnosing the transformation from a BDA to an ICC. CONCLUSION: An "adenoma-carcinoma sequence" may exist in the transformation process from a BDA to an ICC.


Assuntos
Adenoma/patologia , Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/patologia , Neoplasias Hepáticas/secundário , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Adenoma/complicações , Adenoma/cirurgia , Idoso , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/complicações , Colangiocarcinoma/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/cirurgia , Prognóstico
5.
J Cardiothorac Surg ; 16(1): 307, 2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663408

RESUMO

BACKGROUND: Bronchiolar adenoma (BA) is a recently proposed diagnostic terminology, which is considered as the expansion of the concept of ciliated muconodular papillary tumors. BA is considered to be a benign neoplasm, but a few previous cases have been reported with the possibility of malignant transformation. Therefore, the genetic and histological nature of BA is controversial so far. We describe a rare case of multiple BAs with malignant transformation and CCNE1 (cyclin E1) mutation to increase the understanding of this disease. CASE DESCRIPTION: A 56-year-old woman was admitted to our hospital due to two ground-glass nodules (GGNs) in the left lung detected by chest CT without symptom. The pure GGN located in the upper lingual segment about 6 mm in diameter and another mixed GGN located in the dorsal segment about 7 mm. The two GGNs have been found a year ago without treatment, and the mixed GGN become larger to 8 mm with vacuole sign in the next year health checkup. We performed a wedge resection of the two nodules completely by video-assisted thoracoscopy (VATS). Postoperative pathology indicated that the pure GGN was atypical bronchial adenoma, while the mixed GGN was atypical bronchial adenoma with malignant transformation which was missed in frozen section. Gene mutations analysis by next-generation sequencing (NGS) showed CCNE1 gene mutation in both lesions, and her-2 mutation was identified in the mixed GGN. The programmed cell death 1 ligand 1 (PD-L1) expression analysis of tumor cells showed 0% and less than 1% in the pure GGN and the mixed GGN, respectively. CONCLUSION: BA is generally considered to be a benign tumor. The present study indicated that BA may be carcinogenic in atypical cases with some driver genes mutation and we should be vigilant for its potentiality of malignant transformation in clinical practice.


Assuntos
Adenoma , Neoplasias Pulmonares , Nódulo Pulmonar Solitário , Adenoma/diagnóstico por imagem , Adenoma/genética , Adenoma/cirurgia , Ciclina E , Feminino , Humanos , Pessoa de Meia-Idade , Mutação , Proteínas Oncogênicas , Estudos Retrospectivos
6.
BMC Neurol ; 21(1): 417, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34706659

RESUMO

OBJECTIVE: Postoperative cerebrospinal fluid (CSF) leakage represents a challenge even for experienced pituitary surgeons. We aimed to quantitatively synthesize data from studies regarding the risk factors for postoperative CSF leakage after transsphenoidal surgery (TSS) for pituitary adenoma (PA). METHODS: PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched for case-control and cohort studies, focusing on the risk factors associated with postoperative CSF leakage after TSS for PA. Pooled odds ratios (ORs) and 95% confidence intervals were calculated to determine the risk factors. RESULTS: A total of 34 case-control and cohort studies involving a total of 9,144 patients with PA were included in this systematic review. The overall rate of postoperative CSF leakage after TSS for PA was 5.6%. Tumor size, adenoma consistency, revision surgery, and intraoperative CSF leakage were independent risk factors for postoperative CSF leakage (ORs, 3.18-6.33). By contrast, the endoscopic approach showed a slight protective benefit compared with the microscopic approach in TSS (OR, 0.69). CONCLUSIONS: This review provides a comprehensive overview of the quality of the evidence base, informing clinical staff of the importance of screening risk factors for postoperative CSF leakage after TSS for PA. More attention should be paid to PA patients at high risk for CSF leakage after TSS to reduce complications and improve prognosis.


Assuntos
Adenoma , Neoplasias Hipofisárias , Adenoma/cirurgia , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/etiologia , Humanos , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
7.
Med Clin North Am ; 105(6): 1081-1098, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34688416

RESUMO

Pituitary incidentalomas are discovered in approximately 10% to 40% of brain images. A complete patient history, physical examination, and dedicated pituitary function testing are needed, and subsequent results should lead to appropriate patient management. However, most lesions are asymptomatic pituitary adenomas or Rathke cleft cysts with a benign course. Many lesions can be clinically significant, including prolactinomas or other pituitary adenomas that warrant specific pituitary disease treatment. In other cases, mass effect causing visual compromise or refractory headache indicates a need for surgery. Here, various facets of a complex evaluation and treatment algorithm for pituitary incidentalomas are reviewed.


Assuntos
Adenoma/diagnóstico , Adenoma/patologia , Hipófise/metabolismo , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/patologia , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Diagnóstico Diferencial , Humanos , Achados Incidentais , Imageamento por Ressonância Magnética , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/patologia , Hipófise/anatomia & histologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia
8.
Medicine (Baltimore) ; 100(35): e26918, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477122

RESUMO

BACKGROUND: Radical pancreaticoduodenectomy is the only possible cure for pancreatic head adenocarcinoma, and although several RCT studies have suggested the extent of lymph node dissection, this issue remains controversial. This article wanted to evaluate the survival benefit of different lymph node dissection extent for radical surgical treatment of pancreatic head adenocarcinoma. METHODS: A total of 240 patients were assessed for eligibility in the study, 212 of whom were randomly divided into standard lymphadenectomy group (SG) or extended lymphadenectomy group (EG), there were 97 patients in SG and 95 patients in EG receiving the radical pancreaticoduodenectomy. RESULT: The demography, histopathology and clinical characteristics were similar between the 2 groups. The 2-year overall survival rate in the SG was higher than the EG (39.5% vs 25.3%; P = .034). The 2-year overall survival rate in the SG who received postoperative adjuvant chemotherapy was higher than the EG (60.7% vs 37.1%; P = .021). There was no significant difference in the overall incidence of complications between the 2 groups (P = .502). The overall recurrence rate in the SG and EG (70.7% vs 77.5%; P = .349), and the patterns of recurrence between 2 groups were no significant differences. CONCLUSION: In multimodality therapy system, the efficacy of chemotherapy should be based on the appropriate lymphadenectomy extent, and the standard extent of lymphadenectomy is optimal for resectable pancreatic head adenocarcinoma. The postoperative slowing of peripheral blood lymphocyte recovery might be 1 of the reasons why extended lymphadenectomy did not result in survival benefits. CLINICAL TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov (NCT02928081) in October 7, 2016. https://clinicaltrials.gov/.


Assuntos
Adenoma/cirurgia , Excisão de Linfonodo/normas , Neoplasias Pancreáticas/cirurgia , Adenoma/epidemiologia , Adenoma/mortalidade , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Excisão de Linfonodo/métodos , Excisão de Linfonodo/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/mortalidade , Pancreaticoduodenectomia/métodos , Pancreaticoduodenectomia/normas , Pancreaticoduodenectomia/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Prospectivos , Método Simples-Cego
9.
BMJ Case Rep ; 14(9)2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34531232

RESUMO

Canalicular adenoma is a unique, rare, benign salivary gland neoplasm whose reported prevalence varies in different studies. According to literature, this neoplasm has a marked predilection to occur in the upper lip of elderly women. Histological features are usually distinctive and diagnostic. This neoplasm has good prognosis after conservative surgical management but the propensity of multifocal nature and recurrence of this lesion mandates regular follow-up. This case report illustrates the case of a canalicular adenoma in the palate in a 71-year-old male patient. Here, we discuss the differential diagnosis with a brief review of literature.


Assuntos
Adenoma , Neoplasias das Glândulas Salivares , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Idoso , Feminino , Humanos , Lábio , Masculino , Recidiva Local de Neoplasia , Palato , Neoplasias das Glândulas Salivares/diagnóstico , Neoplasias das Glândulas Salivares/cirurgia , Glândulas Salivares Menores
10.
Neurol India ; 69(4): 867-873, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507403

RESUMO

Objective: The present study is to investigate the pre- and post-operative magnetic resonance imaging of pituitary tissues following transsphenoidal resection of pituitary macroadenomas, as well as its clinical significance. Materials and Methods: The medical records of 108 consecutive pituitary macroadenoma patients admitted at Fuzhou 900th Hospital between September 2012 and September 2014 were retrospectively reviewed. Siemens 3. 0T magnetic resonance scanner was used to perform pre- and postoperative MRI scanning, including plain scan and contrast-enhanced scan of SE sequential T1WI and T2WI in sagittal, coronal and axial views. PACS medical imaging system was used to measure the diameter of pituitary adenoma, as well as the volumes of the adenoma and pituitary tissue. Hematoxylin-eosin staining and immunohistochemical staining were also performed. Results: Higher height of pituitary adenoma results in lower rate of posterior pituitary bright spot (PPBS) on MR T1-weighted imaging. Preoperative MR signal intensity of PPBS was negatively related to diabetes insipidus (DI). Normal pituitary tissues were likely to be above the pituitary adenomas in growth hormone-secreting adenoma patients, while mostly located aside in gonadotropin-secreting adenoma patients. Morphological restitution of postoperative pituitary tissues was better in lateral displacement than that in superior or superolateral patterns on pre-operative MR images. Positive rate of PPBS on preoperative MRI is negatively related to adenoma height, and the signal intensity of PPBS is inversely related to postoperative DI. Conclusions: The relative locations of pituitary tissues and adenoma tissues may be associated with the adenoma type and may affect the postoperative remodeling of residual pituitary tissues.


Assuntos
Adenoma , Doenças da Hipófise , Neoplasias Hipofisárias , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos
11.
Zhonghua Yi Xue Za Zhi ; 101(34): 2662-2666, 2021 Sep 14.
Artigo em Chinês | MEDLINE | ID: mdl-34510871

RESUMO

Primary aldosteronism (PA) patients diagnosed with aldosterone-producing adenoma and unilateral adrenal hyperplasia are preferred for surgical treatment.The aim of the operation is to remove the hypersecretory aldosterone tissue of adrenal and to improve the prognosis.Current studies have shown that both partial adrenalectomy and total adrenalectomy can achieve clinical cure for PA, but the choice of surgical methods is still controversial. This paper discusses the efficacy and safety, postoperative changes in cortisol level, postoperative recurrence and surgical techniques of different surgical methods in the treatment of different PA subtypes, so as to find the best surgical methods for different PA subtypes and to maximize the benefits for patients.


Assuntos
Adenoma , Hiperaldosteronismo , Adenoma/cirurgia , Glândulas Suprarrenais , Adrenalectomia , Aldosterona , Humanos , Hiperaldosteronismo/cirurgia , Recidiva Local de Neoplasia
12.
S Afr J Surg ; 59(3): 131a-131c, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34515436

RESUMO

SUMMARY: Primary aldosteronism, eponymously known as Conn's syndrome, has recently gained recognition as the most common cause of endocrine hypertension. Unilateral subtypes, such as aldosterone secreting adenomas, are managed surgically and are potentially curable. The background of refractory hypertension and hypokalaemia in a forty-year-old man raised suspicions of Conn's syndrome which was localised to an aldosterone secreting adenoma in the right adrenal gland. The patient underwent a laparoscopic intraperitoneal right adrenalectomy which resulted in normalisation of his plasma aldosterone concentration as well as improved blood pressure control.


Assuntos
Adenoma , Hiperaldosteronismo , Hipertensão , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/cirurgia , Adrenalectomia , Adulto , Aldosterona , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/etiologia , Hiperaldosteronismo/cirurgia , Hipertensão/diagnóstico , Hipertensão/etiologia , Masculino
13.
Clin Lab ; 67(9)2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34542984

RESUMO

BACKGROUND: Primary hyperparathyroidism (PHPT) in pregnancy has a negative impact. Effective treatment should be timely adopted. METHODS: We report a case of a 24-year-old pregnant woman admitted with PHPT, hypercalcemia crisis, hypokalemia, thyroid nodules, hyperthyroidism, and intrauterine single live fetus in the 2nd trimester of pregnancy. Right parathyroidectomy and partial thyroidectomy were timely performed. Postoperative pathology suggested parathyroid adenoma with capsule invasion and thyroid nodules. RESULTS: Postoperative serum PTH and Ca2+ were effectively reduced. Eventually, a healthy fetus was delivered via cesarean at full term. CONCLUSIONS: Parathyroidectomy within reasonable operative timing can improve maternal and fetal prognosis in PHPT during pregnancy, especially with concomitant hypercalcemia crisis.


Assuntos
Adenoma , Hipercalcemia , Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/cirurgia , Adulto , Feminino , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/cirurgia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia , Gravidez , Adulto Jovem
15.
J Long Term Eff Med Implants ; 31(4): 73-75, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34587418

RESUMO

INTRODUCTION: Primary hyperparathyroidism (PHPT) is a common endocrine entity associated with increased parathyroid hormone (PTH) secretion. A single parathyroid adenoma is the cause of PHPT in the majority of cases. However, due to their embryological origin, discovery of ectopic parathyroid tissue is not extraordinary. CASE PRESENTATION: This is a case of a rare mediastinal parathyroid adenoma in a 56-year-old woman with emphasis on the preoperative diagnosis and accurate localization. CONCLUSION: Due to its small size and its various possible spots, ectopic parathyroid gland adenoma localization can be challenging. For this reason, careful preoperative mapping and surgical planning are essential before any exploration for parathyroid adenomas.


Assuntos
Adenoma , Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Feminino , Humanos , Hiperparatireoidismo Primário/diagnóstico por imagem , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/cirurgia , Pessoa de Meia-Idade , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/cirurgia
16.
Acta Neurochir (Wien) ; 163(11): 3155-3159, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34519880

RESUMO

BACKGROUND: Surgery is currently the first-line treatment of Cushing's disease. Surgery for Cushing's patients requires technical specificity, especially if no adenoma is identified on dedicated preoperative pituitary MRI. METHOD: From 2006 to 2020, 683 patients with Cushing's disease were operated on with a mononostril endoscopic endonasal approach by the same two senior neurosurgeons. Here, we report the particularities of this challenging surgery. CONCLUSION: A rigorous and planned surgical strategy avoids the pitfalls of Cushing's disease surgery and leads to a high rate of endocrine remission.


Assuntos
Adenoma , Hipersecreção Hipofisária de ACTH , Neoplasias Hipofisárias , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Nariz , Hipersecreção Hipofisária de ACTH/cirurgia , Hipófise/diagnóstico por imagem , Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia
18.
Nihon Shokakibyo Gakkai Zasshi ; 118(8): 757-767, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34373395

RESUMO

This study included a 45-year-old woman. In 20XX, we performed colonoscopy (CS) on fresh bloody stools, and a diagnosis of rectal mucosal prolapse syndrome (MPS) was made. In 20XX+14 years, CS was reexamined because of fresh bloody stools, and a biopsy of the same site revealed well-differentiated tubular adenocarcinoma. The lesion was resected via endoscopic submucosal dissection (ESD) and histopathologically diagnosed as MPS with high-grade adenoma and well-differentiated tubular adenocarcinoma. The symptoms improved after ESD, and no recurrence was observed during the 18-month follow-up. We experienced a case of a well-differentiated tubular adenocarcinoma in MPS during the long-term follow-up of MPS. In this case, performing ESD was useful not only for cancer treatment but also in terms of therapeutic effects on symptoms. Although MPS is a chronic benign inflammatory disorder, characterized by rectal mucosal prolapse with fibromuscular obliteration, it is necessary to consider the possibility of the appearance of cancer during the follow-up of MPS.


Assuntos
Adenocarcinoma , Adenoma , Ressecção Endoscópica de Mucosa , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Adenoma/complicações , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Colonoscopia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prolapso , Resultado do Tratamento
20.
Dtsch Med Wochenschr ; 146(15): 950-954, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34344028

RESUMO

Acromegaly is a rare but severe disorder which is usually due to an excessive secretion of growth hormone (GH) by a pituitary adenoma. Screening mainly relies on the measurement of insulin-like growth factor 1, and confirmatory diagnostics includes a GH suppression test. As delayed diagnosis results in increased morbidity and mortality, we here discuss recently published suggestions regarding the biochemical work-up of suspected cases and the follow-up of co-morbidities. Moreover, new analytical tools (such as automatic identification of typical facial changes using artificial intelligence) are presented, hopefully allowing for an earlier diagnosis in the future. So far, surgery is still regarded as therapy of first choice. In cases without postoperative remission, a new imaging approach (combining sellar magnetic resonance imaging and position emission tomography) may improve the results of repeated surgery. The pharmaceutical arsenal now includes the first orally available somatostatin analogue, and recent data on possible drug combinations and the outcome of radiotherapy are presented. Finally, special attention is paid to older and pregnant patients, as well as certain considerations during the COVID-19 pandemic (where appropriate diagnosis and management of acromegaly is particularly challenging).


Assuntos
Acromegalia/diagnóstico , Acromegalia/cirurgia , Acromegalia/diagnóstico por imagem , Acromegalia/terapia , Adenoma/cirurgia , Comorbidade , Diagnóstico Precoce , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Humanos , Prognóstico
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