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2.
Eur J Endocrinol ; 184(1): 1-8, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33112257

RESUMO

Objective: Somatostatin receptor ligands (SRL) are useful to control central hyperthyroidism in patients with thyrotropin-secreting pituitary adenoma (TSH pituitary adenoma). The aim of this study was to describe the frequency of thyrotropin deficiency (TSH deficiency) in patients with TSH pituitary adenoma treated by SRL. Design: Retrospective study. Methods: Patients with central hyperthyroidism due to TSH pituitary adenoma treated by short or long-acting SRL were retrospectively included. TSH deficiency was defined by a low FT4 associated with non-elevated TSH concentrations during SRL therapy. We analysed the frequency of TSH deficiency and the characteristics of patients with or without TSH deficiency. Results: Forty-six patients were included. SRL were used as the first-line therapy in 21 of 46 patients (46%). Central hyperthyroidism was controlled in 36 of 46 patients (78%). TSH deficiency appeared in 7 of 46 patients (15%) after a median time of 4 weeks (4-7) and for a median duration of 3 months (2.5-3). The TSH deficiency occurred after one to three injections of long-acting SRL used as first-line therapy in 6/7 cases. There were no differences in terms of clinical and hormonal features, size of adenomas or doses of SRL between patients with or without TSH deficiency. Conclusions: SRL can induce TSH deficiency in patients with central hyperthyroidism due to TSH pituitary adenoma. Thyrotropic function should be assessed before the first three injections of SRL in order to track TSH deficiency and reduce the frequency of injections when control of thyrotoxicosis rather than tumour reduction is the aim of the treatment.


Assuntos
Adenoma/complicações , Hipertireoidismo/tratamento farmacológico , Hipotireoidismo/induzido quimicamente , Neoplasias Hipofisárias/complicações , Receptores de Somatostatina/uso terapêutico , Adenoma/metabolismo , Adulto , Feminino , Humanos , Hipertireoidismo/etiologia , Ligantes , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/metabolismo , Estudos Retrospectivos , Tireotropina/metabolismo
3.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334740

RESUMO

Myasthenia gravis (MG) is a rare and potentially dangerous autoimmune condition, which affects the acetylcholine receptors at the neuromuscular junction of skeletal muscle. MG's diverse symptomatology may readily masquerade as other neurological conditions, posing a diagnostic challenge to clinicians. We describe a 24-year old man who presented to the emergency department with a new onset internuclear ophthalmoplegia. After a series of investigations, we eventually arrived at a diagnosis of MG with pseudointernuclear ophthalmoplegia with an incidentally detected prolactinoma. We explore the literature regarding the pathophysiology of pseudointernuclear ophthalmoplegia, the link between prolactin and autoimmunity and the association between prolactinoma and MG.


Assuntos
Diplopia/etiologia , Miastenia Gravis/diagnóstico , Transtornos da Motilidade Ocular/etiologia , Neoplasias Hipofisárias/diagnóstico , Prolactinoma/diagnóstico , Humanos , Achados Incidentais , Masculino , Miastenia Gravis/complicações , Miastenia Gravis/imunologia , Transtornos da Motilidade Ocular/diagnóstico , Hipófise/diagnóstico por imagem , Hipófise/metabolismo , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/complicações , Prolactina/sangue , Prolactina/metabolismo , Prolactinoma/sangue , Prolactinoma/complicações , Tomografia Computadorizada por Raios X , Adulto Jovem
4.
Niger J Clin Pract ; 23(11): 1500-1506, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33221772

RESUMO

Objective: To evaluate the relationship between visual acuity (VA) and endocrine status among patients with giant sellar tumors pre and postsurgical treatment. Methods: A 7-year single institution prospective cohort study of patients with giant sellar tumors treated by pterional transylvian microsurgical resection. Patients were evaluated and followed-up by a collaborative team of ophthalmologists and neurosurgeons. Results: Sellar tumors represent 25% of our brain tumors cases (n = 257). Giant sellar tumors were 61 (23.7%) cases. Pituitary adenomas occurred in 40 patients and in 24 of these, the tumor was a functional adenoma. The age range was 16 to 75 years with a mean of 43.7 ± 3.3 years. Visual impairment (n = 60), headache (n = 55), and endocrinopathy (24) were among the common manifestations. VA and visual field defects were experienced by 59 and 39 patients, respectively. For both eyes, endocrine active tumors presented with poorer preoperative VA profile using mean logMAR VA [(χ2 = 10.3, P = 0.002 OD) and (χ2 = 8.9, P = 0.003 OS)]. Postoperatively, the mean logMAR VA profiles of endocrine active tumors showed a significantly better response when compared to endocrine inactive tumors in both eyes [(χ2 = 5.53, P = 0.029 OD) and (χ2 = 6.77, P = 0.037 OS)]. Conclusion: Visual acuity defects are almost invariable in patients with giant sellar tumor and may be associated with an endocrine profile. Surgical resection with normalization of hormone status is rewarded with VA improvement.


Assuntos
Adenoma/cirurgia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Neoplasias Hipofisárias/cirurgia , Transtornos da Visão/etiologia , Acuidade Visual/fisiologia , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/complicações , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Recuperação de Função Fisiológica/fisiologia , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Campos Visuais/fisiologia , Percepção Visual/fisiologia , Adulto Jovem
5.
Klin Monbl Augenheilkd ; 237(11): 1306-1311, 2020 Nov.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33202463

RESUMO

Pituitary tumours are a common cause of functional impairment and degeneration of the anterior visual pathway. Depending on localization and size, they clinically manifest as initially reversible visual field defects. As part of interdisciplinary tumour management, ophthalmologic examinations are of particular importance concerning diagnostics, indication for tumour resection and documentation of functional surgical results. Based on the relationship between clinical dysfunction and manifest atrophy, together with the patient's age and the duration of symptoms, the ophthalmologist can provide insights into the postoperative visual prognosis. Under good conditions, surgical tumour resection often results in significant improvements to visual fields and acuity. Long-term ophthalmological controls are required in cases of persistent visual loss, radiotherapy or tumour remnants abutting the visual pathway.


Assuntos
Adenoma , Neoplasias Hipofisárias , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/cirurgia , Humanos , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/cirurgia , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Transtornos da Visão/terapia , Testes de Campo Visual , Campos Visuais
6.
Medicine (Baltimore) ; 99(41): e22673, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031334

RESUMO

Hyperprolactinemia is a prevalent endocrine disorder presented in patients with non-functional pituitary adenomas (NFPAs). However, the mechanism involved in hyperprolactinemia in NFPA is not fully illustrated. The current study aims to investigate predictors for hyperprolactinemia in NFPA via analyzing relevant clinical features. Thus, in this study, a cohort of 214 cases with integrated medical records was retrospectively analyzed concerning clinical, pathological, and endocrinological studies before and after surgery.Hyperprolactinemia happened in 93 cases (43.5%). Women (adjust odds ratio [OR] = 3.093; P < .01), age of patients (adjust OR = 0.951; P < .01), and serum free tetraiodothyronine (FT4) level (adjust OR = 0.882; P = .02) were independent predictors for developing preoperative hyperprolactinemia. Tumor size and hypopituitarism had no impact on hyperprolactinemia. During a median follow-up of 43.5 (range, 22-80) months, 83.9% patients with preoperative hyperprolactinemia experienced prolactin (PRL) normalization. Preoperative PRL level (adjusted OR = 1.741, P = .03) was the exclusive predictor for PRL normalization after adjusting for tumor volume, preoperative serum FT4 concentration, and postoperative residual. The PRL normalization rate of patients with lower PRL level (<2.35-fold upper limit of normal range) was 95.2% and decreased to 65.5% for patients with higher PRL level.In conclusion, our results suggest existence of potentially alternative mechanisms underlying hyperprolactinemia in NFPAs, like the discrepancy of sex and age and the negative feedback of FT4. Preoperative PRL is a predictor for postoperative PRL normalization, which is of clinically relevant for postoperative management of NFPAs.


Assuntos
Adenoma/complicações , Hiperprolactinemia/etiologia , Neoplasias Hipofisárias/complicações , Adenoma/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos
7.
Mymensingh Med J ; 29(4): 1015-1020, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116111

RESUMO

Hypopituitarism is a rare entity with reported incidence, 4 per 100,000 and about 50% of such patients present with three to five pituitary hormone deficits. A slow onset of symptoms is typical. But, diversified presentations from absence of symptoms to vague clinical features to lethal effects leading to mortality are not uncommon in such disorder. In adults, in such cases symptoms of hypogonadism may be the first noticeable illness for reporting to physicians, but it is often under evaluated or even ignored. Here, we present a case of 40-year-old adult male with panhypopituitarism, who presented with loss of generalized body hair and loss of libido for about last five years but the problem was not evaluated adequately. Later, he developed lethargy, generalized weakness, weight loss and then the underneath cause detected was panhypopituitarism due to pituitary macro adenoma. So, suspicion and hormonal evaluation for hypogonadism would help in early detection and management of progressive hypopituitarism in symptomatic adult patients. Cases of panhypopituitarism need lifelong hormone replacement and follow-up and if pituitary adenoma is present, surgical removal by trans-sphenoidal approach is preferable.


Assuntos
Adenoma , Hipogonadismo , Hipopituitarismo , Neoplasias Hipofisárias , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/cirurgia , Adulto , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/etiologia , Hipopituitarismo/diagnóstico , Hipopituitarismo/etiologia , Hipopituitarismo/terapia , Masculino , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/cirurgia
8.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(8): 540-544, oct. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-196887

RESUMO

INTRODUCCIÓN: Los tumores germinales del sistema nervioso central deben ser correctamente diagnosticados, pues su tratamiento suele ser eficaz y no siempre requieren cirugía. Los objetivos del estudio son describir las manifestaciones endocrinas de estas neoplasias y comparar su momento de aparición con el de las alteraciones neurológicas y visuales. PACIENTES Y MÉTODOS: Revisión de historias de pacientes menores de 14 años atendidos en una unidad de endocrinología pediátrica desde 2000 hasta 2018. Pruebas estadísticas: Wilcoxon y Fisher. RESULTADOS: Se estudió a 12 pacientes (10 mujeres) con una edad al diagnóstico de 9,4±1,7 años y un tiempo de seguimiento de 5,5±3,0 años; 10 presentaban tumores de la región selar, uno pineal y uno bifocal. Las alteraciones clínicas que llevaron al diagnóstico eran neurológicas o visuales en 9casos y hormonales en 3. De los que consultaron por síntomas neurológicos o visuales, 7 refirieron previamente alteraciones hormonales, luego, estas estaban presentes en 10 de los niños al diagnóstico; la más frecuente fue la diabetes insípida central (8 casos). El periodo medio de presencia de síntomas endocrinológicos previos al diagnóstico fue de 25,0±26,2 meses, mucho más largo que el de los neurooftalmológicos, de 2,0±2,1 meses (p = 0,012). CONCLUSIONES: Casi todos los tumores germinales intracraneales presentaron al diagnóstico manifestaciones endocrinas, la más frecuente de las cuales fue la diabetes insípida central. Los síntomas hormonales suelen presentarse bastante antes que los neurooftalmológicos. La correcta valoración clínica y endocrinológica puede adelantar el diagnóstico de estos tumores


INTRODUCTION: Central nervous system germ cell tumors need to be adequately diagnosed because their treatment is usually effective and they do not always require surgery. The study objectives are to describe the endocrine manifestations of these tumors and to compare the time of their onset to that of the occurrence of neurological and visual changes. PATIENTS AND METHODS: The medical histories of patients under 14 years of age seen at a pediatric endocrinology unit between 2000 and 2018 were reviewed. Wilcoxon and Fisher statistical tests were performed. RESULTS: We found 12patients (10 females) with an age at diagnosis of 9.4±1.7 years and a follow-up time of 5.5±3.0 years, 10with tumors in the sellar region, and each one with a pineal gland and a bifocal tumor. Clinical changes leading to diagnosis were neurological and/or visual in 9patients and hormonal in three. Seven patients diagnosed on the basis of neurological or visual symptoms had previously reported hormonal changes, giving us a total of 10 children at diagnosis (the most common diagnosis was central diabetes insipidus, found in 8). Endocrine symptoms had been present before diagnosis for 25.0±26.2 months, considerably longer than neuro-ophthalmological complaints (2.0±2.1 months, p = 0.012). CONCLUSIONS: Almost all intracranial germ cell tumors have associated endocrine manifestations at diagnosis, with central diabetes insipidus the most common. Hormonal symptoms usually appear long before neuro-ophthalmological manifestations. Adequate clinical and endocrinological assessment may allow for an earlier diagnosis of these tumors


Assuntos
Humanos , Masculino , Feminino , Criança , Neoplasias Embrionárias de Células Germinativas/complicações , Doenças do Sistema Endócrino/etiologia , Doenças do Sistema Nervoso/fisiopatologia , Glândulas Endócrinas/fisiopatologia , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Hipofisárias/complicações , Estudos Retrospectivos , Biópsia , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Diabetes Insípido/complicações
9.
Acta Clin Croat ; 59(1): 173-176, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32724290

RESUMO

Endocrinopathies are relatively rare causes of erectile dysfunction. Cases of hyperprolactinemia and pituitary adenomas have been previously reported. We present a clinical case of a 27-year-old male with suspected infertility and recent symptoms of erectile dysfunction. Additional radiological and endocrinologic workup revealed underlying subependymoma, which was expanding in the sellar and suprasellar regions, causing pressure against the pituitary gland. The resulting endocrine disorder caused problems that were subjectively at first manifested mainly as erectile dysfunction. The case is an educative example pointing to the need of taking possible intracranial lesions in consideration when starting workup in a patient presenting with erectile dysfunction. It may be of broad clinical interest not only for endocrinologists but also for practitioners in various fields.


Assuntos
Disfunção Erétil , Glioma Subependimal , Hiperprolactinemia , Neoplasias Hipofisárias , Adulto , Encéfalo , Disfunção Erétil/etiologia , Glioma Subependimal/complicações , Glioma Subependimal/diagnóstico por imagem , Humanos , Masculino , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem
10.
Eur J Endocrinol ; 183(1): C1-C4, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32487776

RESUMO

Acromegaly is a debilitating and disfiguring chronic disease, which occurs in both sexes at any age, associated with multiple comorbidities and increased mortality. It is typically caused by a GH-secreting pituitary adenoma that promotes exposure of body tissues to increased concentrations of GH and IGF-I. The diagnosis of acromegaly is still made very late in a substantial number of patients when the disease is already in advanced stages. An epidemiological study from Sweden has elegantly demonstrated that the longer the diagnostic delay in acromegaly, the higher the number of comorbidities. Moreover, about 25% of the Swedish patients had 10 years or more of diagnostic delay and in this group mortality rate was significantly increased. These results reinforce the importance of shortening the latency period between disease onset, diagnosis and treatment to improve patient outcomes. This commentary article discusses strategies to be embraced by the endocrine community to allow early identification of acromegaly among public and health professionals, as internists, primary care clinicians, different specialists and dentists are the first point of contact for most of the patients. We emphasize that acromegaly should be presented as a sporadic, rather than rare, insidious disease, meaning that there is a considerable chance for health professionals to see a patient with acromegaly throughout their careers. The motto 'you must know it to think of it' is advocated in awareness efforts to reduce time to diagnosis, which results in lower rates of morbidity and mortality and might positively impact healthcare costs.


Assuntos
Acromegalia/diagnóstico , Acromegalia/epidemiologia , Neoplasias Hipofisárias/complicações , Acromegalia/etiologia , Diagnóstico Tardio , Feminino , Humanos , Masculino , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/epidemiologia
11.
Best Pract Res Clin Endocrinol Metab ; 34(2): 101418, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32414619

RESUMO

Cushing syndrome (CS) describes the signs and symptoms caused by exogenous or endogenous hypercortisolemia. Endogenous CS is caused by either ACTH-dependent sources (pituitary or ectopic) or ACTH-independent (adrenal) hypercortisolemia. Several genes are currently known to contribute to the pathogenesis of CS. Germline gene defects, such as MEN1, AIP, PRKAR1A and others, often present in patients with pituitary or adrenal involvement as part of a genetic syndrome. Somatic defects in genes, such as USP8, TP53, and others, are also involved in the development of pituitary or adrenal tumors in a large percentage of patients with CS, and give insight in pathways involved in pituitary or adrenal tumorigenesis.


Assuntos
Síndrome de Cushing/genética , Análise Mutacional de DNA , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/epidemiologia , Neoplasias das Glândulas Suprarrenais/genética , Carcinogênese/genética , Carcinogênese/patologia , Síndrome de Cushing/epidemiologia , Análise Mutacional de DNA/métodos , Análise Mutacional de DNA/tendências , Estudos de Associação Genética/métodos , Estudos de Associação Genética/tendências , Predisposição Genética para Doença , Mutação em Linhagem Germinativa/fisiologia , Humanos , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/genética , Transdução de Sinais/genética
13.
J Endocrinol ; 244(2): 415-429, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32395971

RESUMO

Among all the hormone-secreting pituitary tumours, prolactinomas are the most frequently found in the clinic. Since dopamine is the primary inhibitor of lactotroph function, dopamine agonists represent the first-line therapy. However, a subset of patients exhibits resistance to these drugs, and therefore, alternative treatments are desired. As activins inhibit prolactin gene expression through the inhibition of Pit-1 involving the p38MAPK pathway, in the present work, we studied the local activin system as an alternative inhibitory system for lactotroph hyperplasia treatment. We used two different mouse models of prolactinoma: transgenic mice with overexpression of the human chorionic gonadotropin ß-subunit (hCGß) and mice lacking dopamine receptor type 2. In both models, females, but not males, develop lactotroph hyperplasia from the fourth month of life. We found reduced expression of pituitary activin subunits and activin receptors in hyperplastic pituitaries from both models compared with wild-type counterparts. Consequently, hyperplastic pituitaries presented a reduced activin-inhibitory action on prolactin secretion. Additionally, while female wild-type lactotrophs presented high levels of phospho-p38MAPK, it was lost in prolactinomas, concomitant with decreased activin expression, increased Pit-1 expression and tumour development. In contrast, male pituitaries express higher mRNA levels of activin subunits ßA and ßB, which would suggest a stronger activin inhibitory function on lactotrophs, protecting this sex from tumour development, despite genotype. The present results highlight the importance of the activin inhibitory action on lactotroph function and place the local activin system as a new target for the treatment of dopamine agonist-resistant prolactinomas.


Assuntos
Ativinas/metabolismo , Lactotrofos/metabolismo , Neoplasias Hipofisárias/genética , Prolactinoma/genética , Animais , Agonistas de Dopamina/farmacologia , Resistencia a Medicamentos Antineoplásicos/genética , Feminino , Genótipo , Sistema de Sinalização das MAP Quinases/genética , Masculino , Camundongos , Camundongos Transgênicos , Hipófise/metabolismo , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/complicações , Prolactinoma/tratamento farmacológico , RNA Mensageiro/metabolismo , Fatores Sexuais , Fator de Transcrição Pit-1/metabolismo
15.
World Neurosurg ; 140: 60-62, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32407921

RESUMO

Granular cell tumors of the pituitary gland are rare, slow-growing lesions arising from the neurohypophysis or pituitary stalk. We describe an extremely rare presentation of a pituitary granular cell tumor mimicking an anterior communicating artery aneurysmal rupture with ventricular hemorrhage. The patient was admitted in a comatose state and underwent urgent bilateral external ventricular drainage. Further diagnostic investigation revealed a sellar tumoral mass with suprasellar extension. No vascular anomalies, hormonal abnormalities, or visual disturbances were observed. Macroscopic complete resection without neurologic impairment was obtained via a right pterional approach. Posthemorrhagic hydrocephalus necessitated ventriculoperitoneal shunt placement, and hormonal substitution for panhypopituitarism was provided. The 5-year follow-up examination showed no tumor recurrence. The clinical course of these benign World Health Organization grade I lesions will normally correspond to nonsecreting pituitary adenomas with an insidious development of visual disturbances, hypopituitarism, or hydrocephalus. Sudden onset with potential catastrophic intratumoral and intraventricular hemorrhage is very uncommon.


Assuntos
Hemorragia Cerebral Intraventricular/etiologia , Tumor de Células Granulares/complicações , Tumor de Células Granulares/patologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/patologia , Adulto , Hemorragia Cerebral Intraventricular/cirurgia , Tumor de Células Granulares/cirurgia , Humanos , Masculino , Neoplasias Hipofisárias/cirurgia
16.
World Neurosurg ; 139: 63-69, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32298831

RESUMO

BACKGROUND: Pituitary adenomas are the most common lesion of the sellar region. Very few cases in the literature have described their association with craniopharyngiomas in the same anatomic compartment, an entity defined as collision tumors of the sella. CASE DESCRIPTION: A 35-year-old man presented with headaches and progressive visual disturbances. Radiographic imaging initially highlighted the presence of a pituitary craniopharyngioma. An endoscopic transsphenoidal pituitary approach was performed, during which the tumor was partially resected. The pathology report was positive for 2 entities: a nonfunctioning pituitary adenoma and a papillary craniopharyngioma. This was an unexpected diagnosis based on the surgical and initial radiologic findings. CONCLUSIONS: To our knowledge, this is the first documented case of a collision tumor of the sella comprising a pituitary adenoma and a craniopharyngioma of the papillary type.


Assuntos
Adenoma/cirurgia , Craniofaringioma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neuroendoscopia , Neoplasias Hipofisárias/cirurgia , Adenoma/complicações , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adulto , Craniofaringioma/complicações , Craniofaringioma/diagnóstico por imagem , Craniofaringioma/patologia , Cefaleia/etiologia , Hemianopsia/etiologia , Humanos , Hipogonadismo/etiologia , Hipogonadismo/metabolismo , Masculino , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Proteínas Proto-Oncogênicas B-raf/genética , Osso Esfenoide , Transtornos da Visão/etiologia
17.
Neurosurgery ; 87(2): E140-E146, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32302399

RESUMO

BACKGROUND AND IMPORTANCE: A pituitary adenoma patient who underwent surgery in our department was diagnosed with COVID-19 and 14 medical staff were confirmed infected later. This case has been cited several times but without accuracy or entirety, we feel obligated to report it and share our thoughts on the epidemic among medical staff and performing endonasal endoscopic surgery during COVID-19 pandemic. CLINICAL PRESENTATION: The patient developed a fever 3 d post endonasal endoscopic surgery during which cerebrospinal leak occurred, and was confirmed with SARS-CoV-2 infection later. Several medical staff outside the operating room were diagnosed with COVID-19, while the ones who participated in the surgery were not. CONCLUSION: The deceptive nature of COVID-19 results from its most frequent onset symptom, fever, a cliché in neurosurgery, which makes it hard for surgeons to differentiate. The COVID-19 epidemic among medical staff in our department was deemed as postoperative rather than intraoperative transmission, and attributed to not applying sufficient personal airway protection. Proper personal protective equipment and social distancing between medical staff contributed to limiting epidemic since the initial outbreak. Emergency endonasal endoscopic surgeries are feasible since COVID-19 is still supposed to be containable when the surgeries are performed in negative pressure operating rooms with personal protective equipment and the patients are kept under quarantine postoperatively. However, we do not encourage elective surgeries during this pandemic, which might put patients in conditions vulnerable to COVID-19.


Assuntos
Adenoma/cirurgia , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Neuroendoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Pneumonia Viral/transmissão , Adenoma/complicações , Idoso , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos , Epidemias , Humanos , Pulmão/diagnóstico por imagem , Masculino , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural , Procedimentos Neurocirúrgicos/métodos , Salas Cirúrgicas , Pandemias , Isolamento de Pacientes , Neoplasias Hipofisárias/complicações , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Cuidados Pós-Operatórios , Tomografia Computadorizada por Raios X
18.
J Clin Neurosci ; 76: 166-170, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32253144

RESUMO

The present prospective cohort study evaluates the effect of three-dimensional (3-D) endoscopy on outcome in transphenoidal endoscopic surgery of pituitary adenomas compared to conventional two-dimensional (2-D) endoscopy. Prospective data was collected from patients undergoing endoscopic surgery for pituitary adenomas before and after the introduction of 3-D endoscopy. Patients, grouped by having 2-D or 3-D endoscopic surgery, were compared in regard to procedure time, intraoperative blood loss, complications, hospital stay, grade of resection and quality of life (QoL). Twenty-six patients having surgery with 2-D endoscopy were compared with 29 patients having surgery with 3-D endoscope. Only primary procedures were included. There were no significant differences in baseline characteristics between the two groups. No statistically significant differences in outcome were noted with 3-D endoscopy. Procedure time, complication rate, hospital stay, rate of gross total resection and post-operative QoL were unaffected by surgical technique though there were non-significant increases in new pituitary insufficiency with 3-D endoscopy and diabetes insipidus with 2-D endoscopy. This prospective cohort study fails to show obvious outcome advantages with 3-D endoscopy in pituitary surgery using basic parameters including post-operative QoL. To our knowledge this is the first prospective study published on the matter, thus corroborating results from previous retrospective studies with similar results on 3-D neuroendoscopy and 3-D endoscopy in general. The main advantage of increased depth perception is more likely found in more complex extended transphenoidal skull base procedure.


Assuntos
Perda Sanguínea Cirúrgica , Endoscopia/métodos , Tempo de Internação , Neoplasias Hipofisárias/cirurgia , Qualidade de Vida , Adenoma/cirurgia , Adulto , Idoso , Diabetes Insípido/etiologia , Endoscopia/efeitos adversos , Endoscopia/normas , Feminino , Humanos , Hipopituitarismo/etiologia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/métodos , Neoplasias Hipofisárias/complicações , Período Pós-Operatório , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
19.
World Neurosurg ; 138: 153-157, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32147553

RESUMO

BACKGROUND: Pituitary apoplexy is an acute clinical syndrome caused by infarction and/or hemorrhage of pituitary adenoma, which typically presents with severe headache, visual deterioration, and endocrine abnormalities. However, temporal lobe seizure (and temporal lobe epilepsy) has not been viewed as a symptom of pituitary apoplexy in the literature. CASE DESCRIPTION: To elucidate further such a rare complication of temporal lobe seizure, we describe here the rare clinical manifestations of a 55-year-old previously healthy man with pituitary apoplexy harboring headache, combined palsies involving cranial nerves III to VI, endocrinologic disturbances, and temporal lobe seizure. In addition, we discuss the temporal lobe seizure (and temporal lobe epilepsy) associated with pituitary adenoma based on the literature. CONCLUSIONS: Although further accumulation of clinical data is needed, we would like to emphasize the importance of recognition of temporal lobe seizure caused by pituitary apoplexy, and to suggest that early surgery could be considered as an option in patients displaying such a rare complication.


Assuntos
Epilepsia do Lobo Temporal/complicações , Apoplexia Hipofisária/complicações , Convulsões/complicações , Adenoma/complicações , Epilepsia do Lobo Temporal/diagnóstico por imagem , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/etiologia , Apoplexia Hipofisária/cirurgia , Neoplasias Hipofisárias/complicações , Convulsões/diagnóstico por imagem , Convulsões/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Doenças do Nervo Troclear/etiologia
20.
Best Pract Res Clin Endocrinol Metab ; 34(2): 101382, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32139169

RESUMO

Pituitary surgery is the first-line treatment for patients with Cushing's disease. For patients who are not considered candidates for pituitary surgery, pituitary radiation and bilateral adrenalectomy are further treatment alternatives. Not all patients are cured with pituitary surgery, and a substantial number of patients develop recurrence, sometimes many years after an apparently successful treatment. The same applies to patients treated with radiotherapy. Far from all patients are cured, and in many cases the disease recurs. Bilateral adrenalectomy, although always curative, causes chronic adrenal insufficiency and the remaining pituitary tumour can continue to grow and cause symptoms due to pressure on adjacent tissues, a phenomenon called Nelson's syndrome. In this paper the rate of recurrence of hypercortisolism, as well as the rate of development of Nelson's syndrome, following treatment of patients with Cushing's syndrome, will be reviewed. The aim of the paper is also to summarize clinical and biochemical factors that are associated with recurrence of hypercortisolism and how the patients should be monitored following treatment.


Assuntos
Biomarcadores/análise , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/terapia , Diagnóstico por Imagem/métodos , Técnicas de Diagnóstico Endócrino , Monitorização Fisiológica/métodos , Doença de Addison/diagnóstico , Doença de Addison/epidemiologia , Doença de Addison/etiologia , Doença de Addison/terapia , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/epidemiologia , Adenoma/terapia , Adrenalectomia/efeitos adversos , Síndrome de Cushing/epidemiologia , Síndrome de Cushing/patologia , Humanos , Síndrome de Nelson/diagnóstico , Síndrome de Nelson/epidemiologia , Síndrome de Nelson/etiologia , Síndrome de Nelson/cirurgia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/terapia , Recidiva
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