Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.208
Filtrar
1.
Arch Endocrinol Metab ; 64(5): 614-622, 2021 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-34033303

RESUMO

The usual clinical presentation of non-functioning pituitary adenoma (NFPA) consists of symptoms of mass effect and hypopituitarism. NFPA is a rare condition in young women and an uncommon complication during pregnancy. We present the outcome of three patients with NFPA during pregnancy. Case 1: a 38-year-old woman was referred at 32nd week of spontaneous pregnancy because of diagnosis of a pituitary macroadenoma discovered in the context of progressive visual loss. Hormonal deficiency and hypersecretion were ruled out. Prolactin levels were high as expected. She developed diplopia and severe headache despite the use of dopamine agonists and corticosteroids, so pregnancy was interrupted at 34th week. After an uncomplicated delivery of a healthy newborn, transsphenoidal surgery was performed. The pathology was consistent with a gonadotroph adenoma. She recovered visual field, and remained with normal pituitary function. Postsurgical tumor remnant increased in size during the follow-up. Case 2: a 34-year-old woman was referred due to secondary amenorrhea and galactorrhea. A macroadenoma with suprasellar extension was discovered. Transsphenoidal surgery confirmed a gonadotroph adenoma. Two years after surgery she had a normal pregnancy. Six years after surgery a small tumor recurrence occurred. Case 3: a 23-year-old woman was referred due to a microincidental pituitary adenoma. Laboratory testing was normal. No findings on physical examination. A wait and see approach was decided. Two years after diagnosis, the patient got pregnant without complications. Image remained stable. This article may contribute new cases and provides an extensive review of NFPA during pregnancy.


Assuntos
Adenoma , Galactorreia , Hipopituitarismo , Neoplasias Hipofisárias , Adenoma/cirurgia , Adulto , Feminino , Humanos , Hipopituitarismo/etiologia , Recém-Nascido , Recidiva Local de Neoplasia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Gravidez , Adulto Jovem
2.
J Med Case Rep ; 15(1): 289, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34039424

RESUMO

BACKGROUND: Pregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy. CASE PRESENTATION: We describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin. CONCLUSIONS: Although the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.


Assuntos
Adenoma , Apoplexia Hipofisária , Neoplasias Hipofisárias , Cesárea , Criança , Feminino , Cefaleia , Humanos , Apoplexia Hipofisária/diagnóstico , Apoplexia Hipofisária/terapia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/terapia , Gravidez
3.
BMJ Case Rep ; 14(5)2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33958366

RESUMO

A 49-year-old man presented with new onset headache and diplopia, with right ptosis and limitation of extraocular movements consistent with a third nerve palsy. He had a known diagnosis of a non-functioning pituitary adenoma, and his presentation and neuroimaging were consistent with ischaemic pituitary apoplexy. The patient was otherwise stable with no signs of optic neuropathy or endocrine abnormality. He was observed with close interval follow-up and reported resolution of symptoms within 4 days after onset. Pituitary apoplexy is a potentially life-threatening condition often managed with initial medical stabilisation followed by neurosurgical decompression. The guidelines regarding the utility of surgery in patients with isolated ocular motility disorders are unclear, and recent retrospective studies suggested that outcomes may be similar in patients managed conservatively. This case demonstrates that rapid resolution of an isolated third nerve palsy may occur in this setting, and that observation is a reasonable initial management strategy.


Assuntos
Adenoma , Doenças do Nervo Oculomotor , Apoplexia Hipofisária , Neoplasias Hipofisárias , Adenoma/diagnóstico , Adenoma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/etiologia , Apoplexia Hipofisária/complicações , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/diagnóstico por imagem , Estudos Retrospectivos
4.
J Med Case Rep ; 15(1): 173, 2021 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812374

RESUMO

BACKGROUND: Central hyperthyroidism is a rare form of hyperthyroidism caused by thyrotrope pituitary adenomas. It is characterized by elevated thyroid-stimulating hormone alongside high thyroxine and triiodothyronine. Goiter is the most common symptom of central hyperthyroidism. Surgical resection as well as somatostatin analog therapy typically achieve resolution of hyperthyroid symptoms and restoration of a euthyroid state. CASE PRESENTATION: We report the case of a 30-year-old primigravida Caucasian/White female who presented with abnormal thyroid function testing results and multinodular goiter during pregnancy. Postpartum, she was found to have multinodular goiter on physical examination as well as persistent elevated thyroid-stimulating hormone with elevated free thyroxine and free triiodothyronine. Magnetic resonance imaging disclosed a large pituitary macroadenoma, and she subsequently underwent resection of the mass. She achieved a sustained euthyroid state postoperatively. CONCLUSIONS: This case shows how central hyperthyroidism can present without the more apparent symptoms of thyrotoxicosis and that successful resolution of central hyperthyroidism may be achieved postoperatively.


Assuntos
Hipertireoidismo , Neoplasias Hipofisárias , Tireotoxicose , Adulto , Feminino , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Gravidez , Tireotoxicose/diagnóstico , Tireotropina , Tiroxina/uso terapêutico
5.
Clin Nucl Med ; 46(6): 505-506, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33782291

RESUMO

ABSTRACT: In addition to gastroenteropancreatic neuroendocrine neoplasms, a wide variety of tumors express somatostatin receptors. Somatostatin receptor imaging, heavily utilized in neuroendocrine oncology, may also have utility in the diagnosis of other neoplasms and raises the possibility of potential therapeutic options. We describe the case of a 60-year-old man who underwent 68Ga-DOTATATE PET/CT, demonstrating an avid invasive pituitary macroadenoma. This mass was persistent and refractory despite traditional treatment options. Because of the avidity, 177Lu-DOTATATE therapy was offered, although not ultimately performed, demonstrating a potential treatment for challenging cases utilizing the principles of theranostics.


Assuntos
Adenoma/diagnóstico por imagem , Adenoma/patologia , Órbita/diagnóstico por imagem , Compostos Organometálicos , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adenoma/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Octreotida/análogos & derivados , Octreotida/uso terapêutico , Compostos Organometálicos/uso terapêutico , Neoplasias Hipofisárias/radioterapia , Falha de Tratamento
6.
No Shinkei Geka ; 49(2): 301-315, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762451

RESUMO

Pituitary adenomas are the most common cause of sellar masses although there are a number of other neoplastic, infectious, inflammatory, developmental, and vascular etiologies that should be considered. Pregnancy promotes a physiological increase in the size of the maternal pituitary gland, especially adenohypophysis. The normal maturation sequence of the pituitary gland apparently involves a period of physiological hypertrophy in teenagers. As most incidentalomas in pediatric patients are not associated with hormonal hypersecretion or hypopituitarism, and structural progression is not common, it is hypothesized that the extensive follow-up assessment recommended for adults might not be necessary for children. Patients presenting with a pituitary lesion should undergo a complete history and physical examination that includes evaluations for evidence of hypopituitarism and hormone hypersecretion syndrome. Patients with evidence for either of these conditions should undergo an appropriately directed biochemical evaluation. All patients presenting with a pituitary lesion abutting the optic nerves or chiasm on magnetic resonance imaging should undergo a formal visual field examination. Emergencies in pituitary disease can result from the failure of the pituitary gland to secrete one or more pituitary hormones or from neuro-ophthalmological symptoms due to the mass effect of an expanding hypothalamic-pituitary lesion. Early diagnosis and prompt treatment of endocrine emergencies are mandatory.


Assuntos
Adenoma , Hipopituitarismo , Neoplasias Hipofisárias , Adolescente , Adulto , Criança , Humanos , Hipertrofia , Hipopituitarismo/diagnóstico por imagem , Hipopituitarismo/etiologia , Imageamento por Ressonância Magnética , Hipófise , Neoplasias Hipofisárias/diagnóstico por imagem
7.
BMJ Case Rep ; 14(3)2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33762289

RESUMO

A 53-year-old man presented with 6 months history of weight loss associated with nausea, fatigue, dizziness and headache. On arrival he was in adrenal crisis. Biochemistry revealed anterior hypopituitarism with low cortisol, thyroxine, testosterone and a slightly raised prolactin. He was commenced on steroids, thyroxine and testosterone. MRI pituitary gland was reported to have a 9.4 mm microadenoma. Cabergoline was started for a possible microprolactinoma. Follow-up MRI showed increase in the size of complex cystic lesion causing chiasmal compression raising a possibility of craniopharyngioma. Visual fields assessment was normal. In view of the rapid enlargement, to protect vision and obtain a tissue diagnosis he underwent endoscopic trans-sphenoidal surgery. A cystic lesion was noted intraoperatively originating from pituitary stalk with intrasellar and suprasellar extension. It was filled with white caseous material and fluid. Histology revealed epidermoid cyst. His headache resolved postoperatively.


Assuntos
Cisto Epidérmico , Hipopituitarismo , Doenças da Hipófise , Neoplasias Hipofisárias , Cisto Epidérmico/diagnóstico , Cisto Epidérmico/diagnóstico por imagem , Humanos , Hipopituitarismo/diagnóstico , Hipopituitarismo/etiologia , Masculino , Pessoa de Meia-Idade , Hipófise , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/diagnóstico por imagem
8.
J Clin Neurosci ; 86: 145-153, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33775319

RESUMO

Gamma Knife radiosurgery (GKRS) for lactotroph adenomas (LAs) or prolactinomas is limited due to the effectiveness of medical treatments and surgery. Cases who are refractory to medical treatment and/or surgery may be managed with GKRS. We aimed to describe the effectiveness of GKRS for high-risk lactotroph adenomas (HRLAs) and LAs that were medically and surgically refractory. We analyzed our series of patients with HRLAs and LAs who were managed with GKRS following failed medical treatment and surgery and who had at least three years of follow-up. A total of 52 patients (22 HRLAs and 30 LAs) were included in the analysis of radiological, endocrine, and clinical outcomes. Radiological control was achieved in 68.2% of subjects in the HRLA group and 96.7% of subjects in the LA group. Hormonal control was achieved in 68.2% of patients in the HRLA group and 80% of patients in the LA group. On univariate analysis, hormonal control was significantly associated with pre-treatment volume (p = 0.007), higher margin dose (p = 0.002) and Ki-67 proliferative index (p = 0.007). Complications involved new pituitary hormone deficiencies in 19.2% of patients and asymptomatic peripheral visual field defect in 1.9% of patients. To the best of our knowledge, this is the first study to examine the effectiveness of GKRS in LAs and HRLAs, with the highest median follow-up in the literature. High hormonal control rate, even in HRLAs, and lower complication rates suggest that GKRS should be part of the techniques for managing treatment refractory LAs.


Assuntos
Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Prolactinoma/diagnóstico por imagem , Prolactinoma/cirurgia , Radiocirurgia/tendências , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Hormônios Hipofisários/sangue , Neoplasias Hipofisárias/sangue , Prolactinoma/sangue , Radiocirurgia/métodos , Estudos Retrospectivos , Resultado do Tratamento
9.
J Clin Neurosci ; 86: 252-259, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33775337

RESUMO

Significant restoration of visual function can occur following pituitary tumor resection, although the time course of visual recovery remains poorly understood. This single-centre, two-year, prospective cohort study investigated the temporal patterns of visual recovery in consecutive patients undergoing pituitary tumor resection, between 2009 and 2018. Eyes were stratified based on pre-operative optical coherence tomography (OCT) retinal nerve fibre layer (RNFL) thickness measurements, with thin RNFL being defined as those within the fifth-percentile of age-matched normative values, and normal RNFL as those above the fifth-percentile. Visual function and OCT parameters were assessed pre-operatively, and at 6 weeks, 6 months, and 2 years post-operatively. 456 eyes of 228 patients (mean ± SD age, 53 ± 15 years) were included, of which 114 (25%) eyes had thin RNFL pre-operatively. Visual field recovery was observed in both groups during the first 6 weeks post-operatively (all Q ≤ 0.02), although improvements in visual field parameters between 6 weeks to 6 months were limited to eyes with thin RNFL (both Q < 0.05). No further improvements in visual function were detected beyond 6 months in both groups (both Q > 0.50). Similar trends were observed in linear regression analysis according to baseline visual function in both groups. In summary, eyes with normal RNFL thickness at baseline experienced most of their recovery within the first six weeks following surgery, while eyes with thin RNFL exhibited gradual improvements during the first six months. These findings have important implications when providing patient counselling and prognostication in the pre-operative setting.


Assuntos
Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Recuperação de Função Fisiológica/fisiologia , Campos Visuais/fisiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Quiasma Óptico/diagnóstico por imagem , Quiasma Óptico/cirurgia , Estudos Prospectivos , Retina/diagnóstico por imagem , Fatores de Tempo , Tomografia de Coerência Óptica/métodos , Tomografia de Coerência Óptica/tendências
10.
Turk Neurosurg ; 31(2): 238-246, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33624276

RESUMO

AIM: To analyze the effectiveness of fat and fibrin glue to prevent postoperative cerebrospinal fluid (CSF) leak in pituitary surgery. MATERIAL AND METHODS: Two hundred and eleven patients affected by pituitary adenoma entered this study. Patients that underwent a microscopic transsphenoidal approach between January 2013 and April 2019 were included. All the patients that developed intraoperative CSF leak were treated with fat and fibrin glue. The presence or absence of postoperative CSF leak was considered as a parameter to test the effectiveness of the intraoperative reconstruction technique used. RESULTS: Postoperative CSF leak was observed in 5 patients (2.4%). Among patients with an intraoperative low- grade CSF leak (1 or 2), 97.9% did not develop a postoperative CSF leak. In contrast, those who presented an intraoperative CSF leak of grade 3, had a worse prognosis. CONCLUSION: Fat and fibrin glue is currently an effective method in the treatment of low-grade intraoperative CSF leak. In case of intraoperative CSF leak of grade 3, it should be used combined with the nasoseptal flap technique to obtain a safer reconstruction.


Assuntos
Adenoma/cirurgia , Tecido Adiposo/transplante , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Adesivo Tecidual de Fibrina/administração & dosagem , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Adenoma/diagnóstico por imagem , Tecido Adiposo/diagnóstico por imagem , Adulto , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Retalhos Cirúrgicos/transplante , Transplantes/diagnóstico por imagem , Transplantes/transplante
11.
BMC Surg ; 21(1): 58, 2021 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-33485359

RESUMO

BACKGROUND: Endoscopic endonasal transsphenoidal approaches are broadly used nowadays for a vast spectrum of pathologies sited in the anterior and middle cranial fossa. The usage of neuronavigation systems (neuronavigation) in these surgeries is crucial for improving orientations deeply inside the skull and increasing patient safety. METHODS: The aim of this study was to assess the use of optical neuronavigation, together with an intraoperative O-arm O2 imaging system, in a group of patients with hypophyseal adenoma that underwent a transnasal transsphenoidal surgery, and correlate the accuracy and its deviation during the navigational process against the use of conventional neuronavigation that uses preoperative MRI and CT scans. The overall group consisted of six patients, between 39 and 78 years old, with a diagnosis of hypophyseal adenoma. Patients were treated with an endoscopic transsphenoidal technique and all of them underwent preoperative MRI and CT scans of the brain. These images were used in the neuronavigation system StealthStation S7® during the surgery, where we defined two bony anatomical landmarks, such as a vomer or the origin of an intrasphenoidal septum, in each operated patient. The tip of the navigational instrument, under endoscopic control, pointed to these landmarks and the distance between the tip and the bony structure was measured on the neuronavigation system. Afterwards, intraoperative 3D x-ray imaging was performed via the mobile system O-arm O2® system with automatic transfer into the navigational system. Under endoscopic guidance, we localized the identical bony anatomical landmarks used in the previous measurement and re-measured the distance between the tip and bony landmark in images acquired by the O-arm. The results of both measurements were statistically compared. RESULTS: The mean error of accuracy during conventional neuronavigation with usage of preoperative CT and MRI scans was 2.65 mm. During the neuronavigation, with utilization of intraoperative 3D O-arm images, the mean error of accuracy 0 mm. These mean errors of accuracy (both measurement methods were compared by nonparametric Wilcoxon test) had a statistically significant difference (p = 0.043). CONCLUSIONS: Based on this preliminary clinical study, we conclude that the O-arm is capable of providing intraoperative x-ray 3D images in sufficient spatial resolution in a clinically feasible acquisition. The mean error of accuracy during intraoperative navigation, based on 3D O-arm scans at the skull base, is significantly lower compared to the usage of navigation using conventional presurgical CT and MRI images. This suggests the suitability of this method for utilization during endoscopic endonasal skull base approaches.


Assuntos
Adenoma , Hipófise , Neoplasias Hipofisárias , Base do Crânio , Cirurgia Assistida por Computador , Cirurgia Endoscópica Transanal , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adulto , Idoso , Feminino , Humanos , Imageamento Tridimensional , Período Intraoperatório , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuronavegação/métodos , Projetos Piloto , Hipófise/diagnóstico por imagem , Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Estudos Prospectivos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Cirurgia Endoscópica Transanal/métodos
12.
Clin Imaging ; 74: 41-44, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33429145

RESUMO

Pituitary metastases (PM) from differentiated thyroid carcinoma (DTC) are rare. Various case series and case reports in the past suggest that symptoms of PM from DTC correspond to parasellar lesions that affect adjacent nerves, rather than intrasellar lesions that cause endocrinologic disorders such as diabetes insipidus. This case report describes the occurrence of PM in a patient with a history of papillary thyroid carcinoma that had previously recurred in cervical lymph nodes. The relevant literature is reviewed, and a discussion of the salient points of the case is provided.


Assuntos
Neoplasias Hipofisárias , Neoplasias da Glândula Tireoide , Humanos , Linfonodos , Recidiva Local de Neoplasia , Neoplasias Hipofisárias/diagnóstico por imagem , Câncer Papilífero da Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem
13.
Clin Nucl Med ; 46(1): e44-e46, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33031239

RESUMO

F-FDG PET/CT might discover incidental pituitary lesions. We present the case of a 46-year-old woman with breast cancer metastasis in her pituitary. We analyzed 10,347 FDG PET/CT examinations from a tertiary center, finding 4 cases (0.038%) of pituitary metastatic disease from other cancers. We analyzed the differences between SUVmax in cases of physiological high uptake, primary tumor, and hypophysis metastases from other cancers in our database compared with the literature.


Assuntos
Neoplasias da Mama/patologia , Fluordesoxiglucose F18 , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/secundário , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Transporte Biológico , Feminino , Fluordesoxiglucose F18/metabolismo , Humanos , Pessoa de Meia-Idade , Neoplasias Hipofisárias/metabolismo
14.
Zhonghua Yi Xue Za Zhi ; 100(45): 3626-3631, 2020 Dec 08.
Artigo em Chinês | MEDLINE | ID: mdl-33333688

RESUMO

Objective: To investigate the value of conventional magnetic resonance imaging (MRI) based radiomic model in predicting the texture of pituitary macroadenoma. Methods: The complete data of 101 patients with pituitary macroadenoma confirmed by surgery and pathology in Yijishan Hospital of Wannan Medical College from December 2014 to December 2019 were retrospectively analyzed. According to the texture of the intraoperative pituitary tumor, patients were divided into soft group (n=58) and hard group (n=43). They were randomly divided into training group (n=72) and validation group (n=29) at a ratio of 7∶3. All patients underwent conventional MRI scan of the pituitary gland. Itk-snap software was used to manually outline the T(1)-weighted image (T(1)WI), T(2)-weighted image (T(2)WI) and enhanced T(1)WI image section by section on tumor area of interest (ROI) and perform three-dimensional fusion. Then AK software was imported to extract texture features. The regression analysis methods of minimum redundancy maximum relevance (mRMR) and least absolute shrinkage and selection operator (LASSO) were used for feature selection and radiomic signature establishment. The reliability of the model was verified by 100 leave-group-out cross validation (LGOCV), and the predictive ability of the model was evaluated by drawing the receiver operating characteristic (ROC) curve. The decision curve analysis (DCA) was used to evaluate the clinical application value of the model. Results: The AUC (Area Under the ROC Curve) (95%CI) values of T1WI, T2WI, enhanced T1WI, and the combined sequence model to predict the texture of pituitary macroadenomas in the training and validation groups were 0.91 (0.84-0.98) and 0.90 (0.78-1.00), 0.86 (0.78-0.95) and 0.83 (0.64-1.00), 0.90 (0.83-0.97) and 0.89 (0.77-1.00),0.92 (0.85-0.98) and 0.91 (0.79-1.00), respectively. DCA demonstrated that T(1)WI, T(2)WI, enhanced T(1)WI, and combined sequence model all had good net benefits in clinical practice. Conclusions: T(1)WI, T(2)WI, enhanced T(1)WI, and combined sequence model of conventional MRI all had high efficacy in predicting the texture of pituitary macroadenoma, which provided a new quantitative method for predicting the texture of pituitary macroadenoma.


Assuntos
Neoplasias Hipofisárias , Humanos , Imageamento por Ressonância Magnética , Neoplasias Hipofisárias/diagnóstico por imagem , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos
15.
J Pak Med Assoc ; 70(11): 2072-2074, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33341865

RESUMO

Craniopharyngiomas are common but complex paediatric brain lesions that present interesting management challenges. Quality of life is an important consideration while choosing management options. In this review, we have discussed the existing literature on various aspects of quality of life in patients treated for craniopharyngioma, assessed by variety of measurement tools.


Assuntos
Craniofaringioma , Neoplasias Hipofisárias , Criança , Craniofaringioma/diagnóstico por imagem , Craniofaringioma/terapia , Humanos , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/terapia , Qualidade de Vida
16.
Radiol Clin North Am ; 58(6): 1115-1133, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040852

RESUMO

The pituitary gland is a small endocrine organ located within the sella turcica. Various pathologic conditions affect the pituitary gland and produce endocrinologic and neurologic abnormalities. The most common lesion of the pituitary gland is the adenoma, a benign neoplasm. Dedicated MR imaging of the pituitary is radiologic study of choice for evaluating pituitary gland and central skull region. Computed tomography is complimentary and allows for identification of calcification and adjacent abnormalities of the osseous skull base. This review emphasizes basic anatomy, current imaging techniques, and highlights the spectrum of pathologic conditions that affect the pituitary gland and sellar region.


Assuntos
Imageamento por Ressonância Magnética/métodos , Neuroimagem/métodos , Hipófise/anatomia & histologia , Hipófise/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Feminino , Humanos , Masculino , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/patologia , Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Sela Túrcica/patologia , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos
17.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(8): 980-987, 2020 Aug 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33053542

RESUMO

OBJECTIVES: To evaluate the image quality of magnetic resonance 3D-sampling perfection with application-optimized contrasts by using different filp angle evolutions (3D-SPACE) sequence combined with different fusion methods in image fusion technology and the application value of fusion technology in preoperative evaluation of pituitary macroadenoma. METHODS: We collected MRI data of 43 patients with pituitary macroadenoma confirmed by Xiangya Hospital of Central South University, including collecting conventional MRI scan+enhancement, 3D-SPACE T2WI, and 3D-SPACE T1WI+C image data. 3D-SPACE sequence fusion was used in 6 combinations of 3D-SPACE T2WI/3D-SPACE T1WI+C, which were normal phase+normal phase, reverse phase+normal phase, normal phase+reverse phase, reverse phase+reverse phase, and normal phase pseudo color+normal phase, normal phase+normal phase pseudo color. Two senior radiologists used semi-quantitative methods to evaluate and compare the image quality of different combinations to obtain the best fusion mode. According to the degree of tumor invasion of the optic chiasma, oculomotor nerve, and cavernous sinus vessels, the MRI enhancement, 3D-SPACE T2WI, 3D-SPACE T1WI+C, and 2 3D-SPACE sequence fusion images were performed according to a three-level score system. Taking the intraoperative observation as the gold standard, Fisher probability exact method was used to compare different sequences to show the difference between the degree of invasion of the pituitary macroadenoma to the surrounding tissue and the intraoperative results. RESULTS: The Kruskal-Wallis H rank sum test showed that among the 6 image fusion modes, 3D-SPACE T1WI+C normal phase pseudo-color and 3D-SPACE T2WI normal phase fusion images had the best quality (P<0.05). No significance was observed among the 4 groups in the evaluation of consistency between the intraoperative findings and the graphically displayed extent of tumor invasion into oculomotor nerve (both level I, II, and III, P>0.05). The 3D-SPACE T2WI/3D-SPACE T1WI+C fusion images and the 3D-SPACE T2WI images showed better performance in the evaluation of consistency between the intraoperative findings and the graphically displayed extent of tumor invasion into optic chiasma (level II and III) than that in other two kinds of imaging data of the MRI enhancement group and 3D-SPACE T1WI+C group (P<0.01, P<0.05, respectively), with no significance being observed in level I. The 3D-SPACE T2WI/3D-SPACE T1WI+C fusion images and the 3D-SPACE T1WI+C images showed better performance in the evaluation of consistency between the intraoperative findings and the graphically displayed extent of tumor invasion into cavernous sinus vessels (level II) than that in other two kinds of imaging data of the MRI enhancement group and 3D-SPACE T2WI group (P<0.01, P<0.05, respectively), with no significance being observed in level I and III. CONCLUSIONS: Magnetic resonance 3D-SPACE sequence combined with image fusion technology is better than conventional magnetic resonance sequence for showing pituitary macroadenoma invasion of skull base vascular nerves. The invasion is better than the 3D-SPACE sequence alone, showing that the relationship between tumor and cavernous sinus vascular grade II better than the 3D-SPACE sequence alone. It has good application prospects for preoperative risk assessment and surgical plan.


Assuntos
Aumento da Imagem , Neoplasias Hipofisárias , Humanos , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia
18.
BMC Med Inform Decis Mak ; 20(1): 215, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907561

RESUMO

BACKGROUND: Accurately determining the softness level of pituitary tumors preoperatively by using their image textures can provide a basis for surgical options and prognosis. Existing methods for this problem require manual intervention, which could hinder the efficiency and accuracy considerably. METHODS: We present an automatic method for diagnosing the texture of pituitary tumors using unbalanced sequence image data. Firstly, for the small sample problem in our pituitary tumor MRI image dataset where T1 and T2 sequence data are unbalanced (due to data missing) and under-sampled, our method uses a CycleGAN (Cycle-Consistent Adversarial Networks) model for domain conversion to obtain fully sampled MRI spatial sequence. Then, it uses a DenseNet (Densely Connected Convolutional Networks)-ResNet(Deep Residual Networks) based Autoencoder framework to optimize the feature extraction process for pituitary tumor image data. Finally, to take advantage of sequence data, it uses a CRNN (Convolutional Recurrent Neural Network) model to classify pituitary tumors based on their predicted softness levels. RESULTS: Experiments show that our method is the best in terms of efficiency and accuracy (91.78%) compared to other methods. CONCLUSIONS: We propose a semi-supervised method for grading pituitary tumor texture. This method can accurately determine the softness level of pituitary tumors, which provides convenience for surgical selection and prognosis, and improves the diagnostic efficiency of pituitary tumors.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Conjuntos de Dados como Assunto , Humanos , Gradação de Tumores , Redes Neurais de Computação , Neoplasias Hipofisárias/classificação , Aprendizado de Máquina Supervisionado
19.
Vnitr Lek ; 66(2): 82-86, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32942893

RESUMO

Cushings syndrome (CS) is a relatively rare disease characterized by autonomous hypersecretion of cortisol. The incidence of CS is estimated to be equal to 2-3 cases per million inhabitants per year. The incidence of acromegaly is 3-4 patients per 1 000 000 per year. The disease is caused by hypersecretion of growth hormone which is mainly caused by benign tumour of the pituitary gland. In our case report we present a 41- year old woman suffering from both Cushings syndrome and acromegaly. The patient was examined in National Institute of Endocrinology and Diabetology Ľubochňa for a centripetal type of obesity and hirsutism. Laboratory tests revealed high plasma cortisol levels without circulating variation, hypercortisoluria and elevated plasmatic levels of ACTH. A 2 mg dexamethasone blockade was performed without adequate cortisol suppression in serum and urine up to 8 mg blockade resulted in suppression of 24 hour urine free cortisol. A magnetic resonance imaging (MR) scan revealed suspect pikoadenoma of the pituitary gland (size 2mm). Subsequently trans-sphenoidal resection was performed. Histopathological and immunohistochemical examinations did not reveal the ACTH-producing pituitary adenoma. After surgery hypercortisolism persisted with newly revealed hypersomatotropism. Treatment with Ketoconazole at dose 200mg 1/ 2-0-1 and somatostatin analogues (Lanreotide) at dose 120mg every 42 days were initiated. Control magnetic resonance imaging of the sella demonstrated small tumour of pituary gland of size 3×5mm. Later 3 years after first surgery another trans-sphenoidal resection of residue was performed. Histological and immunohistochemical examinations did not confirm adenoma with ACTH and RH secretion. After second surgery, IGF-1 plasma levels were not normalized with persistence of hypercortisolism. The treatment with Lanreotide at the initial dose as well as Ketoconazole was reinitiated (with increased dose of Ketoconazole to 1-1-1 tbl per 200mg).


Assuntos
Acromegalia , Adenoma , Síndrome de Cushing , Neoplasias Hipofisárias , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adulto , Síndrome de Cushing/etiologia , Feminino , Humanos , Hidrocortisona , Hipófise , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia
20.
Rev. neurol. (Ed. impr.) ; 71(5): 163-170, 1 sept., 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195466

RESUMO

INTRODUCCIÓN: Los adenomas hipofisarios no funcionantes son el grupo tumoral más frecuente en la región selar. Suelen ser neoplasias benignas diagnosticadas por síntomas visuales u hormonales, aunque no es infrecuente detectarlos como un hallazgo casual. OBJETIVO: Analizar los aspectos clínicos hallados en esta enfermedad y su respuesta tras el tratamiento quirúrgico. PACIENTES Y MÉTODOS: En una serie de 100 casos, se analizaron datos epidemiológicos, clínicos, endocrinológicos, visuales y radiológicos antes y después del tratamiento quirúrgico, y se recogen las complicaciones relacionadas con la cirugía y el seguimiento a largo plazo. RESULTADOS: El síntoma más frecuente en el momento del diagnóstico fue la afectación del campo visual (62%), y sólo el 7% de los adenomas se trataba de un hallazgo casual. El déficit hormonal más frecuente era el hipogonadismo hipogonadótropo (48%). Tras la cirugía se observó recuperación completa del defecto campimétrico en el 54,8% de los pacientes, con sólo un 1% de empeoramiento tras la cirugía, y la incidencia de diabetes insípida fue del 4%. La resección fue superior al 95% en el 63% de los casos, a pesar de que el porcentaje de adenomas con invasión del seno cavernoso en grados altos fue elevado (45%). CONCLUSIONES: Aunque el síntoma más frecuente de los adenomas hipofisarios no funcionantes es la afectación campimétrica, ésta tiene una excelente respuesta a la cirugía si se realiza dentro del tiempo adecuado. El grado de invasión del seno cavernoso parece el factor más limitante para una resección quirúrgica completa


INTRODUCTION: Non-functioning pituitary adenomas are the most frequent tumor group in the sellar region. They are usually benign neoplasms diagnosed after visual or hormonal symptoms, although it is not uncommon to detect them as a casual finding. AIM: To analyze the clinical aspects found in this disease and its response after surgical treatment. PATIENTS AND METHODS: In a series of 100 cases, epidemiological, clinical, endocrinological, visual and radiological data were analyzed before and after surgical treatment, as well as the complications related to surgery and long-term follow-up. RESULTS: The most frequent symptom at the time of diagnosis was visual field involvement (62%), and only the 7% of adenomas were a casual finding. The most common hormonal deficit was hypogonadotropic hypogonadism (48%). After surgery, complete recovery of the visual field defect was observed in 54.8% of the patients, only 1% worsening after surgery, and the incidence of diabetes insipidus was 4%. The resection was superior to 95% in 63% of cases, although the percentage of adenomas with invasion of the cavernous sinus in Knosp grades 3 and 4 it was high (45%). CONCLUSIONS: Although the most frequent symptom of non-functioning pituitary adenomas is campimetric involvement, it has an excellent response to surgery if it is performed within the appropriate time. The grade of invasion of the cavernous sinus is the most limiting factor for a complete surgical resection


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/cirurgia , Adenoma/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Adenoma/patologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Endoscopia , Hemianopsia , Seio Cavernoso/diagnóstico por imagem , Seio Cavernoso/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...