No abstract

Growth is usually manifest in the first 3 years after presentation. We recommend an initial magnetic resonance imaging scan at 6 months, with scans to take place at annual intervals for 2 years. A further scan 2 years later will identify any patient with indolent tumors. Thereafter, follow-up should be lifelong every 5 years. Cystic tumors represent a particular threat to patients and should only be treated conservatively with caution.

Purpose Highlight and characterize manifestations, diagnostic/management approaches and outcomes in a contemporary cohort of patients with pituitary metastases (PM) from a large European pituitary center-over 10 years. Methods Retrospective review of PM cases between 1/2009 and 12/2018. Clinical, laboratory, imaging data at PM detection and during follow-up were analysed. Results 18 cases were identified (14 females; median age at diagnosis 61.5 years). Most common primary malignancies were lung (39%) and breast (32%). Most frequent presenting manifestation was visual dysfunction (50%). Gonadotrophin, ACTH, TSH deficiency were diagnosed in 85%, 67%, 46% of cases, respectively; diabetes insipidus (DI) was present in 17%. 33% of cases were detected during investigation for symptoms unrelated to PM. PM management included radiotherapy (44%), transsphenoidal surgery (17%), transsphenoidal surgery and radiotherapy (6%) or monitoring only (33%). One-year survival was 49% with median survival from PM detection 11 months (range 2-47). Conclusions In our contemporary series, clinical presentation of PM has evolved; we found increased prevalence of anterior hypopituitarism, decreased rates of DI and longer survival compared with older literature. Increased availability of diagnostic imaging, improvements in screening and recognition of pituitary disease and longer survival of patients with metastatic cancer may be contributing factors.

In the recent years new technology has led to the development of a bewildering array of imaging procedures. Yet, conventional radiography remains one of the most used tools to diagnose and to aid procedural interventions. Fluoroscopy guidance facilitates targeted drug delivery or radiofrequency directly to the area of pathology, a benefit that has to be balanced against the risks of radiation exposure. In this prospective observational survey of routine practice, dose area product (DAP) and screening time (ST) were recorded in 127 consecutive patients undergoing fluoroscopically guided spinal procedures along with other probable measures of potentially greater radiation exposure such as weight, type of spinal pathology, the ease of recognition of the anatomical landmarks, and the radiographic quality of the image in terms of contrast and graininess. The mean ST was 34±27 seconds (range, 3 to 218 seconds), the mean DAP was 1.18±1.08 Gy cm(2) (range, 0.023 to 6.82 seconds). A correlation between weight and DAP was confirmed (r=0.230, P<0.05, Spearman's correlation coefficient). Patients with spinal pathology (n=33) had higher radiation exposure than those without (DAP median=0.85, U=978.00, P<0.005, r=-0.28, Mann-Whitney test). The DAP values obtained compare favourably with the recommended doses for radiographs and other procedures, although they generally exceed the values for a chest X-ray.