The EEA is a safe and effective way to surgically approach pituitary adenomas, particularly in recurrent tumors, those with supra-sellar extension or cavernous sinus invasion. The remission and complication rates are comparable or favorable compared with those reported in previous series of microscopic and endoscopic approaches.
Two populations of oxytocin-staining neurons have been identified in the paraventricular nucleus: magnocellular neurons that terminate in the posterior pituitary and parvocellular neurons that terminate elsewhere in the central nervous system. Whether these oxytocin neurons are functionally separate was tested by measuring oxytocin concentrations in samples of peripheral blood and cerebrospinal fluid (CSF) obtained simultaneously from lactating rhesus monkeys during suckling. Lactating animals bearing temporary subarachnoid and venous catheters were maintained in a constant photoperiod (0600-1800 h). Samples of CSF were continuously withdrawn by peristaltic pump (0.1 mL/15 min) for 2-4 consecutive days from subarachnoid catheters with the tips placed at the T12-L1 level of the spinal column in four lactating monkeys 4 months postpartum and again after weaning. On 2 of these days, we observed and recorded periods of infant suckling and collected peripheral blood samples (1.2 mL) from the mother at 5-min intervals for 60 min. Oxytocin was measured in blood and CSF by RIA. Oxytocin concentrations increased in the plasma of the lactating monkeys during periods of nursing, with peak concentrations ranging from 4-16.7 microU/mL. No increase in plasma oxytocin was found on the day after the infant was weaned. Variations in the concentrations of oxytocin in CSF were independent of the suckling stimulus and plasma oxytocin concentrations and occurred during observed periods of no nipple contact by the infant and at the time of weaning after the infant had been removed from the mother. Each lactating animal also displayed a normal circadian variation in CSF oxytocin concentrations, with peak and nadir levels during light and dark hours, respectively. We conclude that release of oxytocin into the CSF of lactating monkeys is disassociated from release into the peripheral circulation. The data further support the conclusion that neuronal pathways giving rise to oxytocin in the CSF and the periphery are anatomically and functionally separate in primates.
We report the outcomes of the endoscopic endonasal approach (EEA) for resection of growth hormone secreting pituitary adenomas using 2010 consensus criteria. We also assess outcomes with additional medical therapy and radiosurgery (RS) for patients not achieving remission with EEA alone. A retrospective review of 53 patients who had follow up endocrinologic data at least 3 months post-surgery was performed among patients who were treated by EEA between 1998 and 2012. Data were analyzed for remission using GH and IGF-I levels based on 2010 consensus criteria. We also analyzed the outcomes using 2000 consensus criteria for ease in comparison to prior studies of outcomes of surgery for acromegaly. In this series of mostly large (88.2% macroadenomas), invasive (46.9% Hardy-Wilson C, D, E) adenomas, there were 27 patients (50.9%) who achieved remission after EEA only. For patients who had no remission with EEA alone, RS and/or medical therapy were used and 37 patients (69.8 %) achieved remission overall. Statistical analysis showed larger tumor size, Hardy Stages C, D, E and Knosp Scores 3, 4 to be predictive against remission for EEA only and EEA with other modalities. The volume of residual tumor after EEA was not found to be predictive of remission with additional therapies. We used stringent consensus criteria from 2010 in a series which included a high proportion of invasive GH secreting adenomas to show that EEA alone or combined with other modalities results in comparable remission rates to earlier studies which used less strict criteria, while retaining low complication rates.
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