Clinically non-functioning pituitary adenomas: Pathogenic, diagnostic and therapeutic aspects

Mercado, Moisés; Melgar, Virgilio; Salame, Latife; Cuenca, Dalia

doi:10.1016/j.endien.2017.08.012

Cited by 37 publications

(29 citation statements)

References 104 publications

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“…In 2016, a systematic review and evidence-based guideline for residual or recurrent NFPAs was published by the Congress of Neurological Surgeons, and repeat resection is listed as a level III recommendation for the treatment of symptomatic recurrent or residual NFPAs (10). Mercado (11) reported that the presence of extension into the cavernous sinus and of an adenoma remnant after initial surgery associated with recurrence. Espinosa De Los Monteros et al (12) also evaluated the outcome of surgical reintervention in patients with active acromegaly, and found that only 9% (5/53) of patients achieved complete biochemical cure.…”

Section: Management Of Refractory Pasmentioning

confidence: 99%

The Treatment of Refractory Pituitary Adenomas

Dai

Liu

et al. 2019

Front. Endocrinol.

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Refractory pituitary adenomas (PAs) are defined as aggressive-invasive PAs characterized by a high Ki-67 index, rapid growth, frequent recurrence, and resistance to conventional treatments. It is notoriously difficult to manage refractory PAs because the efficacy of current therapeutic options is limited. The purpose of this review is to address currently employed and promising therapeutic strategies for the treatment of refractory PAs. Except for prolactinomas, neurosurgery is the first-line option, but most refractory PAs often recur or re-grow after initial surgery and require further treatments. Medical therapy, radiotherapy and re-operation are explored when surgery has failed to completely resect tumors; however, refractory PAs are usually resistant to these treatments. As a salvage treatment, temozolomide (TMZ) has shown promising results and is currently used for all types of refractory PAs. However, not all refractory PAs are responsive to TMZ treatment, and some of these PAs are resistant to TMZ. Although targeted therapies such as vascular endothelial growth factor, epidermal growth factor and mTOR inhibitors have also been used to treat refractory PAs, the effectiveness of these targeted therapies is still not known due to a lack of data from randomized prospective trials. As a novel therapeutic method, cancer immunotherapy is a promising strategy for the treatment of refractory PAs, but further preclinical research and clinical trials are needed to assess the efficacy of this new approach. In summary, early identification and a multidisciplinary approach are required to treat refractory PAs.

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Section: Management Of Refractory Pasmentioning

confidence: 99%

The Treatment of Refractory Pituitary Adenomas

Dai

Liu

et al. 2019

Front. Endocrinol.

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“…Clinically nonfunctioning pituitary adenoma is a common type of tumor in the sellar region [1]. e prevalence of nonfunctioning pituitary adenomas varies between 60 and 100 cases per million population [1,2].…”

Section: Introductionmentioning

confidence: 99%

A Nonfunctioning Pituitary Macroadenoma Presenting as Cyclical Vomiting and Severe Hyponatremia in a Young Female

Warapitiya

Muthukuda

Sanjeewa

et al. 2021

Case Reports in Endocrinology

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Introduction. Recurrent vomiting is a commonly overlooked debilitating symptom which causes significant impact on the quality of life. There are several causes for vomiting, ranging from commonly known causes to rare causes. Nonfunctioning pituitary macroadenomas generally present with visual disturbances, headache, and symptoms due to anterior pituitary hormone deficiencies. This case report is about an atypical presentation of a nonfunctioning pituitary macroadenoma in which the patient presented with cyclical vomiting with severe hyponatremia. Case Report. A 23-year-old girl presented with four to five episodes of vomiting per day for two days duration. She had a history of similar episodes of vomiting since 2016, with each episode generally lasting for 4-5 days and occurring in every four to six months. All episodes exhibited similar symptomatology and she was free of symptoms in-between. Generalized body weakness, postural dizziness, reduced appetite, and secondary amenorrhea were other symptoms she has had since 2016. Examination findings showed a low body mass index (BMI) (16 kg/m2) with normal system examination. Investigations showed severe hyponatremia (110 mmol/L) with hypokalemia (3.2 mmol/L) and hypochloremia (74 mmol/L). Her urinary excretion of potassium, sodium, and serum osmolality was low. Urine osmolality was mildly elevated compared to serum osmolality. Blood urea was normal. Severe hyponatremia with minimal hyponatremic symptoms was suggestive of chronic hyponatremia, which was accentuated by ongoing vomiting and possible reduced intake of salt. Further investigations showed evidence of secondary hypoadrenalism, central hypothyroidism, hypogonadotropic hypogonadism, and mild hyperprolactinemia. Magnetic resonance imaging (MRI) revealed a pituitary macroadenoma with mass effect on the optic chiasma. Hydrocortisone and levothyroxine were started, and she underwent transsphenoidal resection of the pituitary tumor. She recovered from cyclical vomiting. Conclusion. There can be multiple overlapping aetiologies for every observed symptom, sign, and abnormal investigation finding. Therefore, aetiological diagnosis is challenging, especially in the presence of an atypical clinical presentation. Cyclical vomiting and severe hyponatremia are atypical presentations of nonfunctioning pituitary macroadenomas.

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“…The diagnostic approaches regarding to NFPAs include perimetry, the evaluation of all anterior pituitary hormone systems, and the sellar region of tumor in MRI [ 8 ]. Except for a few functional PA, which can be controlled by drugs, it hasn’t been any effective drug treatment for NFPAs so far.…”

Section: Introductionmentioning

confidence: 99%

“…The recurrence rate after operation is up to 30%. Radiation therapy is usually used in the treatment of persistent or recurrent adenomas, however, the treatment effect is still unsatisfactory [ 8 ]. So novel therapeutic methods and medicines are needed urgently.…”

Section: Introductionmentioning

confidence: 99%

Identification of driver genes and key pathways of non-functional pituitary adenomas predicts the therapeutic effect of STO-609

Jiang

Wang

et al. 2020

PLoS ONE

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Objective Our study is to identify DEGs (Differentially Expressed Genes), comprehensively investigate hub genes, annotate enrichment functions and key pathways of Non-functional pituitary adenomas (NFPAs), and also to verify STO-609 therapeutic effect. Methods The gene expression level of NFPA and normal tissues were compared to identify the DEGs (Differential expressed genes) based on gene expression profiles (GSE2175, GSE26966 and GSE51618). Enrichment functions, pathways and key genes were identified by carrying out GO (Gene Ontology), KEGG (Kyoto Encyclopedia of Genes and Genomes) analysis and PPI (Protein-Protein Interation) network analysis. Moreover, experiments in vitro were conducted to verify the anti-NFPAs effects of STO-609. Results 169 over-expression genes and 182 low expression genes were identified among 3 datasets. Dopaminergic synapse and vibrio cholerae infection pathways have distinctly changed in NFPA tissues. The Ca 2+ /CaM pathway played important roles in NFPA. Four hub proteins encoded by genes CALM1 , PRDM10 , RIPK4 and MAD2L1 were recognized as hub proteins. In vitro, assays showed that STO-609 induced apoptosis of NFPA cells to inhibit the hypophysoma cellular viability, diffusion and migration. Conclusion Four hub proteins, encoded by gene CALM1 , PRDM10 , RIPK4 and MAD2L1 , played important roles in NFPA development. The Ca 2+ /CaM signaling pathway had significant alternations during NFPA forming process, the STO-609, a selective CaM-KK inhibitor, inhibited NFPA cellular viability, proliferation and migration. Meanwhile, NFPA was closely related to parkinson’s disease (PD) in many aspects.

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Clinically non-functioning pituitary adenomas: Pathogenic, diagnostic and therapeutic aspects

Cited by 37 publications

References 104 publications

The Treatment of Refractory Pituitary Adenomas

The Treatment of Refractory Pituitary Adenomas

A Nonfunctioning Pituitary Macroadenoma Presenting as Cyclical Vomiting and Severe Hyponatremia in a Young Female

Identification of driver genes and key pathways of non-functional pituitary adenomas predicts the therapeutic effect of STO-609

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