Editorial

Oldfield, Edward H.

doi:10.3171/2010.8.focus10215

Cited by 18 publications

(10 citation statements)

References 11 publications

(11 reference statements)

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“…However, reports on the results of endoscopic TS in CD are still scarce, and in studies that have been published (including our own report on the results in the first 35 patients), all patients have a short follow-up period, so no statements about recurrences can be made (23,24,25). Furthermore, it is still unclear whether the endoscopic technique has advantages or disadvantages in patients with very small microadenomas (!5 mm), which occur frequently in patients with CD (26,27). Therefore, some neurosurgeons are reluctant to use this technique in patients with CD (27).…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic transsphenoidal pituitary surgery: a good and safe primary treatment option for Cushing's disease, even in case of macroadenomas or invasive adenomas

Wagenmakers

Boogaarts

Roerink

et al. 2013

European Journal of Endocrinology

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Context: Although the endoscopic technique of transsphenoidal pituitary surgery (TS) has been widely adopted, reports on its results in Cushing's disease (CD) are still scarce and no studies have investigated long-term recurrence rates. This is the largest endoscopic series published till now. Objective: To gain insight into the role of endoscopic TS as a primary treatment option for CD, especially in patients with magnetic resonance imaging (MRI)-negative CD and (invasive) macroadenomas. Design: Retrospective cohort study. Patients and methods: The medical records of 86 patients with CD who underwent endoscopic TS were examined. Data on preoperative and postoperative evaluation, perioperative complications, and followup were collected. Remission was defined as disappearance of clinical symptoms with a fasting plasma cortisol level %50 nmol/l either basal or after 1 mg dexamethasone. Results: The remission rate in different adenoma subclasses varied significantly: 60% in MRI-negative CD (nZ20), 83% in microadenomas (nZ35), 94% in noninvasive macroadenomas (nZ16), and 40% in macroadenomas that invaded the cavernous sinus (nZ15). The recurrence rate was 16% after 71G39 months of follow-up (meanGS.D., range 10-165 months). Conclusions: Endoscopic TS is a safe and effective treatment for all patients with CD. Recurrence rates after endoscopic TS are comparable with those reported for microscopic TS. Our data suggest that in patients with noninvasive and invasive macroadenomas, the endoscopic technique of TS should be the treatment of choice as remission rates seem to be higher than those reported for microscopic TS, although no comparative study has been performed.

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Section: Introductionmentioning

confidence: 99%

“…Furthermore, it is still unclear whether the endoscopic technique has advantages or disadvantages in patients with very small microadenomas (!5 mm), which occur frequently in patients with CD (26,27). Therefore, some neurosurgeons are reluctant to use this technique in patients with CD (27).…”

Section: Introductionmentioning

confidence: 99%

Endoscopic transsphenoidal pituitary surgery: a good and safe primary treatment option for Cushing's disease, even in case of macroadenomas or invasive adenomas

Wagenmakers

Boogaarts

Roerink

et al. 2013

European Journal of Endocrinology

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“…Medication may be used as the sole first-line therapeutic option, as an adjuvant to surgical resection in selected cases, or after stereotactic radiosurgery or fractionated radiotherapy to reduce GH levels, after which there is an expected delay in GH levels, one that typically takes 2-5 years for radiosurgery and 3-10 years for fractionated radiation [41]. Periodically after radiation (at 6 or 12-month intervals), one may need to withhold medical therapy for several weeks (for short-acting agents) or longer (for longer-acting agents), to determine whether the radiation has been effective, and this appears to be clinically reasonable, with no rebound hormone levels or increase in tumor size [42].…”

Section: What Options Are Available For Medical Treatment?mentioning

confidence: 99%

“…Surgical resection is the first-line, gold standard, and the most efficacious treatment option for patients with microadenomas and macroadenomas without extracellular invasion [1,9,42,53]. Both the microsurgical transsphenoidal and endonasal, endoscopic transsphenoidal routes are utilized to access pituitary adenomas.…”

Section: What Are the Surgical Options In Acromegaly?mentioning

confidence: 99%

“…Tumor volume and invasion of parasellar structures (bone, dura, or cavernous sinus walls or contents) as the best predictors of both the limits of resection and of hormone normalization [54]. Thus, hormone control rates are lower in patients with macroadenomas when compared to those with microadenomas; and patients in whom the bone, dura, or cavernous sinus are invaded, have continued reductions in surgical remission rates associated with lower control rates [42]. Even with large and invasive tumors, remission rates in patients where trans-sphenoidal surgery is combined, deliberately, with adjunctive multimodal therapy, long-term remission rates can exceed 80% [55].…”

Section: What Are the Surgical Options In Acromegaly?mentioning

confidence: 99%

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Acromegaly: Overview and Current Management Options

Ahmad,

J. Weil

2023

The Pituitary Gland - An Overview of Pathophysiology and Current Management Techniques

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Growth-hormone-producing pituitary adenomas in adults will be the focus of this review acromegaly is a disorder caused by pathologically excess levels of growth hormone (GH), nearly always secondary to a pituitary somatotroph adenoma, which account for 10–20% of all pituitary adenomas. Acromegaly is a pan-systemic disease, including but not limited to effects of excess growth hormone on the cardiovascular, respiratory, gastrointestinal, metabolic, and reproductive systems. This raises the concern for clinicians and patients alike in diagnosing the underlying disease when multiple systems are involved. Numerous organ systems may be differentially affected, and the multiplicity of signs and symptoms possibly overlap with other conditions, with the typically slow progression of the disease, it may take years from the initiation of biochemical GH excess before a diagnosis of acromegaly is made. The goal of effective treatment of acromegaly is to eliminate hypersecretion of GH and normalize the production of IGF-1 while preserving normal pituitary function. Medication, radiotherapy, and surgery, often in combination, and over time, are required to mitigate, reduce, and eliminate the morbidity and excess, premature mortality caused by GH elevation.

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