Functioning Pituitary Adenoma

Sharif-Alhoseini, Mahdi; Laws, Edward R.; Rahimi‐Movaghar, Vafa

doi:10.5772/33824

Cited by 4 publications

(5 citation statements)

References 75 publications

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“…28,29 Functional macro-adenomas are associated with serious clinical manifestations in most cases, but non-functional types may have or not have this association. 30 Thus, differential diagnosis of both types is important in clinical evaluation or selection of therapeutic strategy. 4,5 DWI and low ADC values are suggested as the predictors of aggressive pituitary macro-adenoma.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of diffusion-weighted imaging-magnetic resonance in differentiating functional from non-functional pituitary macro-adenoma and classification of tumor consistency

et al. 2018

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The purpose of this study was to determine the accuracy of selected first or second-order histogram features in differentiation of functional types of pituitary macro-adenomas. Materials and methods: Diffusion-weighted imaging magnetic resonance imaging was performed on 32 patients (age meanAEstandard deviation ¼ 43.09 AE 11.02 years; min ¼ 22 and max ¼ 65 years) with pituitary macro-adenoma (10 with functional and 22 with non-functional tumors). Histograms of apparent diffusion coefficient were generated from regions of interest and selected first or second-order histogram features were extracted. Collagen contents of the surgically resected tumors were examined histochemically using Masson trichromatic staining and graded as containing <1%, 1-3%, and >3% of collagen. Results: Among selected first or second-order histogram features, uniformity (p ¼ 0.02), 75th percentile (p ¼ 0.03), and tumor smoothness (p ¼ 0.02) were significantly different between functional and non-functional tumors. Tumor smoothness > 5.7 Â 10 À9 (area under the curve ¼ 0.75; 0.56-0.89) had 70% (95% confidence interval ¼ 34.8-93.3%) sensitivity and 33.33% (95% confidence interval ¼ 14.6-57.0%) specificity for diagnosis of functional tumors. Uniformity 179.271 had a sensitivity of 60% (95% confidence interval ¼ 26.2-87.8%) and specificity of 90.48% (95% confidence interval ¼ 69.6-98.8%) with area under the curve ¼ 0.76; 0.57-0.89. The 75th percentile >0.7 had a sensitivity of 80% (95% confidence interval ¼ 44.4-97.5%) and specificity of 66.67% (95% confidence interval ¼ 43.0-85.4%) for categorizing tumors to functional and non-functional types (area under the curve ¼ 0.74; 0.55-0.88). Using these cutoffs , smoothness and uniformity are suggested as negative predictive indices (non-functional tumors) whereas 75th percentile is more applicable for diagnosis of functional tumors. Conclusion: First or second-order histogram features could be helpful in differentiating functional vs non-functional pituitary macro-adenoma tumors.

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Section: Discussionmentioning

confidence: 99%

Accuracy of diffusion-weighted imaging-magnetic resonance in differentiating functional from non-functional pituitary macro-adenoma and classification of tumor consistency

et al. 2018

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“…The tumors are often classified by secretory products they produce. Adrenocorticotropic hormone (ACTH) producing adenomas account for 10–20% of pituitary adenomas [1]. Typically, ACTH producing tumors of the pituitary gland result in Cushing’s disease, a process caused by excess glucocorticoid production [1].…”

Section: Introductionmentioning

confidence: 99%

“…Adrenocorticotropic hormone (ACTH) producing adenomas account for 10–20% of pituitary adenomas [1]. Typically, ACTH producing tumors of the pituitary gland result in Cushing’s disease, a process caused by excess glucocorticoid production [1]. The clinical manifestations of Cushing’s disease include central fat deposition, abdominal striae, moon facies, buffalo hump, osteoporosis, hypertension, hirsutism, gonadal dysfunction, and immunosuppression [1].…”

Section: Introductionmentioning

confidence: 99%

“…Typically, ACTH producing tumors of the pituitary gland result in Cushing’s disease, a process caused by excess glucocorticoid production [1]. The clinical manifestations of Cushing’s disease include central fat deposition, abdominal striae, moon facies, buffalo hump, osteoporosis, hypertension, hirsutism, gonadal dysfunction, and immunosuppression [1]. Less commonly, Cushing’s disease presents with hyperglycemia due to insulin resistance [2].…”

Section: Introductionmentioning

confidence: 99%

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ACTH-producing adenoma of the pituitary gland manifesting as severe insulin resistance

Aghili

Mnatsakanian

Segueni

2019

Journal of Surgical Case Reports

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Pituitary adenomas are commonly benign neoplasms which may manifest with a wide variety of symptomatology. Typically, ACTH- producing tumors of the pituitary gland present with central fat deposition, abdominal striae, moon facies, buffalo hump, osteoporosis, hypertension, hirsutism, gonadal dysfunction, immunosuppression, and less commonly with hyperglycemia due to insulin resistance. We report the case of a 58-year-old male patient with an ACTH producing pituitary microadenoma and type 2 Diabetes Mellitus (DM) whose primary presenting symptom was increasing insulin resistance despite appropriate adjustments to his insulin therapy. Bilateral inferior petrosal sinus sampling showed results highly suspicious for a left sided pituitary microadenoma. Endoscopic endonasal transsphenoidal resection of the pituitary tumor was performed to resect the microadenoma of the left gland. This case adds to the diverse presentations of pituitary adenomas, in that these lesions must be included in the differential diagnosis of a type 2 DM patient with hyperglycemia and insulin resistance.

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“…[ 11 – 14 ] In addition, the relapse rate of FPAs has been reported to be 20% to 45% depending on various endocrine functions. [ 15 – 17 ] Radiotherapy (RT) is frequently used in patients with residual or recurrent PAs with excellent rates of tumor control and remission of hormonal hypersecretion. Compared with conventional RT, CyberKnife stereotactic radiosurgery (CK SRS) allows for the delivery of a high dose of irradiation to the tumor while sparing critical radiosensitive structures, and it is widely used as postoperative adjuvant treatment of PAs.…”

Section: Introductionmentioning

confidence: 99%

Analysis of volumetric response of pituitary adenomas receiving adjuvant CyberKnife stereotactic radiosurgery with the application of an exponential fitting model

Yang

Lin

et al. 2017

Medicine

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Tumor control rates of pituitary adenomas (PAs) receiving adjuvant CyberKnife stereotactic radiosurgery (CK SRS) are high. However, there is currently no uniform way to estimate the time course of the disease. The aim of this study was to analyze the volumetric responses of PAs after CK SRS and investigate the application of an exponential decay model in calculating an accurate time course and estimation of the eventual outcome.A retrospective review of 34 patients with PAs who received adjuvant CK SRS between 2006 and 2013 was performed. Tumor volume was calculated using the planimetric method. The percent change in tumor volume and tumor volume rate of change were compared at median 4-, 10-, 20-, and 36-month intervals. Tumor responses were classified as: progression for >15% volume increase, regression for ≤15% decrease, and stabilization for ±15% of the baseline volume at the time of last follow-up. For each patient, the volumetric change versus time was fitted with an exponential model.The overall tumor control rate was 94.1% in the 36-month (range 18–87 months) follow-up period (mean volume change of −43.3%). Volume regression (mean decrease of −50.5%) was demonstrated in 27 (79%) patients, tumor stabilization (mean change of −3.7%) in 5 (15%) patients, and tumor progression (mean increase of 28.1%) in 2 (6%) patients (P = 0.001). Tumors that eventually regressed or stabilized had a temporary volume increase of 1.07% and 41.5% at 4 months after CK SRS, respectively (P = 0.017). The tumor volume estimated using the exponential fitting equation demonstrated high positive correlation with the actual volume calculated by magnetic resonance imaging (MRI) as tested by Pearson correlation coefficient (0.9).Transient progression of PAs post-CK SRS was seen in 62.5% of the patients receiving CK SRS, and it was not predictive of eventual volume regression or progression. A three-point exponential model is of potential predictive value according to relative distribution. An exponential decay model can be used to calculate the time course of tumors that are ultimately controlled.

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Functioning Pituitary Adenoma

Cited by 4 publications

References 75 publications

Accuracy of diffusion-weighted imaging-magnetic resonance in differentiating functional from non-functional pituitary macro-adenoma and classification of tumor consistency

Accuracy of diffusion-weighted imaging-magnetic resonance in differentiating functional from non-functional pituitary macro-adenoma and classification of tumor consistency

ACTH-producing adenoma of the pituitary gland manifesting as severe insulin resistance

Analysis of volumetric response of pituitary adenomas receiving adjuvant CyberKnife stereotactic radiosurgery with the application of an exponential fitting model

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