Pituitary Tumors Centers of Excellence

Frara, Stefano; Rodríguez-Carnero, Gemma; Formenti, Ana M.; Martinez-Olmos, Miguel A.; Giustina, Andrea; Casanueva, Felipe F.

doi:10.1016/j.ecl.2020.05.010

Cited by 49 publications

(36 citation statements)

References 55 publications

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“…Based on these evidences, COVID-19-related prothrombotic and endothelial systemic illness may be precipitating risk factors for pituitary apoplexy, especially in patients affected by pituitary adenomas. Therefore, increased awareness toward this complication particularly in predisposed patients (macroadenoma on dopaminergic agents, anticoagulant therapy) is needed not only in specialized pituitary tumor centers [ 66 ]. Nevertheless, it can be also thought that due to the reduction in “routine” activities in Neurosurgical departments urgent referrals such as those with pituitary apoplexy may just be among the few patients with pituitary diseases seen during the pandemic.…”

Section: Main Pituitary Manifestations Of Covid-19mentioning

confidence: 99%

COVID-19 and the pituitary

et al. 2021

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Background Despite COVID-19 being identified as severe respiratory viral infection, progressively many relevant endocrine manifestations have been reported greatly contributing to the severity of the clinical presentation. Systemic involvement in COVID-19 is due to the ubiquitous expression of angiotensin-converting enzyme 2 (ACE2) receptor, responsible for the entry in the cells of SARS-CoV-2, Several reports in humans and animal models showed a significant ACE2 mRNA expression in hypothalamus and pituitary cells. Moreover, higher mortality and poorer outcomes have been widely described in COVID-19 patients with obesity, diabetes and vertebral fractures, which are all highly prevalent in subjects with pituitary dysfunctions. Aim To review the main endocrine manifestations of COVID-19 with their possible implications for pituitary diseases, the possible direct and indirect involvement of the pituitary gland in COVID-19, the impact of COVID-19 on the management of established pituitary diseases which can be already at increased risk for worse outcomes and on neurosurgical activities as well as vaccination. Conclusions Our review underlines that there could be a specific involvement of the pituitary gland which fits into a progressively shaping endocrine phenotype of COVID-19. Moreover, the care for pituitary diseases need to continue despite the restrictions due to the emergency. Several pituitary diseases, such as hypopituitarism and Cushing disease, or due to frequent comorbidities such as diabetes may be a risk factor for severe COVID-19 in affected patients. There is the urgent need to collect in international multicentric efforts data on all these aspects of the pituitary involvement in the pandemic in order to issue evidence driven recommendations for the management of pituitary patients in the persistent COVID-19 emergency.

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Section: Main Pituitary Manifestations Of Covid-19mentioning

confidence: 99%

COVID-19 and the pituitary

et al. 2021

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“…Acromegaly is a chronic disease which, if not adequately controlled, heavily impacts on quality of life and survival due to its many systemic comorbidities [10,13,17]. However, the well-known clinical challenges in the management of the disease, i.e., persistent lengthy diagnostic delays [18], which lead to a high prevalence of macroadenomas at presentation with the need for strict control of pituitary tumor growth [19] and the frequent need for multimodal treatment in Pituitary Tumors Centers of Excellence (PTCOE) [20][21][22] are likely to be heavily affected by systemic rearrangements and ongoing crises in healthcare during the COVID-19 pandemic. Moreover, several comorbidities in patients with acromegaly (e.g., hypopituitarism, diabetes mellitus, hypertension, obesity, cardiorespiratory diseases and fractures) [17,23,24] may negatively influence the course and management of COVID-19 [4,5,25] and must be appropriately managed to avoid increased predisposition to viral infection and complications.…”

Section: Discussionmentioning

confidence: 99%

Results from ACROCOVID: an international survey on the care of acromegaly during the COVID-19 era

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Cesana

et al. 2021

Endocrine

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“…The time between surgery and radiotherapy was highly variable. These indications were taken during multidisciplinary meetings, in accordance with current recommendations ( 2 , 7 , 18 , 56 , 57 ). Of note, when no radiotherapy was required beyond 5 years of follow-up, no further tumor progression was observed afterwards, and thus could be considered as long-term controlled by surgery.…”

Section: Discussionmentioning

confidence: 99%

Outcome of giant pituitary tumors requiring surgery

et al. 2022

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ObjectiveThe management of giant pituitary tumors is complex, with few publications and recommendations. Consequently, patient’s care mainly relies on clinical experience. We report here a first large series of patients with giant pituitary tumors managed by a multidisciplinary expert team, focusing on treatments and outcome.MethodsA retrospective cohort study was conducted. Giant pituitary tumors were defined by a main diameter > 40mm. Macroprolactinomas sensitive to dopamine agonists were excluded. All patients were operated by a single neurosurgical team. After surgery, multimodal management was proposed, including hormone replacement, radiotherapy and anti-tumor medical therapies. Outcome was modeled using Kaplan-Meyer representation. A logistic regression model was built to identify the risk factors associated with surgical complications.Results63 consecutive patients presented a giant adenoma, most often with visual defects. Patients were operated once, twice or three times in 59%, 40% and 1% of cases respectively, mainly through endoscopic endonasal approach. Giant adenomas included gonadotroph, corticotroph, somatotroph, lactotroph and mixed GH-PRL subtypes in 67%, 14%, 11%, 6% and 2% of patients respectively. Vision improved in 89% of patients with prior visual defects. Severe surgical complications occurred in 11% of patients, mainly for tumors > 50 mm requiring microscopic transcranial approach. Additional radiotherapy was needed for 29% of patients, 3 to 56 months after first surgery. For 6% of patients, Temozolomide treatment was required, 19 to 66 months after first surgery.ConclusionsGiant pituitary tumors require multimodal management, with a central role of surgery. Most often, tumor control can be achieved by expert multidisciplinary teams.

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Pituitary Tumors Centers of Excellence

Cited by 49 publications

References 55 publications

COVID-19 and the pituitary

COVID-19 and the pituitary

Results from ACROCOVID: an international survey on the care of acromegaly during the COVID-19 era

Outcome of giant pituitary tumors requiring surgery

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