Prognostic Factors of Acromegalic Patients with Growth Hormone–Secreting Pituitary Adenoma After Transsphenoidal Surgery

Taweesomboonyat, Chin; Oearsakul, Thakul

doi:10.1016/j.wneu.2020.12.013

Cited by 7 publications

(9 citation statements)

References 13 publications

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“…Although most microadenomas are asymptomatic, when pituitary tumors cause pituitary hyperfunction or hypofunction, tumor space occupying effect, and pituitary tumor stroke, they will have a negative impact on the human body [ 4 ]. The pituitary gland plays a very important role in maintaining endocrine balance in the human body, functional pituitary adenomas may cause excessive secretion of hormones and cause hyperpituitarism, and the local mass effect of tumors may cause headache, decreased visual acuity, and hydrocephalus symptoms, while giant adenomas may compress intracranial tissues and lead to hypopituitarism [ 5 ]. Therefore, when patients have headache, decreased vision, or visual impairment, combined with sexual dysfunction caused by endocrine abnormalities (male), menopause or lactation stop (female), and abnormal obesity, they should seek medical examination in time to diagnose the existence of pituitary adenoma.…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Cerebrospinal Fluid Leaking following Pituitary Adenoma Transsphenoidal Surgery: A Meta-Analysis and Comprehensive Review

Zhang

Liu

Huang

2022

BioMed Research InternationalRetracted 2022-11-22

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Background. Surgical resection is the main method to treat pituitary adenoma. Cerebrospinal fluid leakage (CSF Leak) is the main complication after transsphenoidal surgery. The impact of postoperative CSF Leak can be predicted in advance, and preventive measures can be taken in time. Clinically, a variety of factors may affect the occurrence of postoperative CSF Leak. In this study, meta-analysis was used to investigate the risk factors of postoperative CSF Leak as a clinical reference. Methods. The databases PubMed, Medline, Embrase, Cochrane library, CNKI, and CBM were searched for all studies on the risk factors of postoperative CSF Leak. Studies were screened and finally included. The quality of the included studies was assessed by the Newcastle-Ottawa scale. We used Revman 5.4 software to conduct the pooled effect size of every potential statistically significant factor. Results. 13 articles with a total of 5967 patients with pituitary adenoma and 405 cases of postoperative CSF Leak were finally included, accounting for 6.79%. All of the 13 articles had a quality score > 5 , indicating good quality. Meta-analysis showed that patient age ( OR = 0.71 , 95% CI (0.41, 1.20), P = 0.20 ) was not a factor influencing postoperative CSF Leak, while BMI ( MD = 2.26 , 95% CI (1.31, 3.20), P < 0.00001 ), tumor size ( MD = 1.35 , 95% CI (0.22, 2.49), P = 0.02 ), whether a second operation was performed ( OR = 2.20 , 95% CI (1.45, 3.33), P = 0.0002 ), and intraoperative CSF Leak ( OR = 8.88 , 95% CI (3.64, 21.69), P < 0.00001 ) were risk factors for postoperative CSF Leak in patients. Discussion. BMI, tumor size, reoperation, and intraoperative CSF Leak are the risk factors of postoperative CSF Leak. However, not all the factors were covered in this study, it is still worth continuing to deeply investigate in this topic.

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Section: Introductionmentioning

confidence: 99%

Factors Influencing Cerebrospinal Fluid Leaking following Pituitary Adenoma Transsphenoidal Surgery: A Meta-Analysis and Comprehensive Review

Zhang

Liu

Huang

2022

BioMed Research InternationalRetracted 2022-11-22

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“…Although considered benign, 25%–55% of PAs present invasive behavior, characterized by the invasion of adjacent structures, including sphenoid sinus, diaphragm sellae, and cavernous sinus (CS) ( 1 ). Cavernous sinus invasion (CSI) is a significant risk factor for incomplete resection, and it is responsible for the failure of endocrinological remission and high rate of tumor recurrence ( 2 – 4 ). Hence, CSI is an important concern in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Application of Convolutional Neural Network in the Diagnosis of Cavernous Sinus Invasion in Pituitary Adenoma

et al. 2022

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ObjectivesConvolutional neural network (CNN) is a deep-learning method for image classification and recognition based on a multi-layer NN. In this study, CNN was used to accurately assess cavernous sinus invasion (CSI) in pituitary adenoma (PA).MethodsA total of 371 patients with PA were enrolled in the retrospective study. The cohort was divided into the invasive (n = 102) and non-invasive groups (n = 269) based on surgically confirmed CSI. Images were selected on the T1-enhanced imaging on MR scans. The cohort underwent a fivefold division of randomized datasets for cross-validation. Then, a tenfold augmented dataset (horizontal flip and rotation) of the training set was enrolled in the pre-trained Resnet50 model for transfer learning. The testing set was imported into the trained model for evaluation. Gradient-weighted class activation mapping (Grad-CAM) was used to obtain the occlusion map. The diagnostic values were compared with different dichotomizations of the Knosp grading system (grades 0-1/2-4, 0-2/3a-4, and 0-3a/3b-4).ResultsBased on Knosp grades, 20 cases of grade 0, 107 cases of grade 1, 82 cases of grade 2, 104 cases of grade 3a, 22 cases of grade 3b, and 36 cases of grade 4 were recorded. The CSI rates were 0%, 3.7%, 18.3%, 37.5%, 54.5%, and 88.9%. The predicted accuracies of the three dichotomies were 60%, 74%, and 81%. The area under the receiver operating characteristic (AUC-ROC) of Knosp grade for CSI prediction was 0.84; the cutoff was 2.5 with a Youden value of 0.62. The accuracies of the CNN model ranged from 0.80 to 0.96, with AUC-ROC values ranging from 0.89 to 0.98. The Grad-CAM saliency maps confirmed that the region of interest of the model was around the sellar region.ConclusionsWe constructed a CNN model with a high proficiency at CSI diagnosis. A more accurate CSI identification was achieved with the constructed CNN than the Knosp grading system.

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“…The cause is, most commonly, an autonomously functioning pituitary adenoma (PA) secreting GH only or GH in combination with prolactin. It has been reported that autonomously functioning PAs secreting GH only account for 25% of all autonomously functioning PAs and for 2-17% of all PAs [1,2,3,4,5]. Acromegaly is characterized by pathological and disproportionate growth of bones, soft tissues and internal organs, and various metabolic abnormalities (diabetes mellitus, lipid abnormalities, cholelitiasis, hyperthyroidism, splanchnomegaly, respiratory complications, cardiovascular complications, hypertension, impaired calcium metabolism, and peripheral neuropathy) [6,7,8,9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Visual disturbances are the major clinical features in many somatotropic PAs and exert mass effects on the optic nerve/chiasm complex, with a reduction in visual acuity in 38%-68.5% and visual field abnormalities in 39.8%-70% of patients [12,13,14,15,16]. The presence of visual disturbances is generally considered a major indication for urgent surgery [2,5,17].…”

Section: Introductionmentioning

confidence: 99%

“…Since there are numerous pathomorphological variants of GH-secreting pituitary adenomas differing in clinical picture and resistance to treatment, a strong interest has emerged to identify the clinical and biological prognostic factors in acromegaly in order to optimize the treatment strategy for patients with the disease. Cuevas-Ramos and colleagues [5,18] aimed to rigorously classify an acromegaly patient cohort defined by clinical, radiological, histopathological, and outcome characteristics, and developed a structural and functional acromegaly classification. They identified three structural and functional acromegaly types distinguished by clinical course, tumor aggressiveness and treatment responsiveness, expression profile of somatotroph surface receptors and markers of cell senescence, and disease outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Features of visual disturbances in patients with newly diagnosed acromegalia

Iegorova¹,

Zadoianyi²,

Guk³

et al. 2022

Oftalmol Zh

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Background: Acromegaly is a complex neuroendocrinologic disorder associated with hypersecretion of growth hormone (GH) and insulin-like growth factor in individuals with completed physiological growth. The cause is, most commonly, an autonomously functioning pituitary adenoma (PA) secreting GH only or GH in combination with prolactin. Cuevas-Ramos and colleagues identified three structural and functional acromegaly types distinguished by clinical course, direction of tumor extension, tumor aggressiveness, expression profile of somatotroph surface receptors and potential responsiveness to treatment. Purpose: To review the features of visual disturbances in patients with newly diagnosed acromegaly. Material and Methods: We retrospectively reviewed the medical records of 174 patients with newly diagnosed acromegaly who underwent endoscopic transnasal transsphenoidal surgery for PA at the Transsphenoidal Neurosurgery Department of the Romodanov Institute during 2018 through 2011. In all patients, the diagnosis of PA was confirmed by a comprehensive morphological study. Of the 174 patients, 11.5% (20 patients; 40 eyes) had visual disturbances (reduced visual acuity and/or visual field defects) and were included in the visual disturbance group. Patients underwent clinical and neurological, endocrinological and eye examination and neuroimaging studies.Results: Visual disturbances were found preoperatively in 20 (11.5%) of the 174 consecutive patients with PA secreting GH only. Of the 20 cases, 17 (85%) were classified as type 3, and 3 (15%), as type 2 according to the structural and functional acromegaly classification of Cuevas-Ramos et al. Suprasellar extension of the pituitary adenoma towards the optic nerve-chiasm complex and compression of the crossed optic nerve fibers caused symmetric chiasmal syndrome in 11 (55%) and primary descending optic atrophy in 14 (70%) patients. After treatment, the numbers of eyes with severe and very severe visual acuity loss reduced by 5% and 7.5%, respectively, and a reduction in visual field defects was observed in 12.5% of eyes. Conclusion:We believe that the application of the structural and functional acromegaly classification by Cuevas-Ramos and colleagues would be useful not only for assessing whether a multimodal approach (comprising neurosurgery, medical therapy and radiotherapy) is required, but also for predicting the risk of developing visual disturbances in a particular case of acromegaly.

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Prognostic Factors of Acromegalic Patients with Growth Hormone–Secreting Pituitary Adenoma After Transsphenoidal Surgery

Cited by 7 publications

References 13 publications

Factors Influencing Cerebrospinal Fluid Leaking following Pituitary Adenoma Transsphenoidal Surgery: A Meta-Analysis and Comprehensive Review

Factors Influencing Cerebrospinal Fluid Leaking following Pituitary Adenoma Transsphenoidal Surgery: A Meta-Analysis and Comprehensive Review

Application of Convolutional Neural Network in the Diagnosis of Cavernous Sinus Invasion in Pituitary Adenoma

Features of visual disturbances in patients with newly diagnosed acromegalia

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