Surgical treatment of pituitary tumours

Buchfelder, Michael; Schlaffer, Sven

doi:10.1016/j.beem.2009.05.002

Cited by 94 publications

(48 citation statements)

References 54 publications

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“…Transsphenoidal surgery reduces autonomous GH secretion in up to 60% of acromegalic patients (1). When autonomous GH secretion persists post-operatively, somatostatin analogues (SSA) are the first treatment option (2).…”

Section: Introductionmentioning

confidence: 99%

DG3173 (somatoprim), a unique somatostatin receptor subtypes 2-, 4- and 5-selective analogue, effectively reduces GH secretion in human GH-secreting pituitary adenomas even in Octreotide non-responsive tumours

Plöckinger

Hoffmann²,

Geese³

et al. 2012

European Journal of Endocrinology

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Objective: Somatostatin analogues (SSA) reduce autonomous GH secretion by activating somatostatin receptors (sst) 2 and 5 in 50-60% of acromegalic patients. However, by inhibiting insulin secretion these SSA reduce glucose tolerance. DG3173 is a novel SSA with additional binding to sst4 and low insulin-suppressing activity. We investigated the effect of DG3173, including its relation to specific tumour characteristics, on GH secretion in human somatotroph adenoma cell cultures (hSA) in comparison with Octreotide. Methods: Twenty-seven hSA were characterised immunohistochemically for their hormone-and sstexpression, granularity and pre-surgical therapy with SSA. GH was determined in supernatants of hSA treated with DG3173 or Octreotide in time-(nZ6) and dose-response (nZ21) experiments. A positive response was defined as GH suppression to below 80% of baseline. Results: In the dose-response experiments DG3173 suppressed GH secretion in more adenomas than Octreotide (10/21 vs 5/21), including 38% (6/16) of Octreotide non-responders. In responders the extent of GH suppression and IC 50 were comparable for both SSA. The response-rate of both SSA was higher in monohormonal vs bihormonal adenomas, yet GH declined similarly in both groups. Neither pre-surgical SSA (nZ6) nor tumour morphology was related to the GH response. However, semiquantitative analysis indicated a small but significant negative correlation between the GH response to Octreotide and the immunoreactivity scores of sst2 expression. Conclusions: DG3173 equalled Octreotide in suppressing GH secretion in hSA. Since DG3173 suppressed GH in some Octreotide-non-responsive adenomas, its clinical effectiveness will be worth testing. Moreover, its reduced insulin-suppressive potency would make it a valuable alternative to Octreotide.

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Section: Introductionmentioning

confidence: 99%

DG3173 (somatoprim), a unique somatostatin receptor subtypes 2-, 4- and 5-selective analogue, effectively reduces GH secretion in human GH-secreting pituitary adenomas even in Octreotide non-responsive tumours

Plöckinger

Hoffmann²,

Geese³

et al. 2012

European Journal of Endocrinology

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“…[16][17][18] Par-tial resection of the wall and evacuation of cyst contents are sufficient for an RCC, whereas a cystic pituitary adenoma may require total resection, not only to relieve mass effect but also to correct hormone excess. 9,[19][20][21] Unnecessary surgical excision of an RCC may lead to serious complications, such as CSF leaks, infection, and hypothalamic injury, though the incidences thereof are very low. 21,22 Thus, obtaining the correct preoperative diagnosis with which to determine the proper surgical indication and to plan the optimal surgical procedure is a major concern for neurosurgeons.…”

mentioning

confidence: 99%

“…9,[19][20][21] Unnecessary surgical excision of an RCC may lead to serious complications, such as CSF leaks, infection, and hypothalamic injury, though the incidences thereof are very low. 21,22 Thus, obtaining the correct preoperative diagnosis with which to determine the proper surgical indication and to plan the optimal surgical procedure is a major concern for neurosurgeons. 9 To date, several characteristic MR imaging appearances of pituitary adenomas and RCCs have been reported, 2,9,12,20,[23][24][25] but there are some cases for which the diagnoses are inconclusive when 1 or 2 imaging findings are used, and none of the studies has systemically analyzed the MR imaging appearances of cystic pituitary adenomas to differentiate them from RCCs.…”

mentioning

confidence: 99%

Differentiation between Cystic Pituitary Adenomas and Rathke Cleft Cysts: A Diagnostic Model Using MRI

Park

Lee

Choi³

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Cystic pituitary adenomas may mimic Rathke cleft cysts when there is no solid enhancing component found on MR imaging, and preoperative differentiation may enable a more appropriate selection of treatment strategies. We investigated the diagnostic potential of MR imaging features to differentiate cystic pituitary adenomas from Rathke cleft cysts and to develop a diagnostic model.

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“…Trans-sphenoidal adenectomy has typically been the accepted initial treatment of choice for the majority of patients with Acromegaly. [7][8][9][10][11][12][13][14][15][16][17] However, the prediction of postoperative disease activity is a major challenge, and even though different criteria for a cure have been suggested, the relationship between these criteria and long term disease control is not well known. 18 -26 The purpose of this is study is to validate the relationship between the early postoperative basal GH level and long term GH level (or in other words, based on GH level early postoperative, what are the chances that the GH will be normalized in long term).…”

Section: Introductionmentioning

confidence: 99%

Validity of Early Postoperative Random GH Level as a Predictor Factor of Long Term Control of GH- Producing Pituitary Adenoma

Assaad¹

2016

EMIJ

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Objective: The aim of this study was to evaluate and to validate the relationship between the early postoperative basal GH level and the long-term surgical treatment outcome of GHproducing pituitary adenoma as well as to present our experience of treating such types of pituitary adenoma in our institute. Materials and Methods:We retrospectively analyzed 103 patients with GH-secreting pituitary adenoma who underwent a surgical treatment between the years 2002 and 2010 in the department of Neurosurgery, University hospital, Damascus.The basal GH level was measured in the first week after surgery.With respect to basal GH levels, the patients were assigned to one of three groups:Group 1: patients with postoperative basal GH levels < 1 ng/mL.Group 2: patients with postoperative basal GH levels between 1-2.25 ng/mL.Group 3: patients with postoperative basal GH levels > 2.25 ng/mL.In every group the hormone activity was monitored postoperatively on a regular basis, the mean follow up duration was approximately 49 months (range 32-96 months). Definitive long term remission of acromegaly was considered to have been achieved when GH levels were less than 1 ng/mL and there was no clinical or magnetic resonance imaging evidence of a persisting disease. Results:The cure rate in Group 1 was 93.75 %, and in Group 2 was 72.72%, whereas in Group 3 all patients presented evidence of tumor residual or recurrence. The overall rate of cure was 45.23%. There was a significant relationship between the early postoperative basal GH concentration and long-term postoperative outcome (p<0.05). Conclusion:The early postoperative basal GH level is a simple and reliable factor that may help with predicting long term surgical outcome of pituitary adenoma.

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Surgical treatment of pituitary tumours

Cited by 94 publications

References 54 publications

DG3173 (somatoprim), a unique somatostatin receptor subtypes 2-, 4- and 5-selective analogue, effectively reduces GH secretion in human GH-secreting pituitary adenomas even in Octreotide non-responsive tumours

DG3173 (somatoprim), a unique somatostatin receptor subtypes 2-, 4- and 5-selective analogue, effectively reduces GH secretion in human GH-secreting pituitary adenomas even in Octreotide non-responsive tumours

Differentiation between Cystic Pituitary Adenomas and Rathke Cleft Cysts: A Diagnostic Model Using MRI

Validity of Early Postoperative Random GH Level as a Predictor Factor of Long Term Control of GH- Producing Pituitary Adenoma

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