Pituitary最新文献

{"title":"Internal validation of THINKERS-PA for outcome prediction after pituitary adenoma radiosurgery.","authors":"Jheremy S Reyes, Constantinos G Hadjipanayis, Georgios Zenonos, L Dade Lunsford, Ajay Niranjan","doi":"10.1007/s11102-026-01756-9","DOIUrl":"https://doi.org/10.1007/s11102-026-01756-9","url":null,"abstract":"<p><strong>Background: </strong>Outcome prediction after Gamma Knife radiosurgery (GKRS) for pituitary adenomas remains guided by tumor anatomy, functional status, prior treatment, optic-apparatus proximity, and physician experience rather than individualized estimates of tumor response, biochemical remission, and endocrine morbidity. We developed THINKERS-PA, a mixture-of-experts (MoE) framework for outcome prediction and prescription-dose simulation after GKRS.</p><p><strong>Methods: </strong>We performed a retrospective study of 125 patients with pituitary adenomas treated with GKRS. Variables available at treatment planning were used to train a three-expert MoE neural network integrating clinical and endocrine history, tumor anatomy and imaging, and radiosurgical dosimetry. Discrete-time survival heads estimated tumor progression, biochemical remission in functioning adenomas, and new hypopituitarism. Secondary endpoints include a favorable composite outcome, visual deterioration, and need for additional treatment. Validation used repeated nested 5-fold cross-validation. A dose-sweeping module evaluated treatment doses.</p><p><strong>Results: </strong>The cohort included 72 functioning and 53 nonfunctioning adenomas. Tumor progression occurred in 14.4%, biochemical remission in 59.7% of functioning adenomas, and new hypopituitarism in 25.0% of patients at risk. Mean out-of-fold time-dependent AUCs were 0.82 for progression, 0.84 for biochemical remission, and 0.81 for hypopituitarism. Corresponding integrated Brier scores were 0.083, 0.143, and 0.119; calibration slopes were 0.89, 0.91, and 0.87; and censoring-aware mean absolute errors were 10.7, 8.6, and 9.8 months. Dose-sweeping estimates were within ± 1 Gy of the delivered dose in 71% of patients.</p><p><strong>Conclusions: </strong>THINKERS-PA provides an internally validated framework for individualized prediction of tumor, endocrine, and treatment-related outcomes after GKRS. External multicenter validation is required before clinical implementation.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of clinical profiling to determine excess mortality in prolactinomas: insights from a large, registry-based cohort.","authors":"Tarik Ziyad Tarik Shwaish, Davide Gori, Claudio Sartori, Federica Guaraldi","doi":"10.1007/s11102-026-01739-w","DOIUrl":"10.1007/s11102-026-01739-w","url":null,"abstract":"<p><strong>Purpose: </strong>Population-based studies overall report no excess mortality among patients with prolactinoma compared with the general population. However, since prolactinomas are clinically heterogeneous, mortality may not be uniform across data-driven patient profiles.</p><p><strong>Methods: </strong>We analyzed 3,378 adult prolactinoma cases (26,118 person-years) from the Surveillance, Epidemiology, and End Results database (2004-2022). Standardized mortality ratios (SMRs) were calculated using US life tables matched by age, sex, calendar year, race/ethnicity, and geography. Among 2,481 patients with available tumor size (18,097 person-years), unsupervised clustering (Fuzzy C-Means) based on age, tumor size, and sex defined patient profiles. Excess mortality ratios (EMRs) compared observed-to-expected mortality across profiles, adjusting for race, calendar year, surgery, and radiotherapy.</p><p><strong>Results: </strong>Prolactinoma was associated with significant excess all-cause mortality (SMR 1.21, 95% CI 1.03-1.41). Two profiles emerged: SAYF (Small and Young, Female-predominant; 63%) and LOOM (Large or Old, Male-predominant; 37%). Among patients with tumor size data, mortality was increased in LOOM (SMR 1.36, 95% CI 1.11-1.65) and reduced in SAYF (SMR 0.48, 95% CI 0.22-0.90), with significant between-profile heterogeneity (EMR 2.92, 95% CI 1.44-5.90; p = 0.003). Results were consistent in sensitivity analyses with imputed data, although the survival advantage in SAYF was attenuated and no longer statistically significant.</p><p><strong>Conclusion: </strong>Prolactinoma captured in a population-based tumor registry was associated with excess all-cause mortality, with heterogeneity across patient profiles. An older, male-predominant profile with larger tumors showed excess mortality, whereas a younger, female-predominant profile with small tumors showed directionally lower mortality. These hypothesis-generating findings warrant further investigation into the underlying biological and contextual factors.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long term neuropsychological evaluation of adult patients with craniopharyngiomas.","authors":"Julie Guillotin, Charlotte Planchon, Julien Engelhardt, Edouard Gimbert, Thomas Cuny, Fadi Alkhiami, Kamel Mohammedi, Antoine Tabarin, Blandine Gatta Cherifi","doi":"10.1007/s11102-026-01742-1","DOIUrl":"10.1007/s11102-026-01742-1","url":null,"abstract":"<p><strong>Introduction: </strong>Craniopharyngiomas are benign tumors that develop in the hypothalamic-pituitary region. Their treatment mainly involves surgery, sometimes combined with radiotherapy. The hypothalamus plays an essential role in hormonal balance and energy regulation, but also in cognition through connectivity circuits. The cognitive impact of craniopharyngioma treatment is poorly understood and has mainly been studied in children.</p><p><strong>Patients and methods: </strong>We report the neuropsychological assessments of 22 adult patients treated for craniopharyngioma with a follow-up of at least 5 years, 16 of whom were diagnosed while being adults. All assessments were performed by a neuropsychologist using validated tests. More than 65% of patients, including those diagnosed in adulthood, showed at least one impairment in executive functioning, especially cognitive inhibition or deficit in organization. 75% of patients reported fatigue. For half of these patients, these impairments needed specific treatment like cognitive rehabilitation.</p><p><strong>Conclusion: </strong>Neuropsychological evaluation has to be part of the follow-up of patients treated for a craniopharyngioma including those diagnosed during adulthood.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between preoperative MRI radiomic features and methylation-defined phenotypes in non-functioning pituitary adenomas.","authors":"Ilies Djebbara, Morten Winkler Møller, Ivar Yannick Christensen, Bo Halle, Christian Bonde Pedersen, Frantz Rom Poulsen, Jan Saip Aunan-Diop","doi":"10.1007/s11102-026-01755-w","DOIUrl":"10.1007/s11102-026-01755-w","url":null,"abstract":"<p><strong>Purpose: </strong>DNA methylation profiling identifies clinically relevant subgroups of non-functioning pituitary adenomas (NFPAs), but requires tumour tissue and is unavailable preoperatively. We investigated whether reported outcome-associated methylation-defined NFPA phenotypes are associated with preoperative MRI radiomic features.</p><p><strong>Methods: </strong>We performed a single-centre retrospective radiogenomic analysis nested within a previously published, outcome-characterised NFPA methylation cohort. Seventy-four patients with preoperative gadolinium-enhanced T1-weighted MRI were included. Tumours were automatically segmented using a fine-tuned U-Net. The primary analysis tested binary discrimination between the outcome-associated low-risk (k1/k2) and high-risk (k3/k4/k5) methylation strata using a prespecified L1-penalised logistic-regression model with leakage-controlled repeated stratified cross-validation, 0.632 + bootstrap optimism correction, and 1000-shuffle whole-pipeline permutation testing.</p><p><strong>Results: </strong>Seven radiomic features were false-discovery-rate significant and four survived Bonferroni correction, predominantly LoG-filtered first-order intensity features. The prespecified model separated high-risk from low-risk tumours with balanced accuracy 0.69 (95% CI, 0.58-0.80), AUC 0.73 (0.61-0.84), 0.632 + AUC 0.71, and permutation p = 0.001. The SF1-restricted analysis remained significant (balanced accuracy 0.73, AUC 0.70, p = 0.008), whereas k3-focused analyses were not significant. Clinical sex-lineage models classified at chance.</p><p><strong>Conclusions: </strong>Preoperative MRI radiomics was associated, at the group level, with a composite methylation-defined risk label previously associated with postoperative regrowth in the same source cohort. The study was clinically outcome-anchored, but the classifier did not use individual regrowth or progression-free survival as its endpoint and should not be interpreted as an independently validated prognostic model. Pooling k3, k4, and k5 does not establish a shared imaging phenotype of aggressiveness. External outcome-linked validation is required before clinical implementation.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Long-term cabergoline use does not predict degree of prolactinoma fibrosis nor significantly impact surgical outcomes.","authors":"Adam N Mamelak, Rachel Fox, Yaakov Rosenberg, Daniel Gomez, Yujie Cui, Anat Ben Shlomo, Artak Labadzhyan, Ning-Ai Liu, Vivien Bonert, Odelia Cooper","doi":"10.1007/s11102-026-01734-1","DOIUrl":"10.1007/s11102-026-01734-1","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13500399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of endothelial dysfunction in women with prolactinoma.","authors":"Mehmet Cagri Unal, Osman Onur Daloglu, Ugur Karabiyik, Nihat Kalay, Kursad Unluhizarci, Zuleyha Karaca","doi":"10.1007/s11102-026-01754-x","DOIUrl":"https://doi.org/10.1007/s11102-026-01754-x","url":null,"abstract":"<p><strong>Aim: </strong>Prolactinoma has been associated with impaired glucose metabolism and adverse cardiometabolic outcomes. This study aimed to evaluate the metabolic effects of hyperprolactinemia and its impact on endothelial function, as well as changes following treatment.</p><p><strong>Methods: </strong>Twenty patients with prolactinoma and 15 age- and BMI-similar healthy controls were included. All participants underwent an oral glucose tolerance test (OGTT) to assess glucose and insulin responses. Endothelial function was evaluated using carotid intima-media thickness (CIMT) and flow-mediated dilation (FMD) measured by Doppler ultrasonography, along with echocardiographic assessment. In patients, all measurements were repeated after six months of treatment, once prolactin levels normalized.</p><p><strong>Results: </strong>The mean age of patients was 26.9 ± 7.4 years with a BMI of 25.1 ± 5.6 kg/m². Patients had higher 120-minute glucose levels during OGTT compared to controls (105.1 ± 24.2 vs. 90.5 ± 15.9 mg/dL, p = 0.015). Following treatment, both 120-minute glucose levels and area under the curve glucose were significantly reduced (p = 0.045 and p = 0.005, respectively). Echocardiographic parameters, including systolic and diastolic function, as well as CIMT, were similar between groups and remained unchanged after treatment. In contrast, FMD was significantly lower in patients at baseline compared to controls (6.81 ± 5.22% vs. 16.8 ± 2.59%, p < 0.001) and improved after cabergoline therapy (13.18 ± 5.78%, p = 0.003), indicating endothelial dysfunction and its reversal with treatment.</p><p><strong>Conclusion: </strong>Patients with prolactinoma exhibit increased glucose intolerance and impaired endothelial function in the absence of overt global cardiac dysfunction. These alterations appear to be reversible following treatment.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in pituitary medicine: what should an endocrinologist know?","authors":"Damla N Costa, Rozalina G McCoy, Debraj Mukherjee, Roberto Salvatori","doi":"10.1007/s11102-026-01747-w","DOIUrl":"https://doi.org/10.1007/s11102-026-01747-w","url":null,"abstract":"<p><p>Pituitary disorders often include complex radiology imaging, rare clinical presentations, and need for multidisciplinary decision-making and prolonged follow-up, all features that make them a natural target for artificial intelligence (AI). The resulting literature is expanding rapidly, but carries an unfamiliar vocabulary and set of methods, which can leave clinicians without a clear entry point. This short perspective offers such an entry point, succinctly outlining how AI learns from data, how a clinical AI application moves from question to deployment, providing examples, and addressing how to read the field critically.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revival of neurophysin-I as a complementary biomarker for circulating oxytocin.","authors":"Elizabeth A Lawson","doi":"10.1007/s11102-026-01745-y","DOIUrl":"10.1007/s11102-026-01745-y","url":null,"abstract":"<p><p>There is renewed interest in oxytocin (OXT) associated neurophysin-I (NP-I) as a surrogate biomarker of endogenous OXT secretion into circulation. OXT measurement in humans remains challenging because current assays vary in their specificity for free and protein-bound OXT, and OXT-related peptide species, including extended forms and peptide fragments, and results are influenced by sample handling and analytical methods. NP-I, a carrier protein that is co-synthesized and co-secreted with OXT, can be measured using a validated sandwich immunoassay without extraction. Studies support NP-I as a promising marker of OXT release to circulation, although it is not a replacement for direct OXT measurement. This Editorial reviews the biological relationship between OXT and NP-I, discusses the advantages and limitations of NP-I as a biomarker, and highlights future opportunities for integrating NP-I measurement with advances in OXT assay methodology to improve understanding of the human OXT system in health and disease.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term endocrine outcomes of transsphenoidal surgery for prolactinomas: a 20-year single-center cohort study.","authors":"Roméo Bujiriri Murhega, Stefan Matei Constantinescu, Christian Raftopoulos, Dominique Maiter, Edward Fomekong","doi":"10.1007/s11102-026-01749-8","DOIUrl":"https://doi.org/10.1007/s11102-026-01749-8","url":null,"abstract":"<p><strong>Background: </strong>The role of transsphenoidal surgery in the management of prolactinomas remains debated in the era of dopamine agonist therapy. This descriptive study evaluated the long-term endocrine outcomes of transsphenoidal surgery in a highly selected single-center surgical cohort.</p><p><strong>Methods: </strong>We retrospectively reviewed all patients who underwent transsphenoidal surgery for prolactinomas at a tertiary referral center between September 1995 and July 2015. Biochemical remission was defined as normalization of serum prolactin levels 6 months after surgery. Persistent disease and recurrence were assessed during long-term follow-up. The analysis was descriptive and all subgroup comparisons were exploratory.</p><p><strong>Results: </strong>Fifty-five patients were included (47 women and 8 men; median age, 30 years), comprising 35 microprolactinomas (64%), 18 macroprolactinomas (33%), and 2 giant prolactinomas (3%). The median follow-up was 10.8 years. Biochemical remission at 6 months was achieved in 29 patients (53%), whereas persistent disease and recurrence were observed in 21 (38%) and 5 patients (9%), respectively. Remission rates were 60% for microprolactinomas and 44% for macroprolactinomas, whereas both giant prolactinomas had persistent disease. No male patient achieved biochemical remission, whereas remission was observed in 29 of 47 women (62%). This observation is exploratory: 6 of the 8 men harboured a macro- or giant prolactinoma and their median preoperative prolactin level was 848.7 ng/mL, against 136.4 ng/mL in women. Transient diabetes insipidus occurred in 9% of patients, whereas permanent complications were uncommon.</p><p><strong>Conclusions: </strong>In this highly selected surgical cohort, transsphenoidal surgery was followed by durable endocrine control in approximately half of the patients and by a low recurrence rate. These descriptive findings are compatible with a role for surgery as a second-line option, but do not allow inference about its comparative effectiveness.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of the TRH test for central hypothyroidism in patients with pituitary and parasellar tumors: a single-center retrospective cross-sectional study.","authors":"Battsetseg Buyandalai, Tetsuya Takamizawa, Kazuhiko Horiguchi, Sho Sekiguchi, Masashi Yoshikawa, Takuya Watanabe, Yutaka Watanuki, Emi Ishida, Satoshi Yoshino, Shunichi Matsumoto, Rei Yamaguchi, Masahiko Tosaka, Masanobu Yamada, Eijiro Yamada","doi":"10.1007/s11102-026-01751-0","DOIUrl":"https://doi.org/10.1007/s11102-026-01751-0","url":null,"abstract":"<p><strong>Purpose: </strong>The utility and diagnostic interpretation of the thyrotropin-releasing hormone (TRH) test for diagnose central hypothyroidism (CeH) remain unclear.</p><p><strong>Method: </strong>To understand the significance of TRH testing for the diagnosis of CeH we reviewed the medical charts of 105 patients who underwent TRH test (200 µg) and analyzed TSH values and responses in three groups. Group 1, the control group, included 25 participants without pituitary and parasellar tumors (PPTs), and with normal pituitary function. Group 2, the CeH group, included 13 patients with PPTs and low free thyroxine (fT4) levels. Group 3 included 67 patients with PPTs but normal fT4 levels.</p><p><strong>Results: </strong>Basal TSH levels did not significantly differ between Group 1 and Group 2. After TRH test, a peak TSH value and fold-TSH response were significantly lower in Group 2. Group 2 showed a higher rate of delayed and prolonged TSH responses and lower fold-free triiodothyronine (fT3) responses. We determined the cut-off values of fold-TSH, prolonged response, and fold-fT3 responses for diagnosing CeH patients with high sensitivity and specificity. Using two or more of these cut-off values further reduced the false-positive rate to 4%. Group 3 had a higher rate of positive results than Group 1, suggesting that there are patients with hidden CeH.</p><p><strong>Conclusion: </strong>In this study, we revealed that CeH can be diagnosed with a TRH test with a probability of more than 90%, and the test may be useful for diagnosing the CeH in patients with normal fT4 levels.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}