Pituitary最新文献

{"title":"Enhancing diagnostic tools for vasopressin deficiency: insights from a single-center cohort study.","authors":"Alessandro Mondin, Giulia Bovo, Giorgia Antonelli, Diego Faggian, Pierluigi Mazzeo, Alessandro Bavaresco, Filippo Ceccato, Mattia Barbot","doi":"10.1007/s11102-025-01538-9","DOIUrl":"https://doi.org/10.1007/s11102-025-01538-9","url":null,"abstract":"<p><strong>Context: </strong>A recent multicenter trial confirmed that hypertonic saline-stimulated copeptin is superior to the arginine stimulation test (AST) for diagnosing vasopressin deficiency (AVP-D). The latter, though less accurate, is cheaper, better tolerated, and easier to perform. We aimed to improve AST diagnostic accuracy by incorporating additional parameters alongside copeptin.</p><p><strong>Methods: </strong>We retrospectively analysed ASTs from patients evaluated for suspected AVP-D. Final diagnosis was defined based on clinical, biochemical, radiological and follow-up data. We evaluated the test diagnostic accuracy based on either literature reported or ROC-based thresholds of several variables even in combination.</p><p><strong>Results: </strong>Nineteen patients were included and 8 were diagnosed with AVP-D. Copeptin response to AST was flat in AVP-D compared to primary polydipsia (PP) but showed limited discriminatory power with the maximal accuracy for copeptin-based parameters reaching 73.7%. AVP-D patients had lower urinary osmolarity (UOsm) and higher plasma osmolarity and serum sodium (Na) at AST end. Na at AST end was the best predictor of AVP-D (≥ 141 mmol/L: sensitivity 87.5%, specificity 100%, accuracy 94.7%, AUC 0.989). A multistep approach initially assessing Na at AST end and, in dubious cases (140-142 mmol/l), also either copeptin peak (≤ 4.1 pmol/L), UOsm (≤ 428 mOsm/kg), or absent posterior pituitary hyperintense signal achieved 100% diagnostic accuracy. Logistic regression using Na at AST end values combined with any of these aforementioned additional variables also reached complete discrimination between AVP-D and PP.</p><p><strong>Discussion: </strong>Combining multiple parameters after AST improved diagnostic accuracy, even without measuring copeptin. Despite the study's retrospective design, small sample, and absence of hypertonic saline testing, findings support the potential utility of a multivariable approach to AST interpretation.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"65"},"PeriodicalIF":3.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182059","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 acromegaly: Why, when and how.","authors":"Alessandro Giustina, Andrea Giustina","doi":"10.1007/s11102-025-01534-z","DOIUrl":"https://doi.org/10.1007/s11102-025-01534-z","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"66"},"PeriodicalIF":3.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181858","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":"Outcomes of stereotactic radiosurgery for pituitary metastases: an international multi-institutional study.","authors":"Hussam Abou-Al-Shaar, Ibrahem Albalkhi, Rimsha K Shariff, Arka N Mallela, Pouneh K Fazeli, Salem M Tos, Georgios Mantziaris, Ying Meng, Kenneth Bernstein, Tehila Kaisman-Elbaz, Hanan Abofani, Yen-Yu Lin, Cheng-Chia Lee, Manjul Tripathi, Rituraj Upadhyay, Joshua D Palmer, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, Khaled Abdelkarim, Amr M N El-Shehaby, Reem M Emad, Selcuk Peker, Yavuz Samanci, Rodney E Wegner, Matthew J Shepard, Roman Liscak, Gabriela Simonova, Timoteo Almeida, Carolina Benjamin, Douglas Kondziolka, Jason P Sheehan, Ajay Niranjan, Constantinos G Hadjipanayis, L Dade Lunsford","doi":"10.1007/s11102-025-01542-z","DOIUrl":"https://doi.org/10.1007/s11102-025-01542-z","url":null,"abstract":"<p><strong>Background: </strong>Pituitary metastases (PM) account for 0.4% of all intracranial metastases and typically present with visual and endocrinological deficits. Stereotactic radiosurgery (SRS) has shown excellent tumor control and safety profile in the management of intracranial metastases. However, its role and safety in managing metastases to the pituitary gland are not well-characterized. This study aims to evaluate SRS outcomes and safety profile in the management of PM in a multicenter international cohort.</p><p><strong>Methods: </strong>The authors retrospectively analyzed data from 63 patients with PM treated with SRS across 12 institutions, assessing clinical and radiological outcomes, including survival rates, tumor control, visual and endocrinological outcomes, and post-treatment complications.</p><p><strong>Results: </strong>Among 63 patients included in the study (median tumor volume: 1.5 cc), SRS demonstrated a local tumor control rate of 93.1% at 12 months. The median survival was 25.4 months and overall survival rates of 77.6%, 65.9%, and 55.1% at 6, 12, and 18 months, respectively. In multivariate analysis, a margin dose for PM > 10 Gy emerged as an independent predictor across progression-free survival (HR: 0.20, p < 0.01), distant metastasis-free survival (HR: 0.30, p = 0.01), and overall survival. (HR: 0.15, p < 0.01). Following SRS, most patients showed stable or improved visual function (n = 17/18). A small percentage of patients experienced complications: developed new visual deficits (n = 1/63), experienced new anterior pituitary hormone deficiency (n = 5/63), and developed arginine vasopressin (AVP)-deficiency post-treatment (n = 2/63).</p><p><strong>Conclusion: </strong>SRS is an important modality in the management of PM, offering excellent local tumor control and survival outcomes with minimal morbidity. These findings support the incorporation of SRS into the multidisciplinary management for treating patients with PM.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"69"},"PeriodicalIF":3.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181859","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":"Muscle dysfunction is associated with poor quality of life in long-term controlled patients with acromegaly.","authors":"Luciana Martel-Duguech, Helena Bascuñana, Jordi Cuartero, Susan M Webb, Elena Valassi","doi":"10.1007/s11102-025-01539-8","DOIUrl":"https://doi.org/10.1007/s11102-025-01539-8","url":null,"abstract":"<p><strong>Purpose: </strong>Acromegaly (ACRO) leads to significant physical and psychological morbidity. Although patients often report persistent muscle dysfunction and impaired quality of life (QoL) after hormone control, the relationship between these two factors remains largely underexplored. Our objective was to investigate the association between muscle function parameters and QoL in long-term controlled ACRO patients.</p><p><strong>Methods: </strong>We studied 36 patients with ACRO (14 males, 22 females; mean age 54 ± 8 years) with controlled GH/IGF-I excess, defined as normalized IGF-I levels and suppressed GH concentrations after an OGTT, during a mean (± SD) of 8 (4) years. Muscle function was assessed using gait speed (GS), timed up and go (TUG), handgrip strength (HGS), and the 30-second chair-to-stand test. QoL was evaluated using the AcroQoL and SF-36 questionnaires.</p><p><strong>Results: </strong>Poor muscle performance, particularly on GS and TUG, was significantly associated with reduced QoL scores on physical, psychological, and social domains of AcroQoL and SF-36 questionnaires. In women, mobility limitations were linked to impaired self-image and physical functioning. In men, reduced muscle strength and mobility were associated with broad QoL alterations on physical and emotional dimensions. These findings highlight the significant impact of muscle dysfunction on both physical performance perception and psychosocial well-being in ACRO patients.</p><p><strong>Conclusion: </strong>Muscle dysfunction in long-term controlled ACRO patients negatively affects QoL, underscoring the need for routine functional assessments and targeted rehabilitation strategies.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"68"},"PeriodicalIF":3.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182002","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":"The diagnosis of GH deficiency in adult β-thalassemic patients: are two different stimulation tests necessary to improve specificity?","authors":"Daniele Sola, Mirna Solange Barrio Lower Daniele, Leila Danesi, Emanuela D'Angelo, Nadia Mirra, Giovanna Graziadei, Elena Cassinerio, Riccardo Pasquali, Massimo Scacchi","doi":"10.1007/s11102-025-01540-1","DOIUrl":"https://doi.org/10.1007/s11102-025-01540-1","url":null,"abstract":"<p><strong>Purpose: </strong>β-thalassemia major (βTM) frequently leads to endocrinological complications of chronic transfusion-induced iron overload, including growth hormone deficiency (GHD). With contrasting data on GHD in adult βTM populations, our study aimed to reevaluate the diagnosis of GHD using multiple tests and its progression over time.</p><p><strong>Methods: </strong>Two experimental studies were conducted in adult βTM patients to assess GH secretory status. The first study reevaluated GH secretion after two years using a GHRH plus arginine test performed initially and during follow-up. The second study applied a glucagon stimulation test to those initially diagnosed with severe GHD, comparing the results with those of a GHRH plus arginine test.</p><p><strong>Results: </strong>The first study involved 80 patients: 67 patients had normal GH secretion at the first test, confirmed in 57 of them. Of the 13 initially diagnosed with GHD, only 3 were confirmed at the second test. The second study included 91 patients: 18 of the initially identified as having severe GHD, were tested with another challenge, but only 6 confirmed severe GHD, suggesting a possible risk of overdiagnosis in initial evaluations.</p><p><strong>Conclusions: </strong>The marked variability in GHD diagnoses among adult patients with βTM highlights the need for multiple diagnostic tests to improve accuracy and avoid unnecessary interventions. Our findings highlight the importance of reassessing GH secretory reserves with multiple tests at multiple time points, supporting a cautious approach to hormone replacement therapy, suggesting to start it only when clearly indicated.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"67"},"PeriodicalIF":3.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180893","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":"Symptomatic venous thromboembolism after transsphenoidal surgery in Cushing's disease: incidence and risk factors.","authors":"Masaaki Mikamoto, Ye Rim Chang, Hang Lee, Nicholas A Tritos, Lisa B Nachtigall, Brooke Swearingen, Karen K Miller, Pamela S Jones","doi":"10.1007/s11102-025-01536-x","DOIUrl":"https://doi.org/10.1007/s11102-025-01536-x","url":null,"abstract":"<p><strong>Purpose: </strong>Cushing's Disease (CD) has been linked to increased venous thromboembolism (VTE) risk. This study investigates the incidence and risk factors of postoperative VTE in patients undergoing transsphenoidal surgery (TSS) for CD.</p><p><strong>Methods: </strong>This retrospective study analyzed patients with CD and non-functioning pituitary adenomas (NFPAs) who underwent TSS at Massachusetts General Hospital from 2005 to 2019. The incidence of VTE within 90 days post-TSS was compared between groups, with early VTE defined as occurring within 7 days. VTE diagnosis was confirmed through imaging, including ultrasound and CT, following clinical suspicion.</p><p><strong>Results: </strong>Of six CD patients with symptomatic post-TSS VTE, five developed VTE within one week (\"early\"), while no NFPA patients experienced early VTE (p = 0.006). Two CD patients presented with pulmonary embolism (PE) on postoperative day (POD) 1 or 2. Two of three with early deep venous thrombosis (DVT) had a history of prior DVT. The overall post-TSS VTE incidence was similar between CD and NFPA patients [6/315 (1.9%) vs. 4/559 (0.7%), p = 0.18]. Patients with CD who developed post-TSS VTE had significantly higher rates of prior history of VTE (p = 0.003) and hypertension (p = 0.038) and larger tumor sizes (p = 0.045) compared to those without post-TSS VTE on univariate analysis.</p><p><strong>Conclusion: </strong>CD patients are at higher risk for early post-TSS VTE, including symptomatic PE. Identifying high-risk patients and implementing perioperative prophylaxis in the immediate postoperative period may help mitigate these complications. Further research is needed to optimize prevention strategies in this population.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"64"},"PeriodicalIF":3.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143392","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":"Genes of the \"regulation of lymphocyte activation\" pathway may influence immune cells infiltration in growth hormone secreting pituitary tumors.","authors":"Sabrina Chiloiro, Flavia Costanza, Giovanni Luca Scaglione, Filippo Russo, Carmela Nardelli, Antonella Giampietro, Pier Paolo Mattogno, Liverana Lauretti, Guido Rindi, Laura De Marinis, Marco Gessi, Antonio Bianchi, Francesco Doglietto, Ettore Domenico Capoluongo, Alfredo Pontecorvi","doi":"10.1007/s11102-025-01537-w","DOIUrl":"10.1007/s11102-025-01537-w","url":null,"abstract":"<p><strong>Purpose: </strong>The tumor microenvironment (TME) may provide a useful framework for understanding the heterogeneous behavior of growth hormone (GH) secreting pituitary adenomas. Although the interest in TME in somatotropinomas has increased exponentially over the last few decades, there is limited elucidation of its mechanisms, particularly in relation to genes expression involved in its regulation.</p><p><strong>Methods: </strong>A retrospective, observational, single-center study was conducted on 85 subjects: 46 patients diagnosed with acromegaly and 39 controls. After DNA extraction, clinical exome sequencing was performed and genomic alterations were detected, classified, and filtered using a dedicated bioinformatics pipeline.</p><p><strong>Results: </strong>5759 unique genetic variants were found in patients with acromegaly. 33 patients (72%) showed the presence of at least one pathogenic variant in at least one of the following genes: FANCD2, SPTA1, TYRO3, and ZNF335. The enrichment pathway analysis of mutated genes was performed and showed that these genes were included in the same genetic pathway called \"regulation of lymphocyte activation\" (GO:0051249). Inflammatory infiltrate was analyzed in histological samples in 26 patients. A significantly higher number of CD68 + macrophages (P-value = 0.008), a lower number of CD8 + T lymphocytes (P-value = 0.037) and a higher CD68 + macrophages/ CD8 + T-lymphocytes ratio (P-value = 0.004) were observed in patients with pathogenic variants of genes of \"regulation of lymphocyte activation\" pathway.</p><p><strong>Conclusion: </strong>This study provides new insights into the genetic basis of the TME in somatotropinomas and suggests that genetics may influence immune cells infiltration in acromegaly.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"63"},"PeriodicalIF":3.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143390","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 to: Osilodrostat improves blood pressure and glycemic control in patients with Cushing's disease: a pooled analysis of LINC 3 and LINC 4 studies.","authors":"Maria Fleseriu, Rosario Pivonello, John Newell-Price, Mônica R Gadelha, Beverly M K Biller, Richard J Auchus, Richard A Feelders, Akira Shimatsu, Przemysław Witek, Marie Bex, Andrea Piacentini, Alberto M Pedroncelli, André Lacroix","doi":"10.1007/s11102-025-01525-0","DOIUrl":"10.1007/s11102-025-01525-0","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"62"},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120653","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":"Impact of nasal septal deviation on surgical outcomes in endoscopic transsphenoidal surgery: a population-based study.","authors":"Chia-En Wong, Da-Wei Huang, Yu Chang, Heng-Jui Hsu, Liang-Chao Wang, Po-Hsuan Lee, Hao-Hsiang Hsu, Pang-Shuo Perng, Chih-Hao Tien, Jung-Shun Lee","doi":"10.1007/s11102-025-01531-2","DOIUrl":"https://doi.org/10.1007/s11102-025-01531-2","url":null,"abstract":"<p><strong>Purpose: </strong>Nasal septal deviation (NSD) is a prevalent condition that may affect the surgical outcome of endoscopic transsphenoidal approach surgery (ETA) for pituitary adenomas (PA). This study aims to evaluate the effect of NSD on perioperative and neuroendocrine outcomes in patients undergoing ETA for PAs.</p><p><strong>Methods: </strong>This study is a retrospective analysis utilized the TriNetX database to evaluate the effect of NSD on perioperative and neuroendocrine outcomes in patients undergoing ETA for PAs. Propensity score matching (PSM) was performed to balance baseline characteristics between NSD and non-NSD cohorts. Outcomes were presented as odds ratios (ORs) with 95% confidence intervals (CIs), calculated using the TriNetX platform. Primary outcomes include perioperative complications and postoperative endocrinological functions.</p><p><strong>Results: </strong>A total of 9,896 patients were included in the initial cohort. After matching, 2,002 patients were included in each group. The mean age at surgery was 53.1 ± 15.8 years for the NSD group and 53.0 ± 16.0 years for the non-NSD groups (SMD: 0.006, p = 0.842). Patients in the NSD group demonstrated a higher risk of postoperative cerebrospinal fluid (CSF) leakage (OR: 2.04; 95% CI: 1.63-2.54; p < 0.001), postoperative diabetes insipidus (DI) (OR: 1.36; 95% CI: 1.18-1.57; p < 0.001), desmopressin use (OR: 1.26; 95% CI: 1.06-1.51; p = 0.009), hypopituitarism (OR:1.63; 95% CI: 1.40-1.89; p < 0.001), and steroid use (OR: 1.43; 95% CI: 1.25-1.62; p < 0.001) as compared to the non-NSD group. Sensitivity analyses confirmed consistent results across different matching models.</p><p><strong>Conclusions: </strong>These findings indicate that patients with NSD undertaking ETA for PAs had higher risks of postoperative complications, including postoperative CSF leakage, DI, desmopressin use, hypopituitarism, and steroid use.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"61"},"PeriodicalIF":3.3,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086487","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":"Posterior pituitary tumors: an entity unto itself.","authors":"Odelia Cooper","doi":"10.1007/s11102-025-01535-y","DOIUrl":"https://doi.org/10.1007/s11102-025-01535-y","url":null,"abstract":"<p><p>Posterior pituitary tumors (PPT) are rare, benign tumors but may lead to compromised hypothalamic and pituitary function. A new study by Kremenevski et al. presents a single institution experience of these tumors, namely, pituicytomas, spindle cell oncocytomas, and granular cell tumors. They incorporate the revised 2022 WHO classification and highlight the preoperative and postoperative endocrine, metabolic, and radiologic outcomes of PPT. This study adds to our knowledge in this rare subset of tumors and underscores the need for ongoing surveillance for hypopituitarism and hypothalamic obesity.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"60"},"PeriodicalIF":3.3,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086488","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}