Pituitary最新文献

{"title":"Hypothalamic obesity in pediatric vs. adult craniopharyngioma: mechanisms, management, and cardiometabolic outcomes.","authors":"Khushal Gupta, Maryam Zeinali, David Altschul, Vijay Agarwal, Michael Karsy","doi":"10.1007/s11102-026-01760-z","DOIUrl":"10.1007/s11102-026-01760-z","url":null,"abstract":"<p><strong>Purpose: </strong>Hypothalamic obesity (HO) is a treatment-related complication in craniopharyngioma (CP) survivors that markedly impairs long-term health and quality of life. Although overall survival exceeds 90% for both pediatric and adult CP, HO prevalence and clinical course differ substantially by age at onset. We aimed to compare HO manifestations, mechanisms, and treatment response between pediatric and adult CP cohorts.</p><p><strong>Methods: </strong>We conducted a scoping review of studies published between 2000 and 2025, comparing pediatric (childhood-onset) versus adult-onset CP cohorts, classified by age at diagnosis. Data on obesity prevalence, mechanistic pathways, therapeutic interventions, and cardiometabolic outcomes were extracted and synthesized.</p><p><strong>Results: </strong>In pediatric CP survivors, obesity rates rise from 5.7% pre-treatment to 57% post-treatment; in adults, from 19.2% to 29.2%. HO severity correlates with the extent of hypothalamic damage by Puget and QST grading. Key mechanisms include disrupted melanocortin signaling, central leptin and insulin resistance, and neuroinflammation via resistin-TLR4 and NLRP3 pathways. GLP-1 receptor agonists (exenatide, semaglutide) have produced marked weight loss in small case series (up to 17% over 6 months with semaglutide), but randomized trials did not meet their primary weight outcomes and direct pediatric-versus-adult comparisons are lacking. Bariatric procedures yield moderate success; sleeve gastrectomy achieves 5-year weight loss comparable to that in non-CP controls (21.7% vs. 21.8%), whereas Roux-en-Y gastric bypass is less effective than in controls (22.7% vs. 32.0%). Both cohorts face significant long-term risks: 2.2-fold higher all-cause mortality and 9.3-fold higher diabetes risk in adults, non-alcoholic fatty liver disease in 47% of pediatric survivors, metabolic dysfunction-associated fatty liver disease in 67.4% of adults, and insulin resistance in approximately 30% of pediatric patients.</p><p><strong>Conclusion: </strong>HO following CP shows distinct age-dependent trajectories in prevalence, underlying mechanisms, and clinical course; suggested age-related differences in treatment response remain to be confirmed in direct comparative studies. Tailored management integrating mechanistic insights and age-specific therapies is critical to mitigating the cardiometabolic burden in these patients.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069951","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":"Staining collagen fibers in pituitary lesions substantially improves the certainty of intraoperative frozen section diagnosis.","authors":"Ursula Keber, Rima Yeghiazaryan, Axel Pagenstecher","doi":"10.1007/s11102-026-01763-w","DOIUrl":"10.1007/s11102-026-01763-w","url":null,"abstract":"<p><strong>Purpose: </strong>Transsphenoidal surgery is the first-line treatment for most pituitary adenomas (PA), also known as pituitary neuroendocrine tumors (PitNET), and a precise intraoperative histopathological evaluation of tissue samples is essential to optimize tumor resection and clinical outcome. However, it still remains a challenge for pathologists to distinguish between PA and pituitary gland. In this study, we evaluated the effect of an additional Cason collagen fiber stain on the accuracy of intraoperative histopathological diagnostics of PAs by visualizing either physiologically retained or pathologically lost lobulation.</p><p><strong>Methods: </strong>A total of 252 cases were included in this study. In the control group (n = 93) cytological smear preparations and H&E-stained frozen sections were evaluated. In the experimental group (n = 159), both H&E- and Cason-stained frozen sections as well as smear preparations were examined. The concordance rate of the intraoperative diagnoses with the final diagnoses made on the paraffin material was determined.</p><p><strong>Results: </strong>When compared with the HE only group, the HE+Cason approach markedly increased the diagnostic accuracy from 87% to 98% (p < 0.001), sensitivity from 90% to 98% (p < 0.05) and specificity from 40% to 100% (p = 0.06), whereas the rate of inconclusive cases was significantly reduced from 11% to 0% (p < 0.001).</p><p><strong>Conclusion: </strong>This study introduces the Cason stain on frozen sections as a rapid, simple and inexpensive diagnostic tool essentially improving certainty in intraoperative histopathological diagnostics of PAs, thus facilitating surgical decision-making and optimizing clinical outcomes.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064051","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":"Pasireotide-LAR and pegvisomant combination in resistant acromegaly: a case series of predominantly mammosomatotroph adenomas.","authors":"Edward Mignone, Elena V Varlamov, Rinki Pandya, Melanie Hakar, Maria Fleseriu","doi":"10.1007/s11102-026-01750-1","DOIUrl":"10.1007/s11102-026-01750-1","url":null,"abstract":"<p><strong>Purpose: </strong>Long-term real-world data on concurrent pasireotide-LAR (PAS) and pegvisomant (PEGV) use in treatment-resistant acromegaly remain limited, especially for mammosomatotroph adenomas in younger adults. We report outcomes of six patients treated with this combination at a single tertiary pituitary center.</p><p><strong>Methods: </strong>IRB-approved retrospective case series. Baseline and follow-up biochemical, radiological, histopathological, treatment and safety outcomes were captured.</p><p><strong>Results: </strong>Six patients (5 females, 1 male; age 15 to 44 years) with somatotroph (n = 2) or mammosomatotroph (n = 4) adenomas, all macroadenomas, received PAS (20 to 60 mg every 28 days) plus PEGV (60 to 280 mg/week) over a median of 3.3 years (range 0.5 to 5.9) after lack of disease control post-surgery despite multiple lines of medical therapy. All six maintained tumor stability and achieved normal IGF-1. One had biochemical escape after 9 months of biochemical control requiring a 2nd surgery and radiosurgery. One patient discontinued PEGV after 3 years due to injection site pain, 3 patients developed hyperglycemia in the pre-diabetes range; no hepatotoxicity, acute symptomatic biliary disease, or arrhythmias occurred.</p><p><strong>Conclusions: </strong>In this series of predominantly mammosomatotroph adenomas in younger adults, combination PAS plus PEGV offers potential durable biochemical control, tumor stability and PEGV dose reduction in treatment-resistant acromegaly. Glucose monitoring during treatment is essential as concomitant use of PEGV does not appear to mitigate PAS-induced glycemic deterioration. Larger prospective studies are needed to better define predictors of response.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031234","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":"Pituitary Society Delphi consensus on the role of radiotherapy for pituitary adenomas.","authors":"Frederic Castinetti, Cecilia Piazzola, John Ayuk, Michael Kosmin, Marco Losa, Hani J Marcus, Alberto M Pereira, Shlomo Melmed, Maria Fleseriu","doi":"10.1007/s11102-026-01759-6","DOIUrl":"10.1007/s11102-026-01759-6","url":null,"abstract":"<p><strong>Context: </strong>Radiotherapy is used as second- or third-line treatment after transsphenoidal surgery for both functioning and nonfunctioning pituitary adenomas. Improved precision delivery may reduce side effects, but use overall has declined, partly due to improved surgical technique and advances in medical therapy, partly reflecting a shift from fractionated radiotherapy to stereotactic radiosurgery in appropriately selected patients, and also due to lack of clear, evidence-based guidelines. Questions remain regarding radiotherapy indications, optimal timing, choice of technique, and follow-up for efficacy and side effects. The aim of this Delphi panel was to establish expert consensus in these areas.</p><p><strong>Design: </strong>The Pituitary Society Steering Committee conducted a modified two-round Delphi panel with 29 international experts from five continents, including neuroendocrinologists, neurosurgeons and radiation oncologists.</p><p><strong>Results: </strong>Among the 26 initial statements, 22 (84.6%) reached agreement after Round 1. Four statements were reconsidered in Round 2, together with an additional question, after which 24 of 27 (88.9%) reached consensus. Panelists agreed that radiotherapy indication and timing should be assessed by expert multidisciplinary tumor boards, including a radiation oncologist, with the technique determined according to patient and adenoma characteristics. They emphasized controlling hormonal secretion while waiting for maximal radiotherapy efficacy in functioning adenomas. Long term follow-up > 10 years is required to assess for delayed efficacy, recurrence and side effects, although panelists agreed on the relatively low medium-term risk with modern techniques.</p><p><strong>Conclusion: </strong>Modified Delphi panel provides practical guidance regarding indications, timing, choice of technique and long-term follow-up of radiotherapy in pituitary adenomas. Modern techniques appear as effective and potentially safer vs. previous ones. Further long-term comparative data are needed.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031209","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":"Infiltrative and inflammatory systemic disorders involving the pituitary gland.","authors":"Betina Biagetti, Pedro Marques, Silvana Sarria-Estrada, Manel Puig-Domingo, Marta Araujo-Castro, Mónica Marazuela","doi":"10.1007/s11102-026-01758-7","DOIUrl":"10.1007/s11102-026-01758-7","url":null,"abstract":"<p><p>The hypothalamic-pituitary region can be affected by a wide and heterogeneous group of infiltrative and inflammatory disorders, including granulomatous, histiocytic, storage, infectious, non-pituitary neoplastic, and autoimmune or inflammatory conditions collectively grouped as hypophysitis. Although individually rare, these disorders are increasingly recognized due to growing awareness, wider use of pituitary imaging, and the emergence of immune checkpoint inhibitor-induced hypophysitis. They typically present with hypopituitarism (often including arginine vasopressin deficiency, which, particularly when accompanied by pituitary stalk thickening, is highly suggestive of a non-adenomatous lesion) together with mass effect symptoms and, in many cases, systemic manifestations reflecting extrapituitary organ involvement. Neuroimaging findings, while rarely pathognomonic, can narrow the differential diagnosis, particularly when pituitary stalk involvement is present: symmetric stalk/gland enlargement with homogeneous enhancement suggests lymphocytic, IgG4-related, or granulomatous hypophysitis, whereas rim enhancement, necrosis, or bone-destructive lesions point toward infectious or neoplastic causes. A structured diagnostic work-up, combining clinical history, hormonal evaluation, targeted laboratory testing, pituitary and systemic imaging, and, when necessary, histopathological confirmation, is essential to establish an accurate diagnosis before committing patients to long-term immunosuppression or unnecessary pituitary surgery. Management requires two parallel strategies: prompt hormone replacement therapy, with urgent attention to corticotroph deficiency, and disease-specific treatment tailored to the underlying etiology, ranging from glucocorticoids and immunosuppressants to antimicrobial therapy, targeted oncologic agents, or surgery. Because pituitary deficits are frequently irreversible and several of these disorders follow a relapsing course, long-term multidisciplinary follow-up is warranted. This review summarizes the pathophysiology, clinical presentation, diagnostic approach and neuroimaging features, for infiltrative and inflammatory hypothalamic-pituitary disorders, aiming to facilitate their timely recognition and appropriate management.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983478","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":"Prolactinoma assessment and management: an international multidisciplinary cross-sectional survey of current practice.","authors":"Sunita M C De Sousa, Hani J Marcus, Christopher D Ovenden, Daniel Prevedello, Stephan Petersenn","doi":"10.1007/s11102-026-01757-8","DOIUrl":"10.1007/s11102-026-01757-8","url":null,"abstract":"<p><strong>Purpose: </strong>Prolactinomas are the commonest pituitary adenoma encountered in clinical practice, yet many aspects of their assessment and management remain variable. The 2023 Pituitary Society Consensus Statement on the diagnosis and management of prolactin-secreting pituitary adenomas provided important contemporary guidance, but the extent to which current practice aligns with these recommendations remains unclear. We aimed to define international multidisciplinary perspectives on resource availability and clinical decision-making in prolactinoma care.</p><p><strong>Methods: </strong>We conducted an international cross-sectional survey of endocrinologists and neurosurgeons involved in prolactinoma management. Questions examined access to clinical resources, awareness of emerging issues in prolactinoma care, and areas of concordance or discordance between reported practice and published guidance.</p><p><strong>Results: </strong>A total of 249 clinicians completed the survey, including 210 endocrinologists and 39 neurosurgeons, from America, Europe, Oceania and Asia. Important resource limitations included inconsistent reporting of Knosp grade and limited availability of transcription factor immunohistochemistry. Only 20% of respondents routinely referred newly diagnosed prolactinoma cases for multidisciplinary team discussion. Most endocrinologists counselled patients regarding dopamine agonist-related risks. Amongst neurosurgeons, reported indications for surgery and views on dopamine agonist-induced tumour fibrosis varied considerably. Although current guidelines support surgery as an equal first-line option in selected microadenomas, cabergoline remained the preferred initial treatment in these scenarios.</p><p><strong>Conclusion: </strong>International prolactinoma practice is heterogeneous and often discordant with contemporary guidance. Most notably, cabergoline therapy remains the preferred treatment strategy in microprolactinomas, and multidisciplinary discussion of prolactinoma cases is infrequent. This survey dataset serves as a roadmap for future research and clinical service improvement in prolactinoma care globally.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 5","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983431","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":"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":"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}