Pituitary最新文献

{"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":"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":"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":"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}

{"title":"Estimation of the biological variation of IGF-I in multimorbid geriatric patients and its clinical implications.","authors":"Olivia Tausendfreund, Hannah Reif, Martin Bidlingmaier, Sebastian Martini, Michaela Rippl, Katharina Schilbach, Sabine Schluessel, Ralf Schmidmaier, Michael Drey","doi":"10.1007/s11102-025-01530-3","DOIUrl":"10.1007/s11102-025-01530-3","url":null,"abstract":"<p><strong>Purpose: </strong>IGF-I is a well-established biomarker for detecting abnormalities in the growth hormone axis and evaluating effectiveness of growth hormone (GH) treatment. Common age-related diseases, such as sarcopenia are associated with impairments in the GH axis, making targeted GH therapy a potential treatment option. Nonetheless, data on the biological variation of IGF-I in older patients are missing, potentially leading to inaccurate interpretation of IGF-I concentrations in the diagnostic and therapeutic process. Our study aims to address this gap.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of IGF-I concentrations measured in samples from the geriatric outpatient facility of the Ludwig-Maximilians-University Hospital, Munich and the respective patient data from the MUnich SArcopenia Registry (MUSAR). Using a mixed-effects model, we estimated the intraindividual biological coefficient of variation (CVi). We calculated the Reference Change Values (RCV) and the Index of Individuality (II).</p><p><strong>Results: </strong>246 serum samples from 89 patients (mean age 83 years, range 70-97) were analyzed. The CV_i ranged from 13.4 to 15.6%, with a mean of 14.7%. RCV was 30.7% for a decrease and 44.3% for an increase in IGF-I concentrations. The II was 0.44.</p><p><strong>Conclusion: </strong>The CV_i of IGF-I in our cohort differs from that previously described in younger and healthier populations and is therefore crucial for identifying significant changes in this geriatric cohort. The high degree of individuality also supports the application of personalized reference intervals. Our study provides data on the biological variation of IGF-I concentrations in geriatric patients; the calculated RCVs have the potential to refine interpretation.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"59"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994707","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":"Cushing's syndrome: Guidance on thromboprophylaxis at last.","authors":"Ashley Grossman","doi":"10.1007/s11102-025-01529-w","DOIUrl":"10.1007/s11102-025-01529-w","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"58"},"PeriodicalIF":3.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041594","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":"Consensus and controversies about diagnosing GH deficiency: a Delphi survey by the GH research society.","authors":"M C Arlien-Søborg, S Radovick, M C S Boguszewski, M Bidlingmaier, G Johannsson, A Grimberg, K K Y Ho, B M K Biller, C S Choong, A R Hoffman, P Backeljauw, C L Boguszewski, J Bollerslev, T Brue, P Chanson, E Christ, S Cianfarani, P E Clayton, P Cohen, A Dauber, M Fleseriu, J Gebauer, A Giustina, C E Higham, R Horikawa, C Höybye, A Juul, M Lodish, X Luo, N Mauras, K K Miller, S Melmed, S J C M M Neggers, N Karavitaki, R Rosenfeld, R Ross, L Savendahl, K Schilbach, P F Collett-Solberg, C J Strasburger, N A Tritos, H M van Santen, K C J Yuen, J O L Jorgensen","doi":"10.1007/s11102-025-01526-z","DOIUrl":"10.1007/s11102-025-01526-z","url":null,"abstract":"<p><strong>Purpose: </strong>Biochemical tests are required for diagnosing GH-deficiency in children and adults, but controversies remain regarding diagnostic criteria and type of biochemical tests. The aim of the study is to map the clinical practices of GHD diagnosis in children and adults.</p><p><strong>Methods: </strong>The Growth Hormone Research Society members initiated a Delphi survey of the diagnosis of GHD in children and adults. Pediatric (n = 18) and adult (n = 25) endocrinologists from 14 countries participated and rated their extent of agreement with 61 statements using a Likert-type-scale (1-7). Consensus was predefined as ≥ 80% of panelists rating their agreement unidirectionally as either ≥ 5 (agreement) or ≤ 3 (disagreement).</p><p><strong>Results: </strong>The pediatric panel reached consensus on 17 of 29 (59%) statements on diagnosis in children, whereas the adult panel reached consensus on 28 of 32 (88%) statements on adult patients. There was general agreement to test for GHD in an appropriate clinical context and also on the timing of testing for GHD in both children and adults. A subnormal IGF-I level was considered diagnostic in both children and adults with panhypopituitarism. In children, there was consensus to recommend the arginine stimulation test and the glucagon test. The insulin tolerance test (ITT) was considered gold standard in adults and there was also consensus to recommend the macimorelin test. A stimulated GH cut-off < 5μg/l was consistent with severe GHD in children, whereas test-specific cut-offs were recommended in adults.</p><p><strong>Conclusion: </strong>Consensus on the GHD diagnosis was lower in pediatric practice, mainly with respect to choice and interpretation of GH stimulation tests.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"57"},"PeriodicalIF":3.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040659","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":"Kidney function in acromegaly: evidence from a long-term observational study.","authors":"Giona Castagna, Silvia Ippolito, Sara Cassibba, Liana Cortesi, Emanuele Costi, Ahmad Harb, Luigi Alberto Lanterna, Angelo Mirco Sicignano, Roberto Trevisan, Alessandro Rossini","doi":"10.1007/s11102-025-01520-5","DOIUrl":"10.1007/s11102-025-01520-5","url":null,"abstract":"<p><strong>Purpose: </strong>Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) are critical regulators of renal development and function. Acromegaly, characterized by chronic GH hypersecretion, leads to renal hypertrophy and glomerular hyperfiltration. While immediate treatment of acromegaly mitigates hyperfiltration, the long-term risk of renal damage in treated patients remains unclear. Our study aimed to assess renal function over time in patients with acromegaly who were followed long-term at our institution.</p><p><strong>Methods: </strong>This study analyzed 80 patients with acromegaly from a single center. Creatinine values were recorded to assess kidney function before and after treatment. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI 2021 formula. eGFR variations were evaluated over the first 12 months after treatment (acute slope) and during long-term follow-up with a mean duration of 11.28 years (chronic slope). Descriptive statistics and multivariable regression analyses were performed.</p><p><strong>Results: </strong>Among the 80 patients (43.7 years, 46 male), 51 underwent surgery (11 of whom also received subsequent radiotherapy), while 29 received exclusively medical therapy. Comorbidities included diabetes (31.25%) and hypertension (65%). eGFR decreased acutely after treatment in all groups, with a more pronounced decline in surgically treated patients (mean - 15.15 mL/min/1.73 m²; p = 0.042). The mean chronic eGFR loss was - 1.28 mL/year, with age (OR 1.09 per year) and diabetes (OR 5.66) significantly associated with a greater decline in eGFR (p < 0.01).</p><p><strong>Conclusions: </strong>Renal hyperfiltration in acromegaly tends to normalize following treatment, with a more rapid response observed in patients who undergo surgery. Chronic kidney disease is highly prevalent in acromegaly and is closely linked to diabetes, which further contributes to the increased cardiovascular risk seen in these individuals.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"56"},"PeriodicalIF":3.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978011","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":"Cognitive function and fatigue before and after transsphenoidal surgery in patients with pituitary adenoma: a prospective study.","authors":"David Krabbe, Tamar Abzhandadze, Thomas Skoglund, Tobias Hallén, Daniel S Olsson, Victor Hantelius, Oskar Ragnarsson, Sofie Jakobsson, Gudmundur Johannsson, Katharina S Sunnerhagen","doi":"10.1007/s11102-025-01527-y","DOIUrl":"10.1007/s11102-025-01527-y","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this prospective longitudinal study was to evaluate cognitive function and fatigue before and 12 months after transsphenoidal surgery (TSS) for a pituitary adenoma.</p><p><strong>Methods: </strong>This study was part of the Gothenburg Pituitary Tumour Study, which consecutively includes patients undergoing TSS at Sahlgrenska University Hospital. Adult patients with a pituitary adenoma were recruited between October 2016 and May 2021. Cognitive function and fatigue were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Multidimensional Fatigue Inventory (MFI-20). Paired comparisons were made for total and subscale scores before and after TSS. Based on normative data, individual scores were classified into one of three categories for symptom severity (normal, moderate, or severe) before and after TSS.</p><p><strong>Results: </strong>Fifty-nine patients (31 females) were included. Among them, 42 had non-functioning pituitary adenomas (NFPA) and 17 had a functioning pituitary adenoma. There were no differences in RBANS total or domain indices before and 12 months after surgery except for the attention index which improved. Total MFI-20 and all subscale scores improved. The improvement was more pronounced in patients with functioning pituitary adenoma, who reported worse fatigue before surgery compared to patients with NFPA. Individual differences between pre- and postoperative scores that also changed category of symptom severity were seen for 37% of all patients regarding cognition and for 35% regarding fatigue. Improvements accounted for the majority of these changes.</p><p><strong>Conclusion: </strong>Cognitive function remained largely unchanged from before to 12 months after TSS, while self-reported fatigue improved.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"54"},"PeriodicalIF":3.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978783","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}