Pituitary最新文献

{"title":"Exploring sex-specific hematological changes and their impact on quality of life in patients with prolactinoma.","authors":"Mario Detomas, Timo Deutschbein, Pasquale Dolce, Yvonne Möhres, Martin Fassnacht, Barbara Altieri","doi":"10.1007/s11102-024-01493-x","DOIUrl":"10.1007/s11102-024-01493-x","url":null,"abstract":"<p><strong>Context: </strong>Despite prolactin´s (PRL) role in stimulating hematopoiesis, anemia is commonly observed in men with macroprolactinomas. However, hematological changes in men with microprolactinomas and women with prolactinomas remain unexplored, and the impact of erythropoietic alterations on quality of life (QoL) is still unclear.</p><p><strong>Objective: </strong>To explore sex-related changes in red blood cell (RBC) parameters and their potential impact on QoL at initial diagnosis of prolactinoma and after normalization of PRL under dopamine agonists.</p><p><strong>Design: </strong>Retrospective, monocentric study involving 205 patients with prolactinoma (127 women, 62%). The SF-36 QoL questionnaire was administered to 57 women and 34 men.</p><p><strong>Results: </strong>In women, no significant changes in RBC parameters were observed at diagnosis or after PRL normalization, regardless the adenoma size. Conversely, men with microprolactinoma showed a significant increase in hematocrit (HCT) and hemoglobin (Hb) levels after PRL normalization (median HCT 42.3 vs.44.0%; Hb 14.5 vs. 15.1 g/dL; both p < 0.005). Men with macroprolactinoma exhibited similar improvements (HCT 40.2 vs. 43.9%; Hb 14.0 vs. 15.1 g/dL; both p < 0.0001). In men, hypogonadism was observed in 73% of patients at baseline, and in 11% after PRL normalization. In male patients where SF-36 was administered at diagnosis and after PRL normalization, energy improvement was observed (median 50 vs. 60, p < 0.05). While changes in Hb and HCT were not significantly impacting the QoL of women and men, persistence of hypogonadism after PRL normalization, negatively impacted all the QoL scores of men.</p><p><strong>Conclusion: </strong>Patients with prolactinoma show sex-dependent changes in RBC parameters. Unlike women, men exhibit decreased HCT and Hb levels irrespective of adenoma size. Of note, the failure to recover from hypogonadism significantly affected the QoL of men.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"24"},"PeriodicalIF":3.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122746","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":"Reappraising prediction of surgical complexity of non-functioning pituitary adenomas after transsphenoidal surgery: the modified TRANSSPHER grade.","authors":"Giorgio Fiore, Giulio A Bertani, Stephanie E Baldeweg, Anouk Borg, Giorgio Conte, Neil Dorward, Emanuele Ferrante, Ziad Hussein, Anna Miserocchi, Katherine Miszkiel, Giovanna Mantovani, Marco Locatelli, Hani J Marcus","doi":"10.1007/s11102-024-01495-9","DOIUrl":"10.1007/s11102-024-01495-9","url":null,"abstract":"<p><strong>Purpose: </strong>Prognostication of surgical complexity is crucial for optimizing decision-making and patient counseling in pituitary surgery. This study aimed to develop a clinical score to predict gross-total resection (GTR) in non-functioning pituitary adenomas (NFPAs) using externally validated machine-learning (ML) models.</p><p><strong>Methods: </strong>Clinical and radiological data were collected from two tertiary medical centers. Patients had pre- and postoperative structural T1-weighted MRI with gadolinium and T2-weighted preoperative scans. Three ML classifiers were trained on the National Hospital for Neurology and Neurosurgery dataset and tested on the Foundation IRCCS Ca' Granda Polyclinic of Milan dataset. Feature importance analyses and hierarchical-tree inspection identified predictors of surgical complexity, which were used to create the grading score. The prognostic performance of the proposed score was compared to that of the state-of-the art TRANSSPHER grade in the external dataset. Surgical morbidity was also analyzed.</p><p><strong>Results: </strong>All ML models accurately predicted GTR, with the random forest classifier achieving the best performance (weighted-F1 score of 0.87; CIs: 0.71, 0.97). Key predictors-Knosp grade, tumor maximum diameter, consistency, and supra-sellar nodular extension-were included in the modified (m)-TRANSSPHER grade. The ROC analysis showed superior performance of the m-TRANSSPHER grade over the TRANSSPHER grade for predicting GTR in NFPAs (AUC 0.85 vs. 0.79).</p><p><strong>Conclusions: </strong>This international multi-center study used validated ML algorithms to refine predictors of surgical complexity in NFPAs, yielding the m-TRANSSPHER grade, which demonstrated enhanced prognostic accuracy for surgical complexity prediction compared to existing scales.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"26"},"PeriodicalIF":3.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123108","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":"The role of BRAF testing of Rathke's cleft cysts to identify missed papillary craniopharyngioma.","authors":"Nicholas G Candy, E Mignone, E Quick, B Koszyca, A Brown, I M Chapman, D J Torpy, N Vrodos, S Santoreneos, S M C De Sousa","doi":"10.1007/s11102-025-01501-8","DOIUrl":"10.1007/s11102-025-01501-8","url":null,"abstract":"<p><strong>Aim: </strong>The differential diagnosis of cystic sellar/suprasellar lesions includes craniopharyngioma (CP) and Rathke's cleft cyst (RCC). Histological differentiation between cystic papillary craniopharyngioma (pCP) and RCC using light microscopy alone is challenging. A major point of difference is that virtually all pCPs are clonal for the BRAF V600E variant, whereas RCCs are not. Noting that BRAF testing of RCCs is not current standard practice, we hypothesised that routinely performing BRAF studies in RCCs might uncover otherwise missed pCPs.</p><p><strong>Method: </strong>We performed a retrospective cohort study of all RCCs operated on at Flinders Medical Centre, the Memorial and Royal Adelaide Hospitals, between 2001 and 2023. In cases with sufficient tissue, we performed BRAF V600E immunohistochemistry (IHC) and BRAF next generation sequencing (NGS) of extracted tumour DNA.</p><p><strong>Results: </strong>Of eleven patients with suitable operative specimens, one patient with an initial diagnosis of RCC was revised to pCP following BRAF testing with equivocal positivity on BRAF IHC and clear identification of the V600E variant on NGS. The patient's subsequent clinical course was aggressive and more compatible with pCP than RCC.</p><p><strong>Conclusion: </strong>This study highlights the potential value of BRAF testing in RCCs to identify missed pCP, which is an especially timely finding given the advent of primary medical therapy with BRAF inhibition for pCP. In the absence of guidelines advising on the use of BRAF studies in sellar lesions, we suggest consideration of BRAF testing of all RCCs, particularly if there is squamous metaplasia or disease recurrence.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"30"},"PeriodicalIF":3.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123327","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":"Outcomes in surgical management of microprolactinomas: an international multi-institutional series.","authors":"Danielle Golub, Timothy G White, Harshal A Shah, Mehdi Khaleghi, Kristin M Huntoon, Ingrid M Zandbergen, Leontine E H Bakker, Luma M Ghalib, Iris C M Pelsma, Ehsan Dowlati, Mark B Chaskes, Judd H Fastenberg, Marco J T Verstegen, Nienke R Biermasz, Daniel M Prevedello, Amir R Dehdashti","doi":"10.1007/s11102-025-01497-1","DOIUrl":"10.1007/s11102-025-01497-1","url":null,"abstract":"<p><strong>Background: </strong>Prolactinomas represent the most common pituitary adenoma subtype, the majority of which are microprolactinomas. Dopamine agonists (DAs) remain the first-line intervention for microprolactinomas, however, many patients either cannot tolerate DAs or require lifelong therapy to maintain hormonal control. As endoscopic endonasal surgery (EES) continues to revolutionize the surgical management of sellar lesions, we sought to reassess the feasibility and efficacy of early surgical resection for microprolactinoma.</p><p><strong>Methods: </strong>Retrospective chart review from 2010 to 2021 of adults who underwent EES for microprolactinoma was performed across three medical centers. Surgical failure was defined as a need to restart DAs, a serum prolactin level greater than 30ng/mL at last follow-up, tumor recurrence, or a need for reoperation.</p><p><strong>Results: </strong>A total of 56 patients were identified with a mean age of 32.9 years and an average of 26.4 months of follow-up. The majority had been on DAs preoperatively (98.2%). The most common surgical indications were DA intolerance (73.2%), tumor unresponsiveness (19.6%), and desire for pregnancy (7.1%). Gross total resection was achieved in 51 (91.1%) cases. The overall surgical remission rate was approximately 70% with failures observed in 17 (30.4%) patients. Multivariate logistic regression identified subtotal resection as the only independent predictor of surgical failure (p = 0.038*). The most common postoperative complication was transient arginine vasopressin deficiency (AVP-D) (21.4%). There were no cases of permanent AVP-D, new visual deficits, or cerebrospinal fluid leak.</p><p><strong>Conclusions: </strong>With a surgical remission rate of nearly 70%, EES represents a safe and viable alternative strategy to long-term DA treatment for microprolactinomas.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"28"},"PeriodicalIF":3.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122949","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":"Medical management pathways for Cushing's disease in pituitary tumors centers of excellence (PTCOEs).","authors":"A Giustina, M M Uygur, S Frara, A Barkan, N R Biermasz, P Chanson, P Freda, M Gadelha, L Haberbosch, U B Kaiser, S Lamberts, E Laws, L B Nachtigall, V Popovic, K Schilbach, A J van der Lely, J A H Wass, S Melmed, F F Casanueva","doi":"10.1007/s11102-024-01485-x","DOIUrl":"10.1007/s11102-024-01485-x","url":null,"abstract":"<p><strong>Purpose: </strong>A recent update of consensus guidelines for the management of Cushing's disease (CD) included indications for medical therapy. However, there is limited evidence regarding their implementation in clinical practice. This study aimed to evaluate current medical therapy approaches by expert pituitary centers through an audit conducted to validate the criteria of Pituitary Tumors Centers of Excellence (PTCOEs) and provide an initial standard of medical care for CD.</p><p><strong>Methods: </strong>Based on the activities of nine international PTCOEs between 2018 and 2020, we evaluated patients under medical treatment and their biochemical control rates.</p><p><strong>Results: </strong>The median number of active patients with CD per center was 117 (35-279), with a median number of 10 new patients with CD managed annually in the endocrinology units of PTCOEs (4-42). The median percentage of patients with CD receiving medical treatment was 13.3% (4.8-82.9). Ketoconazole was the most frequently used drug, with a median rate of usage of 26.5% (5-66.7) of those receiving medical therapy. The median rates of metyrapone and pasireotide use were 17.2% (0-50) and 9.3% (0-51.7), respectively. For cabergoline and osilodrostat, therapy, the median rates of use were 2.8% (0-33.3), and 1.7% (0-25), respectively. Combination therapy was reported to be utilized in 13.6% (0-45.5) of medically treated patients. Mifepristone was used in a single center, representing 1.1% of its medically treated patients. Overall, the median control rate in patients with CD receiving medical treatment was 75% (10-100).</p><p><strong>Conclusion: </strong>Adrenal steroidogenesis inhibitors were the most commonly used medications amongst the centers. Despite the use of combination therapy, up to 25% of patients did not achieve disease control even in PTCOEs, highlighting the need for either more efficient combination therapies or novel therapeutic options.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"23"},"PeriodicalIF":3.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11779774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067540","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":"Sheehan syndrome: a current approach to a dormant disease.","authors":"Zuleyha Karaca, Fahrettin Kelestimur","doi":"10.1007/s11102-024-01481-1","DOIUrl":"10.1007/s11102-024-01481-1","url":null,"abstract":"<p><p>Sheehan syndrome (SS) is postpartum pituitary necrosis leading to severe hypopituitarism. Severe bleeding during delivery and postpartum period results in ischemic necrosis of the enlarged pituitary gland during pregnancy. The improved obstetrical care decreased the incidence of SS significantly, however SS should always be kept in mind in the etiologies of hypopitutarism in women which can be easily recognized by medical history of the patient. The nonspecific signs and symptoms of hypopituitarism result in significant delay in diagnosis and treatment. The diagnostic delay makes the patients to expose hypopituitarism without essential replacement therapies leading to increased morbidity and mortality of the patients. Awareness of physicians about SS is critical for the diagnosis of the disease. In this review, the epidemiology, pathophysiology, clinical manifestations and treatment of SS are discussed in the light of recent studies.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"20"},"PeriodicalIF":3.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041098","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":"Selective resection of the medial wall of the cavernous sinus in pituitary surgery: results of a prospective single center analysis.","authors":"Dan Zimelewicz Oberman, Emiliano Sanchez-Garavito, Carlos Perez-Vega, Angela Donaldson, Osarenoma Olomu, Stephen Graepel, Mark A Edgar, Alfredo Quinones-Hinojosa, Kaisorn L Chaichana, Susan L Samson, Joao Paulo Almeida","doi":"10.1007/s11102-024-01476-y","DOIUrl":"10.1007/s11102-024-01476-y","url":null,"abstract":"<p><strong>Purpose: </strong>Pituitary adenomas, despite their histologically benign nature, can severely impact patients' quality of life due to hormone hypersecretion. Invasion of the medial wall of the cavernous sinus (MWCS) by these tumors complicates surgical outcomes, lowering biochemical remission rates and increasing recurrence. This study aims to share our institutional experience with the selective resection of the MWCS in endoscopic pituitary surgery.</p><p><strong>Methods: </strong>This prospective study included patients diagnosed with pituitary adenomas who underwent endoscopic endonasal surgery at Mayo Clinic, Jacksonville. Inclusion criteria encompassed confirmed pituitary adenomas, selective MWCS resection, and availability of histopathological data. Patient demographics, tumor characteristics, surgical outcomes, and postoperative complications were analyzed using descriptive statistics.</p><p><strong>Results: </strong>Twenty-six cases met the inclusion criteria. Functional adenomas and macroadenomas constituted 80.8% of cases. Recurrent adenomas represented 19.2% of cases. Tumor invasion of the MWCS was confirmed in 76.9% of cases and patients with acromegaly had the highest rate of confirmed invasion of the MW (88.8%). Initial disease control was achieved in 88.5% of the patients, and disease remission at last follow up was observed in those with acromegaly, Cushing's disease and prolactinomas in 87.5%, 83.3% and 66.6% of cases, respectively. Complete resection was achieved in 5/5 nonfunctioning adenomas. There were no carotid injuries, cranial deficits or fatalities observed.</p><p><strong>Conclusion: </strong>Resection of the MWCS is an effective strategy for improving surgical outcomes in pituitary adenomas with potential invasion into this area, especially in patients with functional and/or recurrent adenomas. The procedure demonstrates a positive balance of efficacy and safety, when performed by teams with high level of experience in endoscopic skull base surgery and in selected patients.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"19"},"PeriodicalIF":3.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041095","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":"Relationship between plasma urea and copeptin in response to arginine stimulation in healthy adults, patients with vasopressin deficiency and primary polydipsia.","authors":"Cihan Atila, Sven Lustenberger, Irina Chifu, Emanuele Ferrante, Zoran Erlic, Juliana B Drummond, Rita Indirli, Roosmarijn Drexhage, Andrew S Powlson, Mark Gurnell, Beatriz Santana Soares, Johannes Hofland, Felix Beuschlein, Martin Fassnacht, Bettina Winzeler, Julie Refardt, Mirjam Christ-Crain","doi":"10.1007/s11102-024-01489-7","DOIUrl":"10.1007/s11102-024-01489-7","url":null,"abstract":"<p><strong>Background: </strong>Arginine infusion stimulates copeptin secretion, a surrogate marker of arginine vasopressin (AVP), thereby serving as a diagnostic test in the differential diagnosis of suspected AVP deficiency (AVP-D). Yet, the precise mechanism underlying the stimulatory effect of arginine on the vasopressinergic system remains elusive. Arginine plays a significant role in the urea cycle and increases the production of urea. An increase in plasma urea concentration raises blood osmolality, thereby possibly stimulating AVP release. We therefore hypothesized that the stimulatory effect of arginine on AVP may involve an increase in plasma urea levels.</p><p><strong>Methods: </strong>This analysis combined data from two prospective diagnostic studies. In total, 30 healthy adults (HA), 69 patients with AVP-D, and 89 patients with primary polydipsia (PP) underwent the arginine stimulation test. Infusion of arginine (L--arginine--hydrochloride 21%) at a dose of 0.5 g/kg body weight diluted in 500 mL of 0.9% normal saline was administered over 30 min. Blood was collected at baseline and 60, 90, and 120 min to analyze plasma copeptin and urea. The main objective was to investigate urea dynamics in response to arginine administration and its effect on copeptin release.</p><p><strong>Results: </strong>Plasma urea levels at baseline were comparable and increased 60 min after arginine infusion with a median (IQR) change of + 1.1 mmol/L (+ 0.8, + 1.5) in HA, + 1.4 mmol/L (+ 1.1, + 1.7) in patients with AVP-D and + 1.3 mmol/L (+ 0.9, + 1.5) in patients with PP. Concurrently, plasma copeptin levels substantially increased 60 min from baseline in HA (median change + 5.3 pmol/L (+ 3.2, + 8.8)) and in patients with PP (median change + 2.4 pmol/L (+ 1.2, + 3.8)), but remained stable in patients with AVP-D (median change + 0.3 pmol/L (+ 0.1, + 0.6)). Plasma urea and copeptin levels correlated the most in HA, with a Spearman's rho of 0.41 at baseline. Patients with AVP-D and PP showed only weak correlations of plasma urea and copeptin, with a correlation coefficient between 0.01 and 0.28.</p><p><strong>Conclusion: </strong>We demonstrate a slight increase in plasma urea levels in response to arginine, but plasma urea and copeptin levels were weakly correlated. Based on these findings, the stimulatory effect of arginine on AVP cannot be explained primarily by increasing urea levels.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"18"},"PeriodicalIF":3.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041077","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":"Correlates of prolonged length of stay after endoscopic transsphenoidal surgery for pituitary adenomas: varying definitions and non-clinical factors.","authors":"Khushi H Shah, Nikola Susic, Nicholas V DiStefano, Maxon V Knott, Adham M Khalafallah, Victor M Lu, Carolina G Benjamin, Ashish H Shah, Zoukaa B Sargi, Ricardo J Komotar, Michael E Ivan","doi":"10.1007/s11102-024-01483-z","DOIUrl":"10.1007/s11102-024-01483-z","url":null,"abstract":"<p><strong>Purpose: </strong>Prolonged length of stay (PLOS) can lead to resource misallocation and higher complication risks. However, there is no consensus on defining PLOS for endoscopic transsphenoidal pituitary surgery (ETPS). Therefore, we investigated the impact of varying PLOS definitions on factors associated with PLOS in patients undergoing ETPS.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients with pituitary adenomas who underwent ETPS at our institution from 2012 to 2023. Patients were divided into non-PLOS and PLOS groups based on varying definitions of PLOS: > median, > 4 days, > 75th percentile, and > 90th percentile. Bivariate statistical analyses were conducted using Fisher's exact test, chi-square test, and t-tests. Univariate and multivariate logistic regression identified significant predictors for each PLOS definition.</p><p><strong>Results: </strong>Our cohort (n = 808) had a mean age of 54.37 ± 16.06 years, 50.43% male, and a median LOS of 3 days. The 75th and 90th percentiles of LOS were 4 and 6 days, respectively. The way PLOS was defined influenced associated factors identified. Preoperative KPS score, non-private insurance, and non-home discharge disposition were associated with PLOS across all definitions used (p < 0.05). Increased preoperative tumor volumes and postoperative hyponatremia were associated with PLOS only when defined by the 75th and 90th percentiles (p < 0.05). Non-White race and low income were significantly associated with PLOS > median while intraoperative CSF leak was a significant predictor for PLOS > 90th percentile (p < 0.05).</p><p><strong>Conclusion: </strong>Our study highlights the variability in predictors of PLOS based on its definition and emphasizes the role of non-clinical factors on LOS.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"21"},"PeriodicalIF":3.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041075","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":"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/s11102-024-01471-3","DOIUrl":"10.1007/s11102-024-01471-3","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effect of osilodrostat and hypercortisolism control on blood pressure (BP) and glycemic control in patients with Cushing's disease.</p><p><strong>Methods: </strong>Pooled analysis of two Phase III osilodrostat studies (LINC 3 and LINC 4), both comprising a 48-week core phase and an optional open-label extension. Changes from baseline in systolic and diastolic BP (SBP and DBP), fasting plasma glucose (FPG), and glycated hemoglobin (HbA_1c) were evaluated during osilodrostat treatment in patients with/without hypertension or diabetes at baseline.</p><p><strong>Results: </strong>Of 210 patients, 82.9% met criteria for hypertension and 40.0% for diabetes at baseline. In patients with hypertension, reductions in mean SBP/DBP were observed from week (W)12 to W72, and 49.1%/58.5% of patients with high SBP/DBP (> 130/>90 mmHg) at baseline had normotensive levels at W72. Antihypertensive medication dose was reduced/stopped in 26.8% of patients, and the proportion taking antihypertensive medication decreased from 54.3% at baseline to 47.3% at W72. In patients with diabetes, mean FPG and HbA_1c decreased from W12 to W72, and 33.3%/61.5% with high FPG/HbA_1c (≥ 100 mg/dL/≥6.5%) at baseline had normal levels at W72. Antihyperglycemic medication dose was reduced/stopped in 35.7% of patients, and the proportion taking antihyperglycemic medication decreased from 21.9% at baseline to 17.1% at W72; improvements in SBP/DBP and FPG/HbA_1c were correlated with improvement in mean urinary free cortisol but not weight change. BP/glycemic parameters generally remained normal in patients without hypertension/diabetes at baseline.</p><p><strong>Conclusions: </strong>Patients with Cushing's disease and comorbid hypertension/diabetes receiving osilodrostat had rapid and sustained improvements in SBP/DBP and glycemic control, respectively.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 1","pages":"22"},"PeriodicalIF":3.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060363","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}