Pituitary最新文献

{"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":"https://doi.org/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":"https://doi.org/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":"https://doi.org/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}

{"title":"Colonoscopy in acromegaly: when and why.","authors":"Jakob Dal","doi":"10.1007/s11102-025-01528-x","DOIUrl":"10.1007/s11102-025-01528-x","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"55"},"PeriodicalIF":3.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017318","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":"A post-hoc internal validation of arginine-stimulated copeptin cut-offs for diagnosing AVP deficiency (central diabetes insipidus).","authors":"Cihan Atila, Bettina Winzeler, Irina Chifu, Martin Fassnacht, Julie Refardt, Mirjam Christ-Crain","doi":"10.1007/s11102-025-01523-2","DOIUrl":"https://doi.org/10.1007/s11102-025-01523-2","url":null,"abstract":"<p><strong>Background: </strong>Distinguishing arginine vasopressin (AVP) deficiency (central diabetes insipidus) from primary polydipsia is challenging. While hypertonic saline-stimulated copeptin testing provides the highest diagnostic accuracy, it is often restricted to specialised centres, requiring close monitoring and potentially causing patient discomfort. Initially, arginine-stimulated copeptin was proposed as a simpler alternative, but a head-to-head comparison study found it less precise than hypertonic saline stimulation. However, the same study identified two new high sensitivity and specificity cut-offs for arginine-stimulated copeptin, though these cut-offs have yet to be validated.</p><p><strong>Methods: </strong>This is a secondary post-hoc analysis of the initial prospective multicentre study, including adult patients with confirmed AVP deficiency or primary polydipsia. Participants underwent the arginine stimulation test, with plasma copeptin measured at baseline and 60- and 90 min after arginine infusion. The primary objective was to revisit the original study to internally validate the proposed arginine-stimulated copeptin cut-offs of > 5.2pmol/L (high specificity cut-off with > 90% specificity for primary polydipsia) and ≤ 3.0 pmol/L (high specificity cut-off with > 90% specificity for AVP deficiency).</p><p><strong>Findings: </strong>In total, 96 patients were included between May 2013 and June 2018: n = 38 [40%] with AVP deficiency and n = 58 [60%] with primary polydipsia. At 60 min after arginine infusion, a copeptin level ≤ 3.0 pmol/L showed a specificity of 95% (95% CI: 0.88-1.00) for AVP deficiency, while a copeptin level > 5.2 pmol/L demonstrated a specificity of 97% (95% CI: 0.92-1.00) for primary polydipsia. The ≤ 3.0 pmol/L cut-off accurately identified 71% (n = 27/38) of patients with AVP deficiency, and the > 5.2 pmol/L cut-off correctly identified 69% (n = 40/58) of patients with primary polydipsia.</p><p><strong>Interpretation: </strong>This analysis validates two new copeptin cut-offs of the arginine stimulation test to distinguish AVP deficiency from primary polydipsia: >5.2 pmol/L for high specificity in diagnosing primary polydipsia and ≤ 3.0 pmol/L for high specificity in diagnosing AVP deficiency. These thresholds might offer a practical initial alternative to hypertonic saline testing.</p><p><strong>Registration: </strong>Clinicaltrials.gov (NCT00757276).</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"53"},"PeriodicalIF":3.3,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12031852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050527","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":"Acromegaly facial changes analysis using last generation artificial intelligence methodology: the AcroFace system.","authors":"Hatem A Rashwan, Montserrat Marqués-Pamies, Sabina Ruiz, Joan Gil, Diego Asensio-Wandosell, María-Antonia Martínez-Momblán, Federico Vázquez, Isabel Salinas, Raquel Ciriza, Mireia Jordà, Philippe Chanson, Elena Valassi, Mohamed Abdelnasser, Domènec Puig, Manel Puig-Domingo","doi":"10.1007/s11102-025-01515-2","DOIUrl":"https://doi.org/10.1007/s11102-025-01515-2","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the development of the AcroFace system, an AI-based system for early detection of acromegaly, based on facial photographs analysis.</p><p><strong>Methods: </strong>Two types of features were explored: (1) the visual/texture of a set of 2D facial images, and (2) geometric information obtained from a reconstructed 3D model from a single image. We optimized acromegaly detection by integrating SVM for geometric features and CNNs for visual features, each chosen for their strength in processing distinct data types effectively. This combination enhances overall accuracy by leveraging SVM's capability to manage structured, quantitative data and CNNs' proficiency in interpreting complex image textures, thus providing a comprehensive analysis of both geometric alignment and textural anomalies. ResNet-50, VGG-16, MobileNet, Inception V3, DensNet121 and Xception models were trained with an expert endocrinologist-based score as a ground truth.</p><p><strong>Results: </strong>ResNet-50 model as a feature extractor and Support Vector Regression (SVR) with a linear kernel showed the best performance (accuracy δ1 of 75% and δ3 of 89%), followed by the VGG-16 as a feature extractor and SVR with a linear kernel. Geometric features yield less accurate results than visual ones. The validation cohort showed the following performance: precision 0.90, accuracy 0.93, F1-Score 0.92, sensitivity 0.93 and specificity 0.93.</p><p><strong>Conclusion: </strong>AcroFace system shows a good performance to discriminate acromegaly and non-acromegaly facial traits that may serve for the detection of acromegaly at an early stage as a screening procedure at a population level.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"50"},"PeriodicalIF":3.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12011943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053300","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":"Impulse control disorders in patients with pituitary adenoma managed with or without dopamine agonists: a cross-sectional study from a UK centre.","authors":"Ross Hamblin, Mary White, Athanasios Fountas, Niki Karavitaki","doi":"10.1007/s11102-025-01517-0","DOIUrl":"https://doi.org/10.1007/s11102-025-01517-0","url":null,"abstract":"<p><strong>Purpose: </strong>Studies from various countries raise concerns on the association between dopamine agonist (DA) treatment and impulse control disorders (ICDs) in patients with pituitary adenomas. We investigated the prevalence of ICDs in patients with pituitary adenomas in a UK centre using two instruments applied in clinical practice for assessing ICDs.</p><p><strong>Methods: </strong>Cross-sectional study of adults with prolactinoma, acromegaly or non-functioning pituitary adenoma (NFPA) treated or not with DAs in a pituitary centre. Screening tools for ICD were the Minnesota Impulse Disorders Interview (MIDI) and Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP-RS).</p><p><strong>Results: </strong>Data from 200 patients were analysed [72 prolactinomas (on DA), 71 NFPAs (no DA), 57 with acromegaly (12 on DA)]. The percentage of patients scoring for any ICD was higher in the prolactinoma on DA group compared with the NFPA cases; MIDI 12.7% vs. 1.4% (p = 0.02) and QUIP-RS 46.5% vs. 18.6% (p < 0.001), respectively. DA use was associated with positive scores for all ICDs in the MIDI and with compulsive buying and hobbyism-punding in the QUIP-RS. DA dose or treatment duration were not associated with positive scores. The responses of patients with acromegaly on DA did not differ from those not on these agents in any questionnaire.</p><p><strong>Conclusions: </strong>In this sample of UK patients, prevalence of ICDs is higher in prolactinoma patients on DA compared to those with NFPA not on DA. Differences were not observed between patients with acromegaly treated or not with DA. Different ICD assessment tools have an impact on the detected outcomes.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"52"},"PeriodicalIF":3.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12011938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026030","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":"Epigenetic implications in the pathogenesis of corticotroph tumors.","authors":"Ticiana Paes, Leo J Hofland, Anand M Iyer, Richard A Feelders","doi":"10.1007/s11102-025-01522-3","DOIUrl":"https://doi.org/10.1007/s11102-025-01522-3","url":null,"abstract":"<p><p>Non-mutational epigenetic reprogramming is considered an important enabling characteristic of neoplasia. Corticotroph tumors and other subtypes of pituitary tumors are characterized by distinct epigenetic profiles. The DNA methylation profile is consistent with disease-specific gene expression, which highlights the importance of epigenetic changes in tumor formation and progression. Elucidating the epigenetic changes underlying tumorigenesis plays an important role in understanding the molecular pathogenesis of corticotroph tumors and may ultimately contribute to improving tumor-specific treatment. Here, we provide an overview of the epigenetic landscape of corticotroph tumors. We also review the role of epigenetics in silencing the expression of tumor suppressor genes and promoting oncogenes expression, which could potentially be involved in the pathogenesis of corticotroph tumors. We briefly discuss microRNAs and epigenetic aspects of POMC regulation. Lastly, since the epigenetic changes are reversible, we discuss drugs that target epigenetic modifiers that could potentially be used in the arsenal of Cushing's disease treatment modalities.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"51"},"PeriodicalIF":3.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12011945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030145","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 sella floor reconstruction on Rathke Cleft Cyst recurrence: a systematic review and meta-analysis.","authors":"Ryan Beerling Dolovac, James King, Christopher Ovenden, Jeremy Kam, Yi Yuen Wang, Tony Goldschlager, Mendel Castle-Kirszbaum","doi":"10.1007/s11102-025-01521-4","DOIUrl":"https://doi.org/10.1007/s11102-025-01521-4","url":null,"abstract":"<p><strong>Background: </strong>The optimal surgical technique for managing Rathke's Cleft Cyst (RCC) remains unclear. Leaving the sellar defect open (marsupialisation) after transsphenoidal surgery facilitates ongoing drainage of cyst contents, but cannot be performed in the setting of an intraoperative cerebrospinal fluid (CSF) leak. The effects of intraoperative CSF leaks and sellar floor reconstruction on RCC recurrence require further investigation.</p><p><strong>Methods: </strong>A systematic literature search was conducted for studies reporting RCC recurrence following transsphenoidal surgery, with data on intraoperative CSF leak rates and skull base reconstruction. Studies were classified based on surgical technique: cyst wall resection vs. fenestration, and open (no reconstruction) vs. closed (reconstructed) sellar floor.</p><p><strong>Results: </strong>Nineteen studies, comprising 1,076 patients, were included. The overall radiological RCC recurrence rate was 19.8% over a mean follow-up of 50.4 months. The recurrence rate in closed sella surgeries was significantly higher (32.1%) than in open sellar cases (14.0%) (OR 2.28, 95% CI: 1.41-3.67, p < 0.05). Intraoperative CSF leak occurred in 29.1% of cases. Patients with CSF leaks had a higher recurrence rate (23.4% vs. 12.9%), though meta-analysis demonstrated only a non-significant trend (OR 1.67, 95% CI: 0.95-2.96). Subgroup analysis revealed that intraoperative CSF leaks were significantly associated with increased recurrence after fenestration (38.5% vs. 18.4%, p = 0.03), and cyst wall resection (21.7% vs. 7.8%, p = 0.004). In the setting of an intraoperative CSF leak, there was a trend for lower recurrence when cyst wall resection was attempted (21.7% vs. 38.5%, p = 0.09).</p><p><strong>Conclusion: </strong>Patients undergoing transsphenoidal surgery for RCC experience high rates of postoperative radiological recurrence. Cyst fenestration while maintaining an open sellar floor (marsupialisation into the sphenoid sinus) is associated with a significantly lower risk of recurrence at over 4 years follow-up. Intraoperative CSF leaks were less strongly associated with cyst recurrence, suggesting that watertight reconstruction, rather than the leak itself, is the primary driver of reaccumulation. When a closed sella is necessitated by intraoperative CSF leak, the addition of cyst wall resection may be associated with a lower rate of recurrence than fenestration alone but must be weighed against a higher risk of AVP-deficiency.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"49"},"PeriodicalIF":3.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11996996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989387","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 as first line medical therapy for selected patients with acromegaly.","authors":"Nicoleta C Olarescu, Anders P Jørgensen, Shahriar Atai, Markus K H Wiedmann, Daniel Dahlberg, Jens Bollerslev, Ansgar Heck","doi":"10.1007/s11102-025-01514-3","DOIUrl":"https://doi.org/10.1007/s11102-025-01514-3","url":null,"abstract":"<p><strong>Background and purpose: </strong>In acromegaly, growth hormone (GH) excess and pituitary tumours are typically managed through transsphenoidal surgery, often in combination with somatostatin receptor ligands (SRLs) given either before or following surgery. Although first-generation SRLs (lanreotide and octreotide) are efficacious in many patients, some exhibit resistance.</p><p><strong>Methods: </strong>We present the efficacy of the second-generation SRL, pasireotide, in six patients anticipated to be resistant to first-generation SRLs. The patients had large, hyperintense tumors on T2-weighted MRI and sparse granulation pattern by histology.</p><p><strong>Results: </strong>Over three to eight months, pasireotide reduced tumour volume in all patients and improved GH and IGF-1 levels. Visual field defects normalised. Despite hyperglycemia, requiring antidiabetic treatment in two patients, pasireotide proved effective as a first pharmacological therapy.</p><p><strong>Conclusion: </strong>This series supports the use of pasireotide for rapid tumour control and GH reduction, in selected patients with complex and large tumours, likely to be resistant to first-generation SRLs. This approach expands the therapeutic options for managing the most challenging cases enhancing the potential for other subsequent treatment modalities.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"28 3","pages":"48"},"PeriodicalIF":3.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004203","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}